Italian and international experts in comparison on medicines that have a super-precise target to hit and which, when indicated, can be extremely useful for improving survival
The goal of the precision medicine it is already a reality for many patients with cancer: finding the most effective cure in each individual case, cutting it out on the basis of the characteristics of the specific neoplasm a person suffers, is a possibility for which one in four patients is now a candidate for the new targeted therapies . On the one hand, scientific research increasingly pushes towards precision medicine, which finds its basis in the study of alterations of single genes within cancer cells in order to find a possible therapeutic target, on the other hand, some critical issues remain in Italy to be overcome. This was discussed by leading Italian and international experts during the international conference «Italian summit on precision medicine»Promoted in recent days by the Foundation for personalized medicine.
New paradigm in cancer treatment
If until a few years ago the type of tumor was associated with an organ, now a new paradigm has imposed itself. Advances in research have helped to greatly improve knowledge of biological characteristics of cancer, which allow to identify the alterations of the molecular mechanisms underlying the abnormal behavior of the tumor cell. And this made it possible the identification of new molecular targets which have favored the development of new target therapies, defined precisely as molecular target. “In Italy, the methods of access to extensive identification tests of many alterations at the same time (genomic profiling) are not yet defined in a uniform manner throughout the national territory, as they are not yet included among those provided for by the Lea, i.e. the essential levels of assistance – he explains Paolo Marchetti, president of the Foundation and full professor of Oncology at Sapienza University of Rome -. These diagnostic investigations, indispensable, as required by the Italian Medicines Agency (Aifa, the regulatory body for the use of drugs in our country), for example to be able to use some recently approved drugs regardless of the location of the tumor (following agnostic approval) are only available in some large research institutions. An inevitable consequence is the possible disparity of therapeutic opportunities among citizens ”.
Why Molecular Tumor Boards are indispensable
According to recent estimates, with molecular analyzes every year 20,600 patients with specific types of cancer can access the most suitable therapy. In Italy, however, only 2% of the tests are performed with the most advanced technology. “Knowing the DNA mutations present in a patient’s neoplasm, the molecular characteristics of a single tumor, is therefore essential to guide therapeutic choices: target therapy, in fact, they can only be used if the presence of specific markers is detected in the tumor cells (or, in some cases, in the blood or in other biological samples taken from the patient) – underlines Giuseppe Curigliano, president of the congress, full professor of Oncology at the University of Milan and primary at the European Institute of Oncology -. To make the new precision oncology model effective, however, the Molecular Tumor Boards, indispensable for interpreting the results of molecular tests and choosing the best therapy, must be made operational throughout the national territory. We must as soon as possible the characteristics of the regional Molecular Tumor Board which must identify, in agreement with the multidisciplinary group of the individual healthcare structures, the best therapy for a given patient based on his or her genomic mutation profile. To date, only nine Regions have deliberated on this issue. Finally, we must identify the ways in which it is possible to make available target drugs that may be identified and not yet available outside of clinical trials “.
From the interventions at the conference it emerges that for a real, equitable and universal application of precision oncology, a new clinical and management path is necessary that also includes the real taking in charge of the patient by a group composed of several experts. «The extraordinary opportunity offered to patients by precision oncology requires multidisciplinary groups with the pathologist, the geneticist, the molecular biologist as well as the oncologist, the surgeon and the radiotherapist, who know how to identify in the presence of many variables which is the best treatment for the individual patient at that time – adds Marchetti -. Precision oncology also means using increasingly advanced tests capable of recognizing hundreds or thousands of alterations from solid biopsies or blood sampling to understand some resistance mechanisms. To accomplish all this it is essential to combine the availability of genomic tests and drugs with new organizational paths. It should not be the patient or his family who understand if these methods are useful for a particular patient, but the multidisciplinary group that is in charge of the patient within the regional oncology network. Unfortunately, in many Regions the oncological networks are not yet functioning, with the consequent unacceptable inequality of access to these paths in our country “.
Advantages for patients and NHS
The availability of access to the profiling test, once extended to all Regions, would allow both the use of the most effective therapy available for the individual patient, and an advantage in terms of expenditure for the National Health Service, avoiding the use of less effective treatment with related costs. It is not just a question of equality of care for all patients, but also of optimization of economic resources. «The genomic approach to oncological diseases will implement precision medicine in the diagnosis, treatment and prevention of tumors – concludes Curigliano -. And this, as underlined by economic sustainability analyzes, will allow for customize treatments and to save economic resources. The synergy between basic research, clinical, regulatory bodies and patients will be the key to implementing this approach in Italy “.
November 15, 2021 (change November 15, 2021 | 19:34)
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