Genomic examinations save unnecessary chemo in those with lower risk of relapse with benefits in terms of quality of life for patients and economic savings for the system
Abruzzo, Autonomous Province of Bolzano, Campania, Emilia Romagna, Lombardy, Lazio, Piedmont, Sardinia, Sicily, Valle d’Aosta and Veneto are the 11 regions that to date, almost a year after the establishment of the special 20 million fund of Euro, have actually made genomic tests available free of charge for women with breast cancer to understand if it is possible to avoid chemotherapy. These are tests that, only in some types of patients affected by hormone-responsive breast cancer at an early stage, allow to predict the risk of relapse and, therefore, to exclude chemotherapy in addition to hormone therapy after surgery, avoiding unnecessary toxicity for the sick is a waste of money for the National Health System.
In Italy 10,000 women could benefit
The experts of the Italian Association of Medical Oncology (Aiom), on the occasion of the second day of the national congress of the scientific society, underlined that due to bureaucratic and administrative delays there is a real risk of having to wait another 6-9 months for the exams to be available to all women who would need it, who in the meantime have only two choices left: to wait or pay for the test out of their own pockets (at a cost of about 2 thousand euros). In the last twelve months, heavy delays have accumulated first at the central government level, then at the level of individual Regions and Autonomous Provinces – he explains Saverio Cinieri, president-elect Aiom -. It is an intolerable situation that for the umpteenth time has created a patchwork of assistance in our country. We ask the regions and local health authorities to speed up the processes to find the tests, obviously in full compliance with the rules governing this kind of purchases by health facilities. According to estimates, these tests can be prescribed to more or less one in five patients, for a total of over 10 thousand women who in our country alone could benefit every year from tests that are easy to perform and which, for the NHS, would be relatively inexpensive and would save (for each non-prescribed chemotherapy) around 7 thousand euros. These molecular analyzes – continues Cinieri, director of the Medical Oncology and Breast Unit of the Perrino Hospital in Brindisi – are able to support the oncologist in the personalization of therapies in some types of patients with early stage breast cancer: they are able to identify, in some types of patients, who has the best or worst prognosis and is more or less likely to benefit from adjuvant chemotherapy or hormone therapy alone.
Why are these tests needed
With over 55 thousand new cases estimated in 2020 in our country, breast cancer is the most frequent cancer not only in women, but in absolute terms. Survival 5 years after diagnosis reaches 87%, but it must be considered that relapse for this type of neoplasm can occur up to more than 20 years from the initial diagnosis, especially in women with hormone receptor positive carcinoma: for this it is essential to be able to understand who is most in danger and can better calibrate the cure. About 70% of cases of luminal-type breast cancer, that is, it expresses estrogen receptors but not the HER2 protein (the so-called ER positive / HER2 negative) – clarifies Giordano Beretta, Aiom national president -. After surgery, systemic treatment involves the use of hormone therapy in cases considered to be at low risk of relapse or the addition of adjuvant chemotherapy (ie after surgery) to hormone therapy, in the presence of a high risk. In “intermediate” risk luminal disease, there is a significant therapeutic uncertainty, because in the international and national guidelines there are no binding indications on when it is possible to omit chemotherapy or when it is necessary to administer it. These cases are placed in a sort of “gray zone”, in which the choice of the correct therapy following surgery is challenging and the use of genomic tests, which have proved effective in many studies, is decisive. recommended by the most important international guidelines, such as those of the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the St. Gallen International Breast Cancer Conference.
The example of Emilia Romagna
Chemotherapy drugs can cause much feared side effects (such as hair and hair loss, skin and nail damage, nausea or vomiting, anemia, chronic fatigue, altered smell and taste) that we are often able to stem today, but which however they have an impact on the lives of patients – adds Beretta, director of Medical Oncology at Humanitas Gavazzeni in Bergamo -. The use of genomic tests must be considered an investment that generates savings for the public purse and above all avoids suffering for women. From Emilia Romagna comes a positive example of how it was possible to shorten the wait for patients and optimize the path while waiting for the Region to make the purchase tender to choose, among the various models available, the test to be repaid. Already at the beginning of August 2021, a specific provision was approved and 850 women will be able to receive genomic tests for free each year – underlines Claudio Zamagni, director of the Senological and Gynecological Medical Oncology of the S. Orsola-Malpighi Polyclinic of Bologna -. We have to thank the local institutions who had the foresight to speed up access processes but our role was also fundamental. As representatives of the clinicians we solicited the department and obtained an important result. While waiting for the regional competitions, the individual hospitals, from Piacenza to Rimini, can purchase the tests which will then be reimbursed by the region. It is a winning choice that is bringing excellent results and that can be taken as a model by other regions.
October 23, 2021 (change October 23, 2021 | 16:46)
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