The Lazio Region is concluding the new structuring of the regional Oncological Network through which to guarantee everyone equal access opportunities so as not to risk having a different assessment depending on the entrance door to the Regional Health Service.
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“Precision Oncology is based on the identification of possible therapeutic targets to which a drug capable of interacting specifically with that target will be associated, producing an advantage in the patient”. It all seems very simple, it now seems perfectly acquired but, he clarifies Paolo MarchettiScientific Director of IDI Irccs and Professor of Medical Oncology at Sapienza, in reality we find ourselves in an extremely more articulated and complex research and clinical context”.
The path of comparison and reflection on precision Oncology in the wake of the Health Series dedicated to the subject and created with the unconditional support of Lilly, today touches the Lazio Region where the clinical, scientific and organizational approach points decisively towards the concept of network.
“First of all – underlines the professor – we must make an essential premise and that is that in precision oncology there are three different models: the histological model, which is based on the recognition of alterations predictive of response to a specific drug, on the availability of that drug , on the evaluation of the results obtained in prospective clinical studies that allow us to understand what the value of that drug is, on the approval of the regulatory bodies which, on the basis of the value, defines the purchase price of that drug with the company; the agnostic model, which is based on the same premises as the histological model but no longer regards a single type of tumor but all tumors that have similar characteristics; the so-called mutational model, in which a large number of 300, 500, 1000 genes and probably even more in the future are studied.
But not with the sole purpose of identifying more targets, this would be a dramatic mistake in the clinical management of patients because it is not by identifying a greater number of locks that we will then be able to open all the doors if we do not have all the keys needed for those locks ”.
The complexity of this new and fascinating approach to oncological therapies is therefore evident as much as the uncertainties that still remain to be revealed before pushing the foot on the accelerator paroxystically. As Marchetti explains well, “the mutational model is subject to great uncertainty regarding the clinical results of its use, which is why studies are underway all over the world to try to better understand, on the one hand, what are the possible ways of interacting with some tumors with specific targets, on the other to better understand what are the mechanisms that determine a factor of resistance to these drugs, when correctly associated with a given target”.
This is why, warns Marchetti, no one should feel excluded from the possibility of accessing these innovative models of therapy. “No one is denying patients real therapeutic opportunities. The histological model, also based on the study of the molecules for which we have drugs already available, is present throughout the Lazio Region, but looking for other alterations and then not having a drug available means only wasting resources”.
In any case, these models need a diagnostic and assistance structure suitable for the challenges that this innovation requires. For this reason, the Lazio Region is developing the new structure of the regional Oncological Network through which to guarantee everyone equal access opportunities and not risk having a different assessment depending on the entrance door to the Regional Health Service. The Oncological Network model chosen is that of the Comprehensive Cancer Network (not of the Comprehensive Cancer Center) and that is, Marchetti continues, “a functional link between physically distant or separate structures, where patients will certainly not move from one structure to another but fabrics and information”.
A new organizational approach too
But how will it be possible to combine the sustainability of the system with the need to change the paradigm in one of the important areas of care in our health system? In addition to primary and secondary prevention on which Joseph Quintavalle, General Manager of the Tor Vergata University Hospital has very few doubts The main road seems to be the one indicated by Marchetti: “I would say that perhaps today we have definitively surpassed the Clinical Trial Center – underlines Quintavalle – with a new vision and a new diagnostic approach and therapeutic that starting from the Next Generation Sequencing, passes through multidisciplinary teams connected to each other. And when we talk about teams we talk about networks – he adds – in which we must have the courage and intellectual honesty to associate public and accredited private sectors which, in the Lazio Region, express skills of the highest level ”.
The last mile of the Lazio Region
“Right now – he underlines for his part Massimo Annichiarico, Director of Health and Social-Health Integration of the Lazio Region – we are at the last mile of the process of formalizing what is the regional planning document of the Oncology Network. A particularly important mile because it is the one that concerns the comparison with patient associations and in general with civic representation associations to discuss the organizational model that we have imagined”.
A model which, Annichiarico explains, “once the citizen has a need, he takes it in and ensures that the same citizen, from that moment on, no longer has to do anything alone. It is the regional health service that will have to put in place all the mix of necessary and differently combined actions according to what is the type of necessary response that the patient can benefit from. And this target of action, therefore this so-called precision medicine, consists precisely in the ability of the system to give a clear answer. It is not a magic bullet that is the same for all citizens, but a bullet that exactly hits the genetic and morphological characteristics of that tumor in that precise individual, in that precise moment, combining with various other choices that today, in this moment allow us to convey the drug through the use of systems such as monoclonal antibodies, such as highly refined forms of genetic engineering that bring the drug exactly to the point where it has to attack the cells that need to be affected”.
In short, a real Copernican revolution which, however, will never work if, as described, a new way of organizing diagnostic and therapeutic services is not implemented throughout the region.
December 16, 2022
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