by Vera Martinella
Two thousand Italians fall ill with mesothelioma every year, an aggressive disease often diagnosed late. A study coordinated by our country opens a new way to save patients time
There are approximately two thousand new cases diagnosed every year in Italy of pleural mesothelioma, an aggressive and still very difficult to treat tumor, which in nine out of ten patients is due to exposure to asbestos. If until a few years ago the prognosis was often unfavorable, with an average survival of less than a year, today research has made progress thanks to the arrival of immunotherapy, which appears more effective than chemotherapy. He indicates it a study published in the prestigious scientific journal The Lancet
the results of which demonstrate the effectiveness of a new therapeutic option in the case of unresectable or metastatic neoplasms.
An occupational disease
Mesothelioma is a particularly aggressive neoplasm that affects the mesothelium, a fibrous membrane that covers various organs and structures including the lungs and the internal part of the rib cage (pleura), the heart (pericardium), the intestine (peritoneum) and the testes. strictly linked to exposure to asbestos or asbestos and although the use of this material (extraction, import, export, marketing and production) in our country has been prohibited since 1992, the peak incidence of mesothelioma has not yet been reached because the period latency between contact with risk factors and the appearance of the tumor of 20-40 years. Without considering that in Italy the quantities still present in many territories remain significant and reclamation is proceeding slowly. This tumor can arise decades after exposure to asbestos: today, therefore, it continues to be diagnosed precisely due to the intense use of the mineral from the Second World War until the beginning of the nineties – confirms Federica Grosso, head of the Structure Mesothelioma and rare tumors of the Santi Antonio e Biagio and Cesare Arrigo Hospital of Alessandria —. The sectors most involved are construction and heavy industry, from which 60% of the cases in the National Registry archives derive. In some areas of our country, such as Casale Monferrato, Mestre, Savona, Ancona, in Friuli Venezia Giulia, in the Monfalcone and Trieste area and in Bari, mesothelioma is a frequent tumor due to the presence of shipyards and factories where mesothelioma was used. ‘asbestos, but in most of the territory rare.
Symptoms of mesothelioma
Asbestos is a certain carcinogenic agent, not only for pleural mesothelioma, but also for the lungs, larynx, ovary, peritoneum, pericardium, tunica vaginalis of the testicle (mesothelium covering the testicle), colorectal, esophagus, stomach and pharynx. surveillance of the people most exposed to the risk of falling ill is fundamental, that is, former workers in factories that produced or processed asbestos – underlines Francesco Perrone, president of the Italian Association of Medical Oncology -. The most commonly affected professional figures are: shipyard and construction workers, workers in automotive mechanics, insulating materials, pipe and heating system installation companies. Mesothelioma generally manifests itself around the age of 70 and in most cases is diagnosed in an advanced or metastatic stage, when surgery is not an option and survival rates are low. Unfortunately, in the initial stages, the tumor does not give clear signs of its presence. The first symptoms, usually present for a few months when diagnosed, are chest pain, difficulty breathing and cough. The most frequent sign is the formation of pleural fluid in the chest.
Improves survival
Recent studies have highlighted the role of immunotherapy in this neoplasm and the IND.227 study marks a further important progress in research, adds Grosso. The results of the research, published in The Lancet in early November 2023, were presented in recent days, during the plenary session of the national Aiom congress in Rome: immunotherapy with pembrolizumab in combination with chemotherapy with platinum and pemetrexed, in the first line, significantly improved overall survival, reducing the risk of death of patients by 21%. At three years, 25% of patients treated with the combination were alive, compared to 17% with chemotherapy alone. Progression-free survival was also significantly better. Seventeen Italian centers participated in the trial – explains Marilina Piccirillo, medical director of the Clinical Trials Unit of the Pascale in Naples and scientific coordinator of the IND.227 study in Italy -. An improvement in survival three years after diagnosis of 8% is a significant result in a pathology such as mesothelioma, which still has a poor prognosis. The same applies to survival free from disease progression (i.e. the time between the end of treatment and the moment in which the tumor recurs) and for response. The latter, which is equivalent to a reduction in the size of the tumor, was achieved in 62% of patients treated with pembrolizumab in combination with chemotherapy, compared to 38% of those treated with chemotherapy alone, therefore almost a doubling of the response rate. This is important, because patients with mesothelioma are often very symptomatic and the reduction in the size of the tumor generally corresponds to better control of respiratory symptoms and pain. We hope that this new therapeutic option will be made available in clinical practice as soon as possible.
The value of independent research
IND.227 an independent clinical trial (non-profit, i.e. not directly promoted by the pharmaceutical industry), conducted by three cooperative groups and coordinated by the National Cancer Institute IRCCS Fondazione Pascale di Napoli, the Canadian Cancer Trials Group (CCTG) and the French Cooperative Thoracic Intergroup (IFCT). The standard of care for pleural mesothelioma for 20 years has been represented by chemotherapy, with unsatisfactory results – concludes Perrone, who is also director of the Clinical Trials Unit at Pascale -. This phase 3 study involved 440 patients from 51 centers in Italy, Canada and France and demonstrates the high value of independent research. It should also be highlighted that almost half of the patients, 212, were Italian, demonstrating the central role played by our country. The study design is the result of the work of Italian and Canadian researchers. International academic collaborations like this represent an important tool for exploring new strategies against cancer and for defining new treatments capable of improving patient prognosis, especially in the case of uncommon diseases such as pleural mesothelioma. The results of this research, in fact, are destined to have a tangible and significant impact on the lives of patients.
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November 20, 2023 (modified November 20, 2023 | 07:49)
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