To give cancer patients ever faster and more personalized responses to therapies, thus improving the effectiveness of treatments and avoiding unnecessary toxicity with inappropriate drugs, it is necessary to develop a national plan for research in oncology. This was supported by Carmine Pinto, President of FICOG (Federation of Italian Cooperative Oncology Groups) and Director of Medical Oncology of the Comprehensive Center of the AUSL-IRCCS of Reggio Emilia, an internationally recognized researcher on bio-molecular characterization and “personalized” therapies in care of tumors. Speaking at the meeting “Precision medicine in oncology, scenarios and application models”, organized by Edra and the American Study Centers with the support for the dissemination of Roche, the oncologist highlighted the need to ensure continuity between clinical practices and research in precision oncology, cancer medicine that seeks to identify the most suitable treatment based on the genome and its mutations through NGS (Next Generation Sequencing), the most innovative technologies for genomic sequencing. If you want to enhance personalized medicine, make it equally accessible throughout Italy and compete internationally, the way forward is to create new organizational models within the regional oncological networks, with greater funding and innovative technologies, economic sustainability of drugs. and tests.
Professor Pinto, where is research in precision oncology in Italy today. How can it be enhanced and made available?
Today we are able to identify so-called “driver” molecular alterations that intervene in the evolution of a tumor and to develop targeted drugs on specific targets. The problem is that there is a lack of global governance and strategy in the field of translational and clinical studies in our country. Studies often overlap and do not integrate, and this involves a non-rational use of resources and an extension of time. To improve and implement cancer research in all areas from prevention, diagnosis and therapies, it would be important to coordinate them in a national program, as happened for example in the United States, with strategic objectives and adequate resources, also defining an inter-relationship between the public and the world of industry. And in this perspective of increasingly personalized oncological therapies on a molecular basis, it is essential to build a single national platform to enter and process data so as to be able to give faster responses to patients and be more competitive internationally. All this is possible only if we have more resources, more staff for structured scientific research, and strong coordination for a national cancer research plan.
What are the opportunities offered by precision medicine to health systems, in particular to the oncology field?
It is a Copernican revolution. Today, precision oncology allows us to define which molecular alterations favor the development and evolution of a tumor in the patient, then to define for which patient a specific therapy is most appropriate, acting quickly and in a personalized way. All this also translates into an enormous economic advantage for the health system: treating patients with selective therapies allows us to use the drugs we have available in a targeted manner, to keep the disease under control for longer periods and therefore to reduce the impact of care, and also to increase the chances of recovery.
You have estimated that a fund of € 25 million a year is needed to carry out NGS tests for all patients who would benefit from it. How do you arrive at this figure?
NGS tests today do not have an “official” rate. We proceed with a multiplication by codes of other tariffs. With a study carried out in two Italian public centers, we have defined an average rate of approximately 1,150 euros, including both consumables and the cost of personnel, environments and equipment. Considering what is recommended at European level for an “appropriate” use of NGS tests, we believe that today in Italy for patients with advanced stage cancer we would need to carry out about 21,000 NGS tests per year, concerning lung adenocarcinoma, cancers of the biliary tract, and neoplasms for which, after a first line of standard therapy, we do not have effective treatments available. To allow this number of patients to be able to access the tests, at the rate we have considered, a fund of about 25 million euros may be needed.
In addition to money, however, governance is also necessary. What does the document drawn up by FICOG together with the Istituto Superiore di Sanità say to this proposal?
It should be reiterated, as I said earlier, first of all in which situations it is appropriate to perform NGS tests. We have European recommendations that clearly tell us that for some advanced cancers NGS tests can have important advantages in defining the best therapy for a patient. If we know for which patients there is an indication for the test, we must also put ourselves in a position to be able to perform them. We therefore need to have molecular biology laboratories with significant technological and professional values. Today there is a lack of equity in the national territory, there are regions with molecular biology laboratories every 30-40 kilometers and regions where the shortage is significant. The need to develop governance at the national level is therefore very strong. The answer is to define and program molecular biology laboratories within the regional oncology networks, which consider population volumes, logistics and test quality. The goal is to guarantee patients in all regions of our country NGS tests in the appropriate situations, with quality responses and adequate timing. In conclusion, the biological samples will have to travel and no longer the patients.
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