Taking charge in the Breast Unit right from diagnosis and therapy before the scalpel help to identify the most suitable treatment path for each patient
When breast cancer is diagnosed, everyone’s desire is to rush to the surgeon and get rid of it. Now it is clear that at least in the case of HER2 positive cancer in the initial phase it would be better to undergo a neo-adjuvant therapy, that is to take drugs directed against the HER2 protein, hyper-expressed by the neoplasm, before surgery: the response to therapy in fact ‘predicts’ the likelihood of relapse and therefore can better target subsequent treatments, reserving a different path for high-risk women. However, this must be decided by a multidisciplinary team, because only in this way can each one be addressed to a truly personalized intervention, which takes into account all aspects of the disease.
Therapy before surgery
Early stage HER2 + cancer affects around 8,000 women each year and accounts for around 15-20 percent of new diagnoses; positivity to the HER2 protein is not good news, because it is a receptor that stimulates cell growth and division and therefore makes the tumor more aggressive. Two new researches now indicate the most appropriate treatment pathways for different types of patients, at more or less high risk of relapse. The Katherine study, for example, was conducted on women undergoing neo-adjuvant therapy with anti-HER2 drugs (trastuzumab) who despite this had a residual disease, therefore they were at high risk of relapse: in these women it has been shown that the use of trastuzumab-emtansine, which is the antibody associated with a chemotherapy drug, reduces the risk of relapse or death by 55 percent compared to trastuzumab alone. “Subjecting the majority of women with HER2 positive cancer to neo-adjuvant therapy and assessing the response means understanding before surgery if the tumor is more or less sensitive and therefore if it will regress more or less completely”, explains Lucia Del Mastro, coordinator of Breast Unit of the IRCCS San Martino Polyclinic Hospital in Genoa. «If after neo-adjuvant therapy there is a residual disease, the risk of metastasis is high, but this is reduced by using the conjugated monoclonal antibody trastuzumab-emtansine, which carries the chemotherapy directly on the tumor cells. The response to neo-adjuvant therapy can therefore act as a ‘guide’ to treatment, but today it is offered only to 38 percent of patients, much less than what happens in other countries “.
Team multidisciplinari
However, there is also positive news for patients who did not receive therapy before surgery: the Aphinity study has shown that in these women the combination of trastuzumab with another anti-HER2 drug, pertuzumab, can reduce the risk of relapses by 28 percent. In short, it is possible to identify the most suitable and effective pathways for the various patients, but to do so, the collaboration of the various doctors present in the multidisciplinary teams, those found in the Breast Units, is needed: it is no coincidence that the women followed by these centers have a 18 percent higher survival rate. As Viviana Enrica Galimberti, director of the Surgical Breast Surgery Division of the European Institute of Oncology in Milan, observes, “In the multidisciplinary teams oncologist, surgeon, anatomopathologist, radiologist and all the professionals involved in the treatment discuss each case to establish from time to time the more effective approach: teamwork that must begin as soon as possible on each case, because in this way the patient’s path will be personalized in each step and therefore also effective ». Given the availability of an increasing number of therapies with specific targets, identifying the right ones becomes more and more essential: also for this reason the anatomy-pathologist is indispensable now more than ever, because as explained by Caterina Marchiò, professor of Pathological Anatomy of ‘University of Turin, “It is no longer just a question of characterizing the tumor at the time of diagnosis, but also of assessing the extent of the pathological response before and after surgery, to predict the prognosis and direct therapies: only in this way is it possible to true personalization of the treatment “.
October 21, 2021 (change October 25, 2021 | 13:24)
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