Patient access to agnostic therapies begins with the execution of a genomic profiling test, continues with the interpretation of the data, to arrive at the therapeutic choice
My father was diagnosed with lung cancer. I’ve heard of new “agnostic” drugs, what are they?
He answers Joseph CuriglianoDirector of the New Drug Development Division for Innovative Therapies, European Institute of Oncology, Milan
“Agnostic” drugs are the new era of cancer therapy. They get their name from a Greek term meaning “without knowing,” which is also an indication of how these new drugs work: they do not affect a single type of tumor, as most current medicines do, but they target a group of mutated genespotentially responsible for the development of the disease. These are “ubiquitous” genes, that is, they are common to various tumors, regardless of the organ in which they originate. Patient access to agnostic therapies begins with the execution of a genomic profiling test, continues with the interpretation of the data, to arrive at the therapeutic choice. The key point of the new process is represented by genomic profiling, i.e. the identification of alterations that play a fundamental role in the development of neoplasms: for this reason it is important that genomic tests are carried out, carefully selecting the patients for whom to do them. Let me explain: today we know that some solid tumors (for example those of the non-small cell lung, the papillaries of the thyroid, some subtypes of the ovary, pancreas and salivary glands) are characterized by the presence of mutated RET genes.
Good results
“Agnostic” drugs have proven to be able to effectively block the action of this range of genes: they thus make it possible to treat more neoplasms, therefore also more patients, guaranteeing them innovative, latest generation therapies with proven benefits. Among these therapies praseltinibalready in use for specific lung cancers, performs a positive action on tumors with mutated or amplified RET genes: your father may also be a candidate if his specific carcinoma falls within the characteristics described. The still preliminary, but promising data we have gathered from a study leads us to have confidence in these drugs: well over half of patients with RET-mutated solid tumors treated with praseltinib had a complete response to therapy and in the remainder the disease partially regressed. We were thus able to effectively control the pathology in a high percentage of patients, around 83%: a very interesting figure if we consider that these results have been maintained over time, the tumor has not progressed and survival increased by about one year on average.
Mutated genes
The result is even more relevant considering that RET tumors are usually difficult to treat because they are often refractory (unresponsive) to many traditional therapies. In the United States, then, the regulatory body (i.e. the Food and drug administration, FDA) has provided a fast-track approval for selpercatinib for adult patients with solid tumors who have molecular abnormalities of RET. This information on the effectiveness of “genetic target” drugs, such as agnostic ones, will be increasingly valuable for treatments truly personalized on the gene profile of the single type of cancer and therefore more effective. And the choice of therapy can be supported by genetic tests, i.e. which estimate the potential probabilities of developing the disease in relation to the presence of specific mutated genes, to be performed in selected patients with important risk factors. Therefore, if your father was asked for a genetic test, it is important to perform it to better target the cure.
July 6, 2023 (change July 6, 2023 | 10:00)
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