In the era of precision oncology there is an element that cannot be underestimated: the complexity of the patient, almost always elderly and suffering from other pathologies besides oncology, and of the therapies he takes. Yes, because the whole castle of personalized treatment risks falling if the chosen medicines have a negative interaction. Not to mention the effect on patients’ quality of life. Paolo Marchetti, Scientific Director of IDI in Rome, Full Professor of Oncology at the La Sapienza University of Rome and President of the Foundation for Personalized Medicine explains this to us.
Prof. Marchetti, in oncology what is meant by “therapeutic reconciliation”?
Specific drugs for oncological pathology are chosen for each patient after a more or less long process of identifying the clinical and biological characteristics of the patient and his pathology. A whole series of parameters and aspects concerning the specific conditions of the individual patient must be taken into account. However, this challenging diagnostic-therapeutic path can be thwarted by possible interactions between oncological drugs and those taken for other diseases that are often present. This is the principle of therapeutic reconciliation: making sure that all treatments are compatible with each other.
Could it happen that your patient is under medical treatment for other health problems?
Yes, it is a very frequent clinical condition and we are often faced with chronic diseases typical of the elderly, such as hypertension and diabetes. It should not be forgotten that half of all cancers affect men and women over the age of 70. In a work published by Graziano Onder, geriatrician of the Gemelli Polyclinic, a few years ago, over 60% of men and women over 65 (over 12 million people) in our country took more than 4 drugs every day, with more than 10% being he took over 9.
At the ESMO 2022 Congress you presented a study on therapeutic reconciliation. What is it about?
We conducted an analysis of 170 patients treated at 20 Italian cancer centers affected by metastatic breast cancer. All participants were treated with CDK4 / 6 cyclin-dependent kinase inhibitor drugs. The study, AB-Italy, involved 170 patients and confirmed the efficacy of abemaciclib in real clinical practice. Together with the authors of the main study, we evaluated possible negative interactions between oncological drugs and those against other concomitant pathologies.
How did you analyze the data of the patients selected for the research?
We used a specific and innovative IT platform developed by a collaboration between the University of Berlin Charité and the Sapienza University of Rome, Drug-Pin. The platform assigns a score to drug combinations and therefore with a few simple operations on the computer it is possible to make the integration between the different therapies more harmonious.
What results have you achieved and what benefits can there be for patients?
We identified a group of 38 participants for whom the platform indicated a negative score and who then took drugs that led to a negative interaction. These patients had a 6-month lower PFS (disease-free survival) than those who did not score negative. It is evident that these interactions have great clinical relevance. In fact, a drug that is able to guarantee a PFS of 6 months is considered as an active and effective therapy. All the benefits produced by innovation and research risk being nullified. In this sense, therapeutic reconciliation is an indispensable partner of precision oncology.
So medical oncology is increasingly committed to finding the most appropriate therapy for the individual patient?
The study that we recently conducted, and presented to our European colleagues in Paris, gives us a solicitation. Once again it is clear that, in times of precision oncology, the identification of therapeutic targets and the use of active drugs is an extraordinary result in the treatment of cancer, but that is not all. We must pay close attention to the patient who hosts the tumor while too often we are focused only on the neoplasm. We tend to forget that cancer has many and varied interactions and cancer cells are only part of the problem.
Are you planning other studies such as the Foundation for Personalized Medicine on this topic?
The data presented were related to women affected by breast cancer and are already partially confirmed by others that we are collecting on patients with mutated BRAF metastatic melanoma and treated with molecularly targeted drugs, where the 6-month advantage in PFS is confirmed in patients who did not have a negative drug interaction score, assessed with Drug-Pin. This study will be published shortly.
Is our country at the forefront of clinical cancer research?
Of course. This is what emerged at the last ESMO congress in Paris regarding precision oncology. The overall evaluation of the patient must be our priority, it is no longer sufficient to analyze only the cancer cells. This is one of the goals we set ourselves with the birth of the Foundation for Personalized Medicine.