Triple negative metastatic cancer is a particularly aggressive form of breast cancer that is rarely talked about. But the need to receive information and assistance from patients is great, also because there are several therapeutic innovations that can be communicated today. Among the most promising therapeutic options, drug-conjugated antibodies stand out in particular, which have been shown to reduce the risk of disease progression by 60% and halve the risk of death. To talk about specific therapeutic opportunities, dedicated paths, and information and socio-assistance services that patients can benefit from today, AIOM (Italian Association of Medical Oncology), in this month of November, will launch the first awareness campaign dedicated to women with this type of breast cancer. The initiative, promoted by oncologists and implemented with the support of Gilead, will also involve all patient associations. AIOM will promote the campaign on its social networks and will organize a series of webinars, involving oncologists and patient associations, which will be broadcast live on AIOM TV. “The goal – explains Saverio Cinieri, AIOM National President – is to talk about this form of breast cancer, to illustrate, on the one hand, the complexity of the treatment process, and on the other, the progress of therapies and research perspectives “.
Why is it so difficult to cure triple negative breast cancer
In 2020, there were approximately 55,000 new breast cancer diagnoses, with approximately 8,000 new cases (15% of the total) of triple negative breast cancer (TNBC). “As the name indicates, in this subtype of breast cancer there is a lack of receptors (for estrogen, progesterone and HER2) which, on the other hand, in other forms makes it possible to act with targeted therapies acting as a target – explains Lucia Del Mastro, director of the Medical Oncology Clinic of the IRCCS San Martino Polyclinic Hospital of Genoa and full professor of Oncology at the University of Genoa. – This characteristic has made TNBC a more difficult tumor to treat than the others until recently, because it can only be tackled with chemotherapy and because it is generally characterized by greater biological aggression “.
Even a recent French study, published by the online scientific journal ESMO OPEN, has further confirmed that this type of cancer is much more aggressive than the other subtypes of breast cancer. After evaluating the survival of over 20,000 patients with metastatic breast cancer between 2008 and 2017, it was found that the median survival of patients with hormone receptor positive and HER2 negative was 43 months, with a 5-year survival of 36. %, which in the HER2 positive subgroup was 50 months, with a 5-year survival of 44%, and that in the triple negative subgroup a median survival of only 14.5 months was recorded, with a five-year survival of 11%. “Precisely because of this very short survival, patients with triple negative breast cancer are able to receive fewer lines of treatment, with the percentage of” attrition rate “(ie abandonment rate) of clinical trials that gradually increases – emphasizes Del Mastro – Gaining time, delaying the progression of the disease as much as possible, is therefore the first goal to be pursued thanks to the new therapies that research is making available ”.
Metastatic breast cancer, the requests of Europa Donna presented in the Lombardy Region
The new therapies
The therapeutic options available until a few years ago to treat TNBC were limited to classic chemotherapy, with decidedly unsatisfactory results. “The therapeutic landscape today, on the other hand, is finally changing also for this type of tumor – comments Michelino De Laurentiis, director of the Department of Breast and Thoracic Oncology of the National Cancer Institute IRCCS” Fondazione G. Pascale “in Naples – Following the path already taken by research in the last two decades for other subtypes of breast cancer, the innovative therapies available today are: immunotherapy, which is added to chemotherapy in tumors expressing PDL1, a marker of immunological sensitivity present in about 40-45% of all triple negative, PARP inhibitors, an active oral therapy in tumors with hereditary mutation of the BRCA1 and 2 genes (which represent about 15% of all triple negative tumors), and drug-conjugated antibodies, potentially effective in most part of triple negative tumors. These are therapies that promise to extend life expectancy without generating major toxicities and to lay the foundations for chronicizing even triple negative metastatic cancer ”.
If immunotherapy and PARP inhibitors have proved effective especially in patients in the first lines of treatment, drug conjugated antibodies, on the other hand, have shown themselves to be able to meet a strong therapeutic need not satisfied in the most advanced lines. In fact, these are drugs that target extremely powerful chemotherapy molecules directly into cancer cells, thanks to the role played by antibodies. It is the latter that specifically bind to a molecule present mainly on neoplastic cells, causing their death. In this way, healthy tissues are not exposed to the action of the drug and the side effects for the patient are reduced.
Triple negative breast cancer, Aifa ok to drug reimbursement
The role of associations
Hundreds of patient associations will participate in the campaign. “There is still a need to work together to create knowledge and information on the fact that breast cancer is not one and that patients who receive a diagnosis do not all have to face the same path – explains Rosanna D’Antona, President of Europa Donna Italia – When it comes to cancers such as the triple negative, there are still many objectives to be achieved to ensure a good quality of care and life ”.
One of these is the right of patients to have immediate access to new therapies. “Even more than the others, these women cannot and must not wait – adds Anna Maria Mancuso, President of Salute Donna Onlus – Every time, on the basis of proven clinical data, the possibility of resorting to new and more effective therapies is envisaged, our commitment must be aimed at supporting an acceleration in making them available and also in making sure that they are usable in as many health facilities as possible ”.
The issue of accelerating the availability of drugs is also at the top of the agenda of the IncontraDonna Foundation. “In the first days of October, as a Foundation, we sent a letter addressed to the top management of AIFA in which we wanted to underline how despite the fact that Italy ranks among the first European countries in the field of authorization of medicines, as regards drugs for breast cancer – in particular for metastatic breast cancer – the waiting times to arrive in the Official Gazette are still too long – concludes Sonia Carisi, Director General of the IncontraDonna Foundation – Time is a crucial factor, the fastest possible access to this type of therapy is fundamental in the long road that must lead to the chronicization of the disease “.
