With the experience accumulated over the years and above all with the scientific innovations that provide increasingly effective attack tools, the attack on cancer becomes more strategic and timely with early therapeutic interventions before and after surgery that really allow to increase healings. The numbers are the litmus test: in six years (2015-2021), in Italy, cancer mortality has decreased by 10% in men and 8% in women. 3.6 million citizens live after diagnosis, one in four patients (over 900 thousand people) has the same life expectancy as the general population and can be considered cured. A big sigh of relief for the many who receive a diagnosis of cancer and who now no longer have to consider it a sentence.
Cancer: personalized prevention and a new mutational model
by Irma D’Aria
A new subtype for breast cancer
The new paradigm in the fight against cancer consists of the possibility of anticipating treatments at an early stage, i.e. before (neoadjuvant therapy) or after (adjuvant) surgery, to increase the number of chronic or cured patients. A lot of progress has been made for breast cancer, the most frequent in our country with 55 thousand new diagnoses every year (in 2020 there were 377 thousand total cases). “A real revolution is underway in breast cancer therapy, based on increasingly targeted and effective treatments – he says Saverio Cinieri, president of Aiom (Italian Association of Medical Oncology) as part of a scientific event with the most important experts organized today and tomorrow in Rome, at the La Nuvola Congress Center, by Astrazeneca, a company at the forefront of cancer research with 97 projects under study to identify innovative therapeutic solutions for 11 onco-haematological diseases (lung, breast, gynecological, blood, prostate, bladder, stomach, liver, pancreas, cervix, gastrointestinal tract cancers). “In fact, a new subtype is emerging, that is with low expression of the Her2 protein, which has important therapeutic consequences, because it can redefine the treatment for about half of the patients affected by metastatic disease, today not treated with targeted therapies because they are considered Her2 negative “.
Breast cancer, “smart” chemo slows down the disease
by Daniele Banfi
Early stage hereditary breast cancers
“The research findings in early stage hereditary breast cancers, occurring in women with mutations in one or both of the two specific genes called BRCA1 and BRCA2, are also important,” continues the Aiom president. “Olaparib, the parent targeted therapy of the class of Parp inhibitors, targets mutations in these genes, to further reduce the risk of recurrence and increase the chances of recovery. In the OlympiA study, adjuvant, i.e. post-surgery treatment with olaparib demonstrated a significant improvement in overall survival, reducing the risk of death by 32%. The results of this study represent a potential step forward for patients with early breast cancer and at high risk of relapse and support the importance of testing at diagnosis for Brca1 and 2 mutations ”.
Discovery of “corrupted” cells of the immune system that help tumors
by Valentina Guglielmo
The era of precision medicine
Olaparib is reimbursed in Italy in the first-line maintenance treatment of ovarian cancer and in the treatment of triple-negative metastatic breast cancer with the gene mutation. It is also reimbursed in castration-resistant metastatic prostate cancer with Brca1 / 2 mutations, progressing after previous therapy with a new hormonal agent. “Olaparib has opened the era of precision medicine also in prostate cancer, the most frequent neoplasm in men with 36 thousand new diagnoses every year in our country”, he explains Romano Danesi, director of the Department of Laboratory Medicine of the Pisan University Hospital. The molecule has more than tripled survival free from radiological progression, guaranteeing a good quality of life “.
Lung cancer: Italian study combines cancer vaccine with chemo or immunotherapy
by Irma D’Aria
The importance of genetic testing for various cancers
The Brca test therefore becomes a fundamental step in the diagnosis and choice of treatment not only of breast and ovarian cancers but also of metastatic prostate cancer. “Knowing the mutational status of the Brca genes – continues Danesi – is very important and the test should be performed on all patients at the time of diagnosis of one of these three neoplasms. The identification of variants in the Brca1 / 2 genes allows, in fact, to undertake a path of oncogenetic counseling in family members to identify high-risk carriers. To the latter we can offer targeted programs for the early diagnosis of tumors associated with Brca family transmission syndromes and strategies aimed at reducing the risk “.
Genetic mutations in lung cancer
Genetic mutations are able to guide the choice of therapy even in lung cancer. “It is the third most frequent cancer, with about 41 thousand new diagnoses every year in Italy, but it remains the big killer with 34 thousand deaths in 2021”, continues Danesi. In patients with early stage non-small cell lung cancer (IB-IIIA), post-surgical treatment with osimertinib, targeted anti-Egfr therapy, is curative. Talking about healing in this very difficult to treat disease is a great achievement, unthinkable just a few years ago. Immunotherapy with durvalumab is also aimed at, in unresectable stage III non-small cell lung cancer “.
Tumors of the blood
Healing has long been a reality in most blood cancers: today 70% of patients affected by oncohematological diseases are alive 10 years after diagnosis or can be considered cured. Chronic lymphatic leukemia, with 3,400 new diagnoses every year in Italy, is the most frequent among leukemias. Traditional immuno-chemotherapy is still effective, but only in some cases. “After the revision of the European guidelines, which has reduced the number of patients eligible for this approach, targeted therapies are destined to become more and more the standard of care”, underlines Armando Santoro, director of the Humanitas Cancer Center at the Humanitas Irccs Clinical Institute in Rozzano. “In B lymphocyte diseases, inhibitors of the BTK protein, which fall into the class of targeted therapies, allow the disease to be controlled effectively. In particular, acalabrutinib showed a significant benefit in terms of long-term efficacy and tolerability in both first-line treatment and relapsed or refractory disease. The results of the clinical studies have shown a non-inferior progression-free survival and fewer atrial fibrillation events for acalabrutinib compared to the first generation of this class of drugs ”.
The research continues
Despite the many advances made, research does not stop and continues to explore new therapeutic possibilities with innovative mechanisms of action. “Our research pipeline – he concludes Mirko Merletti, Vice President Oncology AstraZeneca – covers nearly all major types of cancer, many are considered difficult to treat and have not benefited from therapeutic innovations for many years. In this sense, important perspectives are also opening up in tumors of the liver and biliary tract. Furthermore, thanks to diagnostics, we are able to identify the patients most likely to benefit from a particular treatment. We have worked on the development of diagnostic testing platforms on the national territory such as AZFastNet, today the only reference in the country for the Health System and the scientific community in the field of precision medicine in oncology and genetic data. Finally, we are committed to promoting projects aimed at speeding up the diagnosis and leading to a chronicization of cancer. For example, we are founding partners of the ‘Lung Ambition Alliance’, which aims to overcome the barriers to screening and early detection of lung cancer. In this way, patients can have more therapeutic alternatives and greater chances of survival and treatment “.
The campaign on the right to be forgotten
Over 900 thousand people in Italy today have recovered from a tumor. Even if they have overcome the disease, they risk facing difficulties in accessing some services, such as applying for mortgages and loans, taking out insurance and adopting children. The campaign “I am not my tumor”, promoted by the Aiom Foundation, fits into this context, which would allow Italy to follow the virtuous example of other European countries (France, Luxembourg, Belgium, Holland and Portugal), which already protect their citizens former cancer patients with an ad hoc law.