The Italian College of primary hospital medical oncologists: «Underused genomic tests and serious regional disparities. The establishment of the Molecular Tumor Boards (MTB) is late, present only in 13 Regions”
Which region you go to, genomic tests (and innovative treatments) you find. Little or nothing has changed in the way patients access innovative cancer therapies, despite the fact that they have multiplied in recent years and represent the future. Paradoxically, the progress achieved with genomic profiling tests capable of analyzing the entire human genome (Next Generation sequencing, NGS) and with the establishment of teams of experts dedicated to the clinical interpretation of this new data (Molecular Tumor Board), it has significantly widened disparities in access.
In fact, only in half of the cases patients are offered tests based on NGS techniques, e.g the interdisciplinary teams now indispensable for precision medicine are present in only 13 regionswith a great variability of organizational models.
Precision oncology, access to innovative treatments and humanization
These data, which emerged in a research conducted by the Italian College of primary hospital medical oncologists (Cipomo) with the contribution of Cergas SDA Bocconi, prompted the four main oncology scientific societies (Cipomo, Italian Association of Medical Oncology-Aiom, College of Medical Oncologists Universitari-Comu and Italian Society of Pathological Anatomy and Diagnostic Cytopathology-Siapec) to formulate 14 “recommendations” to make the availability of precision oncology homogeneous throughout the national territory. The document was also published in the prestigious journal of the American Oncology Association (Asco) JCO Precision Oncologyand it is one of the themes that have been at the center of the third edition of Cipomo Day in recent days.
«Combining precision oncology, access to innovative treatments and humanization represents the challenge of Italian oncologists for their patients today – comments Luisa Fioretto, president of Cipomo and director of the Oncology Department and SOC Medical Oncology, USL Toscana Centro Company -. The rapid technological development of molecular diagnostics and the availability of new drugs require increasingly frequent adjustments to clinical pathways and activities in oncology. If not governed, dynamics such as hyper-specialization and path fragmentation can interfere with the integration and continuity of careundermining the patient-doctor relationship and the social perception of the relevance of healthcare.”
The topic was also at the center of the recent Cipomo Day. «Cipomo Day offers the opportunity for a direct comparison between the experiences of all regional realities on a key theme, such as humanization, in which references to precision oncology, access to genomic tests and innovative treatments cannot be missing – explain the three presidents of the conference, Alessandro Follador (head doctor in Tolmezzo), Andrea Mambrini (head doctor in Massa Carrara) and Clementina Savastano (primary doctor in Salerno) —. In the round tables of the three regional macro-areas, critical aspects, organizational and management methods of oncology facilities will be discussed, in particular in reference to breast, lung and gastrointestinal cancers implemented to combine new therapeutic possibilities with quality of life and with the psychological, emotional, spiritual, relational and social dimension.”
During the event the experts discussed the 14 key points, useful guidelines to iron out inequalities in access to oncology
of precision and regional differences, with the presidents of the North, Center and South of Cipomo. «This is in fact an objective that cannot ignore the possibility of accessing NGS technologies and the expertise of a Molecular Tumor Board, regardless of geographical position» underlines Gianpiero Fasola, director of the Oncology Area department of the Friuli Centrale University Health Authority and first author of the paper.
In the work just published, in fact, it is highlighted the need, not only to increase the number and homogeneous distribution of Molecular Tumor Boards, but also to standardize the procedures, composition, skills and prerogatives of these multidisciplinary groups. «It is useful that the composition of the Molecular Tumor Boards is functional and reasonably agile, while taking into account the different contexts. Our experience also stands out the important role of the figure of a project managerdedicated to the management and implementation of organizational innovation”, highlights Fasola. As well as expanding access to genomic testingexperts recommend relying on tests that analyze panels of genes (between 20 and 50) sufficient to satisfy first-level diagnostic needs, as established by the guidelines.
Flexibility and innovation
«Larger panels could offer redundant, inadequate and confusing information, especially in the absence or lack of professionals capable of correctly interpreting the results – underlines Luigi Cavanna, past president of Cipomo and head of oncology at the Piacenza nursing home -. At the same time you need to maintain a certain flexibility to keep up with innovation. For this reason, the first level diagnostic panels should be updated periodically by professionals identified at regional level according to the coordination model developed”.
The document also specifies that, in cases where there is a need to carry out advanced analyses, which require large panels (greater than 50 biomarkers), these should be performed by a limited number of qualified operators and high-volume laboratories identified by national health authorities. «It is also important, and cited in one of the 14 statements, the creation of a national coordination group for activities relating to precision oncology with the aim of analyzing the functioning of the different models adopted and supporting the institutions in defining the guidelines – concludes President Fioretto -. We must ensure that precision oncology and equal access to the best treatments do not remain abstract concepts, but become a reality in daily clinical practice.”
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November 30, 2023 (modified November 30, 2023 | 07:23)
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