2023-09-06 16:55:31
by Health Editor
A new post-surgery drug, reimbursed and also available in Italy, can significantly reduce the risk of recurrence in patients with early stage cancer
Also available in Italy is a new therapy that manages to reduce the risk of recurrence and death by more than 50% in patients with early-stage lung cancer: the Italian Medicines Agency (AIFA) has in fact granted reimbursement to atezolizumab , anti-PD-L1 monoclonal antibody, in the adjuvant (ie post-operative) phase for the treatment of stage II-IIIA non-small cell lung cancer. In short, one can aspire to healing
The tumor
Every day in Italy about 115 people discover they have lung cancer (for a total of almost 44 thousand new cases registered in 2022), which remains a fearsome big killer because more than 70% of patients arrive at diagnosis late, when the disease is already in an advanced stage and unfortunately the chances of healing are reduced. The neoplasm, in fact, does not show clear signs of its presence at the outset and when it does it generally already progresses in the metastatic phase, when things get complicated, the treatments are more complex and the chances of recovery decrease, even if different therapies are available today innovative technologies that manage to significantly prolong the survival of the sick.
New perspectives for those in the early stages
The novelty concerns that 30% of patients who discover the disease in the initial phase and for whom immunotherapy after surgery opens up new perspectives. The Italian approval of atezolizumab, which follows last year’s European approval, is based on the results of the IMpower010 phase III (multicenter and randomized) study, the results of which demonstrated that treatment with atezolizumab in the adjuvant setting, after complete resection and chemotherapy at platinum-based, reduced the risk of disease recurrence or death by 57% in patients with stage II-IIIA non-small cell lung cancer, with high PD-L1 expression and in the absence of EGFR mutations or ALK, compared to best supportive care.
Healing Goal
In the face of a high relapse rate, with approximately 60% of stage II and 75% of stage III patients relapsing five years after surgery, managing this patient group was still a challenge still open for researchers and clinicians. Recurrence is a frequent event even for completely resected early stage patients and a difficult moment in the course of treatment – declares Silvia Novello, Full Professor of Medical Oncology at the University of Turin and president of WALCE Onlus -. With the aim of making these stages of the disease truly curable, the research aims at reducing the percentage of recurrences, always respecting the patient’s quality of life. Immunotherapy has proved to be an excellent means of achieving this goal. Having atezolizumab innovation now available as the first approved adjuvant immunotherapy helps significantly reduce the risk of recurrence and broaden patient care prospects. In this context, it is essential that the optimal management of the patients takes place by a multidisciplinary team that includes several experts (including surgeon, oncologist, pathologist, radiotherapist, pulmonologist, psychologist) and meets to evaluate the situation and guarantee the choice of the best treatment.
Different procedures after surgery
Currently radiologists, nuclear physicians, interventional pulmonologists and thoracic surgeons evaluate the operability or otherwise of non-small cell lung cancers in the early stages, considering that surgery with curative intent is now the standard treatment option for a better prognosis – explains Filippo de Marinis, director of the Thoracic Oncology Division of the European Institute of Oncology (IEO) in Milan and president of the Italian Thoracic Oncology Association (Aiot) –. After surgery, the pathologist identifies the stage of the resected disease which guides the indication for any adjuvant chemotherapy treatments. With the reimbursement of atezolizumab, the pathologist can perform PD-L1 testing. If overexpression of PD-L1 is present, in selected pathological stages II-III, immunotherapy can be practiced after 2 months of standard chemotherapy for 1 year. This option reduces the risk of death by more than 58% and increases 5-year survival by 18% compared to chemo alone. The indication therefore requires an update of the treatment strategy and the path of the lung cancer patient with a key role played by the various figures of the multidisciplinary team, including the surgeon, who will have to include this new step in the diagnostic path to evaluate the eligibility of the patient to treatment.
More experts to better evaluate each individual case
In the treatment of patients with early stage lung cancer, the Lung Unit (Pulmonary Unit, following the example of the Breast Units already present for breast cancer) assumes an increasingly central role, which contributes to taking charge of the patient, so that the feasibility of adjuvant therapy can be immediately assessed – underlines Federico Rea, director of Thoracic Surgery and Lung Transplant Center of the University Hospital of Padua -. Today, the path of these patients in fact provides for an integration of treatments and an update of the diagnostic path for the execution of PD-L1, EGFR and ALK tests. The novelty of atezolizumab marks a change of pace, as demonstrated by clinical studies whereby adjuvant immunotherapy allows more effective results, regardless of the type of surgery performed on the patient, while at the same time presenting better drug tolerability than chemotherapy alone . The impact of recurrences in oncology is also significant in organizational terms for the Healthcare System and being able to reduce the rate of disease recurrence brings benefits primarily for patients but also for the System from a sustainability perspective concludes Saverio Cinieri, National President of AIOM ( Italian Association of Medical Oncology).
September 6, 2023 (change September 6, 2023 | 16:55)
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