Several studies indicate important progress thanks to immunotherapy and molecularly targeted drugs: 77% less relapse in operable patients and a 40% less risk of death in metastatic patients
Although that ai lungs remains a very difficult tumor to heal definitively, also because unfortunately the majority of people arrive at the diagnosis at an advanced stage, the prospects for the sick improve considerably: different new drugs (also combined with classic chemotherapy) lengthen the survival of metastatic patients, are effective in reducing relapses in operable ones and improve not only the quantity, but also the quality of life of those who fall ill. So, step by step, it went from a few months of life to several months, even several years. An “unthinkable” goal until a few years ago, today instead documented by the results of various researches presented during the congress of the European Society of Oncology (European Society for Medical Oncology – Esmo), which closes today in Paris.
115 new cases a day
Every day, in Italy, more than 115 people discover they have the disease and the numbers in Italy are growing, especially among women and younger people, even non-smokers or former smokers. “Lung cancer is still today the deadliest tumor in Italy and, with 41 thousand new cases every year, one of the most frequent – remember Filippo de Marinis, Director of Thoracic Oncology at the European Institute of Oncology (Ieo) in Milan -. Unfortunately, more than 70% of patients arrive at the diagnosis too late and even in the 30% of people who discover it neoplasm in the early stages, when it is still operable, unfortunately, relapses are very frequent. Knowing if and which genetic alterations are present within the neoplasm of each patient can make a big difference: it is also based on any DNA mutations, in fact, that therapy is now decided for many types of cancer. With the new target therapies and with immunotherapy we have gained time against the disease, a time now several years long, which those directly concerned manage to spend well, with few side effects ». To better understand the innovations that emerged at the Esmo 2022 conference, it must be remembered that lung neoplasms are divided into non-small cell carcinomas (about 80-85% of the total) e small cell carcinomas.
Progress in operable patients
‘Updated results from the phase three ADAURA study of 682 participants showed that osimertinib produced a clinically significant and sustained improvement in disease-free survival compared to placebo in the adjuvant (postoperative) treatment of patients with non-small cell lung cancer in early stage (IB, II and IIIA) presenting mutations in the epidermal growth factor receptor (EGFR) following radical resection – says De Marinis -. These patients, in the initial stage, after the operation they were candidates for chemotherapy to prevent possible relapses, with unsatisfactory results. Nearly half of the patients who are diagnosed with stage IB and three-quarters of those with stage IIIA will relapse within five years. Today we are in the third generation of drugs for EGFRR-mutated patients and the results of this trial indicate the advantages of taking daily a tablet drug (osimertinib, in fact) for three years: the risk of recurrence or death is reduced by 77% compared to those on chemo or placebo and disease-free survival is about five and a half years (65.8 months) for those taking this drug, compared to nearly two years. In addition, over time, osimertinib reduces the risk of central nervous system recurrence. These are truly significant data and define a new standard of care, in the face of excellent tolerability (the most frequent side effects are, in the first months of treatment, acne, diarrhea and chronic fatigue, but overall the quality of life is optimal) “. A few days ago this strategy got the green light also in our country: the Italian Medicines Agency (Aifa) approved the reimbursement osimertinib as an adjuvant treatment of early stage non-small cell lung cancer (IB-IIIA) with EGFR mutations.
Metastatic patients: one in five alive at five years
Long-term survival becomes a reality even for those with metastatic neoplasia, as indicated by the results of two trials (KEYNOTE-189 and KEYNOTE-407) which highlighted the advantages obtained by combination of an immunotherapy drug (pembrolizumab) with chemotherapy in the first-line treatment of non-small cell carcinoma, both squamous and non-squamous type. “Before these fundamental studies, lung cancer had a five-year survival rate of 10%, one of the lowest,” he comments. Marina Garassino, professor of medicine and pulmonary oncology specialist at the University of Chicago, principal investigator of the KEYNOTE-189 study -. These results show significant improvements in the five-year survival of patients treated with pembrolizumab plus chemo and confirm the important role of these pembrolizumab-based regimens as a standard of care in metastatic non-small cell lung cancer. ‘ The data of the KEYNOTE-189 study show, in patients with non-squamous type, that with pembrolizumab plus pemetrexed and platinum-based chemotherapy (cisplatin or carboplatin) an overall five-year survival rate of 19.4% is achieved compared to 11 , 3% with chemotherapy alone, the risk of death is reduced by 40% and the overall survival has more than doubled compared to chemotherapy alone (22 months compared to 10.6 months) “. In patients with metastatic non-small cell squamous cell carcinoma, the results of the KEYNOTE-407 study indicate a five-year overall survival rate of 18.4% with pembrolizumab plus carboplatin-paclitaxel or nab-paclitaxel compared to 9.7%. with chemotherapy alone. The risk of death is reduced by 29% and median overall survival appears to be 17.2 months in the pembrolizumab and chemotherapy group compared to 11.6 months with chemo alone. “It significantly improves overall survival at five years, doubling it compared to chemotherapy alone: timmunochemotherapeutic treatment thus confirms itself as a cornerstone of first-line therapy lung cancer, “he explains Silvia NovelloProfessor of Medical Oncology at the University of Turin and Head of Pulmonary Oncology at the San Luigi Gonzaga Hospital in Orbassano.
Levels of sodium in the blood
The fight against the most serious cases can also include the analysis of low sodium levels in the blood: a process called hyponatremia (i.e. a sodium concentration lower than 135 mEq / l), which represents one of the main electrolyte alterations found in clinical oncological practice. This is indicated by an Italian study presented at the Parisian conference by Rossana Berardi, Full Professor of Oncology at the Polytechnic University of Marche and director of the Oncology Clinic of Ancona. “Already several scientific evidences testify how hyponatremia is responsible for an increase in morbidity (or a series of diseases associated with cancer) and mortality for cancer patients – concludes Berardi, member of the national board of the Italian Association of Medical Oncology (Aiom) -. It is also linked to one longer duration of hospital stays and associated costs. Our preliminary data allowed to identify a group of 12 different miRNAs (small segments of RNA involved in the regulation of the gene expression of the cells of our organism) expressed in the tumor samples of 10 eunatremic patients (with normal blood sodium concentrations) compared to ten hyponatremics. It was then observed that some downregulated miRNAs (expressed in lower concentrations) are associated with a worse survival, while others upregulated (expressed in a greater extent) are instead correlated with a better overall survival ». A small step forward in understanding these mechanisms, with data that now need to be validated on a larger sample of patients in order to exploit hyponatremia and arrive at effective biomarkers, already in the early stages of the disease, in predicting response to treatments and prognosis of patients.
September 13, 2022 (change September 13, 2022 | 17:30)
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