During the next congress of the American Society of Clinical Oncology, which officially opens on June 4, 2021, an Italian oncologist will receive one of the most important scientific awards: the BJ Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology awarded to personalities who have globally distinguished in the research, diagnosis and treatment of cancer in the elderly. What the Asco (American Society of Clinical Oncology) tribute to Cesare Gridelli is “the deserved recognition for his exceptional work and his dedication to scientific research and care with the aim of improving the life of those who, in old age, find themselves having to face a diagnosis of cancer at lungs »reads the motivations.
From Naples to the highest international levels
«At the beginning of my career, in the late nineties, a patient was considered ‘old’ at 65 and the lung cancer therapies available at the time were too heavy for most patients to bear – says Gridelli -. We could only give them pain-relieving and palliative care: this is why I committed myself to looking for better alternatives to offer to people with “gray hair”, who were then and still are the majority of cancer patients “. Born in Naples, Gridelli has never left Campania, except for those periods of study and professional improvement abroad that all the best doctors have in their curriculum: he graduated in Medicine and Surgery at the Federico II University of Naples in 1985, he specialized in Oncology and then in Internal Medicine in the same university, he worked at the National Cancer Institute Pascale and since 2001 he has directed the Medical Oncology of the Moscati Hospital of Avellino. He is the author of more than 750 publications in Italian and foreign scientific journals and is considered, both nationally and internationally, one of the leading experts in the field of lung cancer, especially in old age.
Finding effective treatments for those who only had palliatives
With about 41 thousand new cases every year, lung cancer is still the leading cause of cancer death in Italy and the third most frequent malignancy in the population. It is mainly the fault of smoking, which alone is responsible for more than eight out of ten cases. «It is one of the most widespread and most aggressive cancers – recalls the specialist -. And if in most patients the prognosis remains severe, also due to the late discovery of the disease, scientific research has made important steps forward, earning a lot in terms of quantity and quality of life. When I started dealing with this neoplasm, about 30 years ago, the standard cure was cisplatin-based chemotherapy, very toxic and with too many side effects to endure for those who already had many ailments typical of “old age”. In those years at Pascale I started a journey, also inspired by the collaboration with Silvio Monfardini, one of the leading experts in the world of geriatric oncology who, not surprisingly, also preceded me in winning the Kennedy prize in Asco ».
In 1997 the first studio of its kind in the world
Gridelli’s first major success came in 1997 when his phase three study was published evaluating a new treatment option for patients over 70 with advanced stage non-small cell lung cancer (the most common type): a only chemotherapy drug, vinorelbine, was well tolerated and proved to be active. «It was the first study in the world of its kind dedicated to the elderly with lung cancer – explains Gridelli – only a dozen Italian centers participated. Then, given the promising outcomes, the phase three ELVIS study was opened, to which over 40 Italian hospitals joined, and we were able to demonstrate that this option had few side effects and improved the lives of patients, who experienced less pain and dyspnea and that therefore they also lived a little longer than the standard then (which was the only supportive therapy). This trial was once again “a world first”: never before had anyone had the quality of life of the sick as their main objective “. It was also the beginning of a long journey always in the same direction, the one on which the oncologist is proceeding today, thanks to the development of new drugs: “Before we experimented with different chemotherapy drugs, such as the dreaded cisplatin (but at attenuated doses, better tolerated but still active) and carboplatin, then molecular targeting drugs and, in recent years, immunotherapy have arrived. With different mechanisms of action and with greater efficacy, the objectives remain unchanged: to slow down the progression of advanced cancer, to gain months or years so that patients can live well “.
Challenges in today’s elderly patients
In the last quarter of a century, not only the treatments available for this type of cancer have changed, but the way we evaluate patients has also changed. The numbers speak for themselves and cancer remains a typical age of advancing age (6 out of 10 patients are over 65), but today those over 75 are considered elderly. «The real challenge is to get the message across that, in front of a patient, we must look at his biological age and not his chronological one – concludes Gridelli -. In short, it is necessary to decide the therapies based on the general state of health of the person and not just looking at how old he is: you have to evaluate the other diseases that may be present, what other therapies he follows, if he leads an active life, if he is autonomous, the analyzes to evaluate the functionality of the organs (primarily kidneys and heart) if he lives alone and so on. And to do this we need simple and quick tools that we are trying to develop, so that they are available in all departments: a sort of quick test that frames the person as a whole and helps the oncologist to prescribe the most suitable therapy. And for the treatments to be “adequate” it is necessary that the trials leading to the approval of new drugs are also conducted on elderly patients, who are still largely excluded today: 30 years ago mainly patients were recruited up to 65 years old, today we include a little more, up to around 70-75, but the over 80s are still out ».
June 1, 2021 (change June 1, 2021 | 20:16)
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