Lung cancer diagnoses are increasing among women in Piedmont: by 1.5% per year. And there is little doubt about the main cause: cigarette smoking, which is the major risk factor for this neoplasm and is increasingly common in the female population. However, smoking is not the only aspect that worries us. In the year of the pandemic, in the Region, there was a significant reduction in hospital admissions for the first visits in the oncology field, due to the fear of contagion. A figure in line with the national one which saw, in 2020 compared to 2019 for all cancers, an 11% decline in new diagnoses, 13% in new treatments and 18% in surgical interventions. And the reduction in patient access to Piedmont hospitals, especially during the lockdown, is showing the first negative signs.
New diagnoses at an advanced stage are increasing
“In our facility in Asti, in recent months we have observed a clear increase in the diagnosis of lung cancer in an advanced stage, with severe symptoms, sometimes in a condition of severe respiratory failure and the need for urgent intervention”, says Daniele Pignataro, Director of Medical Oncology Cardinal Massaia Hospital. The case of patients already undergoing treatment is different, to whom it was possible to ensure therapeutic continuity thanks to the presence of a consolidated regional Oncology Network: “In my structure, as in all the others in the Region – continues Pignataro – all the necessary measures are in place to avoid exposing cancer patients, who are often in a particularly fragile condition, to the risk of contagion, with the diversification of environments, the creation of ad hoc paths and, when possible, the use of telemedicine. The necessary non-deferrable therapies continued regularly, but with limited access, with the necessary exceptions, to patients only for both outpatient and day hospital activities ”. In the most critical periods of the pandemic, the delivery of oral drugs at home was also activated in many structures for some categories of patients.
When the cancer is stage III
Now, this increase in late-stage lung cancer diagnoses poses a worrying picture as the chances of controlling the disease shrink. “When the neoplasm is identified in a still localized stage, however, it is possible to undertake a path that allows the control of the disease and the prolongation of survival”, says Lucio Buffoni, Head of Oncology at Humanitas Gradenigo in Turin. For patients affected by stage III non-small cell lung cancer (the most frequent form), when the tumor often cannot be removed surgically, today there are several therapeutic options, including immunotherapy.
The new results at 5 years
For decades, chemo-radiotherapy was the only option available: helping to change the landscape was the 5-year international phase III PACIFIC study, presented at the latest American Society of Clinical Oncology (ASCO) Congress. The results of the study demonstrated the benefits of immunotherapy in locally advanced non-small cell carcinoma. Specifically, there was a five-year overall survival rate of 42.9% for patients treated with durvalumab compared to 33.4% with placebo after chemo-radiotherapy. After immunological treatment lasting up to one year, 33.1% of durvalumab-treated patients did not progress five years after enrollment, compared with 19% for placebo. “The study – underlines Buffoni – has shown that durvalumab administered as maintenance therapy, after chemo-radiotherapy treatment, significantly increases survival even in the long term. The implications on the care front are very beneficial. This confirms the possibility of offering a treatment with curative intent in these patients “.
The importance of molecular tests
To ensure the best therapy, staging and molecular profiling are essential. “The stage of the disease and the molecular characteristics – concludes Pignataro – define the appropriate therapy. Giving the right drug to the right patient at the right time dramatically increases the percentage of people who recover or achieve long-term survival. In all this, however, it is necessary to emphasize that the best weapon we have at our disposal remains primary prevention: only by fighting cigarette smoke, responsible for more than 85% of cases, is it possible to considerably reduce the incidence and , consequently, the mortality of lung cancer “.