Triple negative. Two words that accompany the diagnosis of breast cancer in about 1.5 cases out of 10. And that make it appear even more fearful. If, in fact, many therapies have been developed for other types of breast cancer that overturned the prognosis within 20 years, for triple negative cancer there has been little progress. The scenario, however, has partially improved in the last few years and is still about to change, as we report in the Health Breast newsletter.
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What is triple negative tumor
Let’s go in order and start with the name of this tumor. The “three minus” indicate that the disease does not depend either on estrogen or progesterone (it is not, that is, hormone-dependent), or on human growth factor: therefore, it is useless to use those therapies that have the function of blocking these hormones. This is one of the reasons (not the only one) why triple negative is generally considered to be the most clinically aggressive of breast cancers (although not all behave in the same way). It mainly affects young women, often with mutations in the BRCA1 gene and for which the possibility of recurrence and metastasis is high.
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The treatment today
How is this cancer treated today? “For patients with early stage cancer, the standard adjuvant treatment in Italy is still chemotherapy, unless it is part of a clinical trial”, he replies. Alessandra Gennari, associate professor of Oncology at the University of Eastern Piedmont and director of Medical Oncology at the Novara Maggiore University Hospital: “For patients with metastatic cancer, on the other hand, there are two possibilities for the first line of treatment: a part About 40% may receive atezolizumab immunotherapy along with a chemotherapy drug. These are patients who have a particular biomarker – called PD-L1 – which indicates a higher likelihood of responding to immunotherapy. only chemotherapy “.
As the disease progresses, if the mutation in the BRCA genes is present, target therapy with the Parp inhibitor may be used. In all other cases, chemotherapy drugs are continued. In short, there is a great need for new treatments.
Two new drugs approved in Europe
However, this picture is about to change in the near future. These days the news of the approval in Europe of a new drug for metastatic patients: it is called sacituzumab govitecan and is the first of a new class.
It is a monoclonal antibody directed against Trop-2, a protein that helps cancer grow, present on cancer cells in over 90% of cases. The antibody carries with it, directly to the target, the chemotherapy SN-38 (for this reason it is called conjugated antibody), thus acting in a highly specific and precise way.
The drug has been approved for those who, after the discovery of metastases, have already done two or more lines of treatment: “When, that is, the only alternative would be chemotherapy, which however gives unsatisfactory results for many patients”, he explains. Giampaolo Bianchini, Head of the Mammella Group of the IRCCS San Raffaele Hospital in Milan, among the research groups that contributed to the development of sacituzumab govitecan in Italy: “The efficacy results of this drug, compared with the different chemotherapies available today, have shown a doubling the chances of survival and a seven times higher response rate “.
A promising new drug for triple negative breast cancer
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Sacituzumab govitecan is not the only novelty regarding triple negative cancer. The European Commission has also approved an immunotherapy (the second for this disease), called pembrolizumab, which has already been widely used in other types of cancer for several years. The approval is for the first line of treatment, in combination with chemotherapy.
Now we will have to wait for the Medicines Agency (Aifa) to make these two new therapies reimbursable in Italy. Which – we remember – received strong support from the International Consensus Conference on metastatic breast cancer which was held at the beginning of November. “According to the new guidelines – the experts stressed – patients with triple negative breast cancer should have access to sacituzumab govitecan and anti-PD-L1 immunotherapies, especially pembrolizumab”. The same is supported by the new guidelines of the European Society of Medical Oncology (Esmo).
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In small steps
“The patients – continues Gennari – face the first treatments after the diagnosis of metastasis with great confidence, but when there is a progression, discouragement risks taking over. This drug is the result of a technological innovation that gives new hope, which allows to think about chronicity and to add healthy life even after the first therapeutic lines “.
“I see that research is really making great strides,” he says Roberta Romani, president of the Annastaccatolisa association, dedicated to triple negative cancer. “I lost my daughter Anna Lisa 10 years ago to this disease and in this time new drugs have been discovered and new intervention techniques have been developed. I am confident that it will really make a difference.” For six years, the association has been awarding a two-year research grant to young scientists, worth 22,000 euros a year, precisely to promote studies in this area: “Ours is a drop in the bucket, but we also contribute by doing awareness, because the first prevention is cultural. We get sick more and more but we also heal more and more “.
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The Women in Meta campaign
With the aim of raising awareness, a new campaign promoted by Gilead Sciences Italia under the patronage of Europa Donna Italia was launched yesterday, entitled “Donne in meta”. The metaphor is that of rugby, a sport based on mutual support in every game situation, to tell women that they are not alone.
“The help of those close to you is essential, but it is also essential that the woman is not afraid or embarrassed to ask for it, from her partner as from relatives, friends and even one of the many associations that are ready to support her”, he underlines Rosanna D’Antona, president of Europa Donna Italia: “Furthermore, there is another message that we want to spread with this initiative: being informed about the disease is equally important and in this sense doctors are called upon to work as a team, giving more space to dialogue during the visits. We often speak of young women, in the midst of their social, family and working life “.
First of all, in fact, there is a strong need for information. This was revealed by a survey carried out by Elma Research for the campaign and which involved over 100 women with triple negative breast cancer and some of their partners. The survey investigated the fears – mainly related to the concept of time and uncertainty – the wishes, expectations and hopes of patients and caregivers. And he highlighted 5 actions to support their path: get help to foster positive feelings, focus on the present; trust in research and current treatments; support without judging; meet their needs.
And from the point of view of the partners? Unfortunately, it emerges that they do not feel adequate to give emotional support. It is therefore no coincidence that the testimonial of the campaign is a man: Marco Bortolami, head coach of Benetton Rugby after making 112 appearances for the national team as a player. “Rugby is a sport very far from individuality – he says – What strikes me in this survey is how central the psychological challenge is. In sport it is the same: only when you accept the psychological challenge, becoming aware of the difficulties but also of the opportunities, you can face it. We men are always too focused on what we can do in a practical way while often just being close to those we love. Having the experience of those who have already been through it can help a lot. What do you need to team up? Know the roles mutual expectations, knowing how to help each other so that others can do a better job. In certain moments we have to rely on others. Feeling lost – he concludes – is not a feeling that should make us feel guilty. If we keep it closed in us it takes away our energy, but if it is externalized it loses power. I think it is important, on every occasion, to accept being afraid in order to transform this feeling into strength “.
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