From liquid biopsy to the possibility of monitoring the molecular factors that precede the development of a tumor. It is a new frontier of oncology research: to talk about it, oncologists, biologists, psycho-oncologists and patient associations met today at the Palazzo Pirelli in Milan, for a national conference promoted by the Lombardy Region.
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A conference on prevention
“Every year, 60 thousand Lombard citizens are affected by cancer and 40% of these cases could be avoided by correcting incorrect lifestyles – he recalls Gianluca Vago, Director of the Department of Oncology and Hemato-oncology of the State University of Milan and President of the CNAO Foundation – Prevention, therefore, is confirmed as the watchword, but prevention that must be personalized and active. On this occasion, we want to focus attention on the efforts that all research is making to recognize the presence of a neoplasm as early as possible and, even more, to identify risk markers before its development”.
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The difference between primary prevention and early diagnosis
A distinction is obligatory: we are talking here about primary prevention, which is very different from early diagnosis. Prevention, in fact, means preventing the disease from developing, while early diagnosis serves to intercept it when it is already present, albeit in an initial stage. Mammographic screening, for example, is useful for early diagnosis, because it does not prevent getting sick, but allows breast cancer to be detected when it is still very small. The colonoscopy which is done as part of colorectal cancer screening, however, can be a real act of primary prevention, because it intercepts polyps when they are not yet tumors. The same goes for HPV screening, which can detect the presence of the virus and any pre-cancerous lesions.
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The possibilities offered by liquid biopsy
On the early diagnosis front, efforts are moving towards personalization and stratification. “But primary prevention is also becoming more refined, and is starting to look at molecular markers of risk – continues Vago -. One of the tools that are changing the scenario is the liquid biopsy, as demonstrated by a recent study published in New England Journal of Medicine”. “The introduction of the liquid biopsy (which allows, for example, the sequencing of the DNA circulating in the plasma, ed.) represented a real paradigm shift – he confirms Andrea Sartore-BianchiDirector of the Scientific Committee of the Niguarda Oncology Foundation of Milan, who has conducted important studies with the use of this tool in the field of colorectal cancer: on the driver mutations that “trigger” it and which are responsible for the onset of drug resistance.
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We need a new organizational model
The challenge, therefore, is not only to intercept the hallmark signals of cancer but also those of “pre-cancer”. An area on which little research is still done, as he reiterates Giuseppe CuriglianoProfessor of Medical Oncology at the University of Milan and Director of the Development Division of New Drugs for Innovative Therapies at the IEO, according to whom it is essential to start thinking about real 360-degree prevention centers and paths, well separated (even physically ) from those dedicated to those who have developed an illness: “Taking care of prevention – he states – should be one of the primary tasks of the healthcare system”.
What we know about tumor biology
The tumor takes years to develop, remember Luca Quagliata, molecular biotechnologist at the University of Heidelberg in Germany: “The DNA of each of us receives thousands of daily lesions which are however repaired by tumor suppressor genes. If these genes stop functioning, they no longer repair the damage and somatic mutations are formed (acquired, ed.) which represent an indicator of the inactivity of the ‘controller’ genes: a condition that precedes the development of solid tumors. It is called genomic instability and today we know that, together with chronic inflammation, the imbalance of the immune system and bacterial flora, it constitutes a prodromal factor of cancer”.
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A new line of research has developed around this knowledge called Cancer Driver Interception, which represents the possibility of personalizing primary prevention. “Just as we can control blood pressure and cholesterol levels in cardiovascular diseases, today we can verify and monitor the mutations that lead to the onset of tumors – he explains Giuseppe Mucci, President of Bioscience Foundation – It is an approach potentially capable of ‘intercepting’ the natural history of tumor progression even before the onset of the disease. An approach which naturally requires confirmation and validation studies on large population data, but which is increasingly gaining ground in the oncology field.”
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Without leaving behind those who have already had cancer
Today, over 830 thousand women live in Italy with a diagnosis of breast cancer. “Most of them have an excellent quality of life, but too many ex-patients still start smoking again, consume alcohol excessively, or do not carry out physical activity – they underline Anna Maria Mancuso of Women’s Health and Adele Patrini by Europa Donna Italia – As patient associations we are committed to raising awareness on these issues, also reiterating the fundamental role of psycho-oncological rehabilitation for the return to a normal working and emotional life, with the aim of avoiding the onset of relapses. These actions must be systematized.” Primary prevention in fact – he concludes Gabriella Pravettoniprofessor of cognitive and decision-making psychology at the University of Milan – also involves psychological and social support, which helps to contain states of anxiety and stress and to modify lifestyles”.