Today, specialists have more and more precise information on the various tumor subgroups and are able to exploit targeted drugs that are effective in different cases
Although breast cancer is among those with the best survival rates, so much so that nine out of ten women in Italy are alive five years after diagnosis, new effective treatment strategies are needed. In fact, this neoplasm remains not only the most widespread among women in our country (in 2020 they were identified 55 thousand new cases and estimated at about 37 thousand Italians living with a metastatic form), but also the leading cause of cancer death. A sad record due to the high frequency of breast cancer, the particular aggressiveness of some subtypes and also the possibility of having relapses after many years. Thanks to scientific research, however, the opportunities for treatment and healing are increasingly widening as emerges from the national conference “Focus on breast cancer” organized in Udine.
Liquid biopsy and DNA alterations for precise diagnoses
“Breast neoplasms well reflect the advances in diagnosis and therapies that have occurred in oncology in recent years – underlines Fabio Puglisi, director of the Department of Medical Oncology at the IRCCS CRO in Aviano and scientific director of the congress -. We are living in an era in which scientific evolution is extremely rapid. There is therefore a need to extricate oneself in a more favorable situation for patients, but also with greater complexities to manage. Today we are able to have much more biological information on the various subtypes of carcinomas and thus new avenues for drug development are opening up.. Close collaboration between the various specialists and also between clinicians and experimental oncologists is very important. Innovative strategies are also emerging in which it is essential to invest resources to implement the possibilities of healing. This is the case with the liquid biopsy, a non-invasive procedure that allows us a more precise diagnosis of the molecular nature of the carcinoma through the identification of alterations present in the DNA. Thanks to the advancement of technology an additional resource is artificial intelligence which, when used in oncology, can give us a quid more to achieve better results than in the more recent past ».
With genomic testing, unnecessary therapies are avoided
Today in Italy, women living with a diagnosis of breast cancer are 834.200. Overweight or obesity, smoking, excessive alcohol consumption, sedentary lifestyle (those who exercise regularly are much less likely to get sick). And then there is the familiarity: Those with first degree relatives (mothers, grandmothers, aunts, sisters) who have developed breast cancer are more likely to get sick. Finally, genetics: there are genetic variants, for example the BRCA1 and BRCA2 genes, which greatly increase the risk of getting sick. Knowing precisely the specific subtype of carcinoma from which the individual patient suffers (although very rarely the neoplasm also affects males) is decisive for establishing the most correct therapeutic procedure, to avoid as much as possible both the occurrence of a relapse and the use of strategies that are too “heavy” in those who have a not very aggressive form. Genomic tests that allow you to save unnecessary chemo, made reimbursable in all regions after more than a year from its introduction in our country, go from this point of view. «They are easy to perform exams that have undoubted advantages – he clarifies Saverio Cinieri, president of the Italian Medical Oncology Association (Aiom) -. They allow better selection of adjuvant therapy and therefore the choice, or not, of chemotherapy in addition to anti-hormonal treatment in the disease with positive hormone receptors. It is one of the hottest topics in recent years, also because the real free availability, for all patients throughout Italy, has been postponed several times due to bureaucratic-administrative problems and delays. From a strictly scientific point of view genomic testing must be part of daily clinical practice because I contribute to improving the lives of patients and allow the health system to save money ».
The therapeutic armamentarium is growing
At the Friulian meeting, the participants also discussed the latest therapies introduced in 2021. “It has been a year full of innovations for the treatment of breast cancer – he says. Michelino De Laurentiis, director of the Senology and Thoraco-Pulmonary Department of the Tumor Institute of Naples -. Among these, it should be noted adjuvant therapy with anti-hormonal agents and cyclin-dependent kinase inhibitor (abemaciclib, a treatment that is not yet reimbursed in Italy). Important data were also obtained in increasing the survival of metastatic carcinoma: the drug Ribociclib in association with the aromatase inhibitor Letrozole has proved to be a winning combination in some sub-groups of patients with so-called “luminal” carcinoma, where an unprecedented figure is recorded: 60 months median survival“. Finally, encouraging signs are also arriving in the context of triple negative breast cancer which is by far the most aggressive form of cancer. “We have encouraging news coming fromimmunoterapia — conclude Lucia Del Mastro, coordinator of the Breast Unit of the IRCCS San Martino di Genova -. After being used in the treatment of melanoma and other cancers, she is also showing its potential in both advanced and early stage breast cancer. In addition to the data we already knew on atezolizumab, new ones on pembrolizumab are added. Regarding advanced HER2 positive disease excellent results are those relating to the use of the immunoconjugate trastuzumab-deruxtecan. It is a very effective treatment that uses an antibody to which chemotherapy binds, which is conveyed directly to the tumor site where it is released, facilitating greater activity and limiting toxicity. Another important change is that relating totyrosine kinase inhibitor tucatinib in combination with trastuzumab and capecitabine. The combination of the three drugs has shown good efficacy in the treatment of patients with brain metastases from HER2-positive carcinoma ».
February 18, 2022 (change February 18, 2022 | 09:38)
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