Lung tumors, in Puglia over 2,200 new cases per year

Every year in the Puglia Region, over 2,200 new cases of lung cancer are recorded, one of the neoplasms with the greatest social and health impact. In total, in Italy, only 117,800 people live after a diagnosis. The net five-year survival rate is 16% for men and 23% for women. Cigarette smoking is the main risk factor for the onset and is responsible for 85%-90% of the cases observed in our country. Today, thanks to the progress of scientific research, it is possible to obtain numerous and important information on the molecular characteristics of the individual tumor. Multiple molecular targets have been identified and this has led to the development of therapies capable of acting in a targeted manner (target therapy). Another important innovation is represented by immunotherapy, which is based on the activation of the immune system towards tumor cells. The prospects opened up by these therapeutic approaches are at the center of the “Excellence in Lung Cancer” conference, which opens today in Bari and which sees the participation of over 70 of the top national experts in one of the most feared oncological diseases.

“The pathology is divided into two subgroups – he underlines Domenico Galetta, from the IRCCS John Paul II Cancer Institute in Bari – There is small cell carcinoma (or microcytoma) which alone represents 15% of cases and in which, except in cases diagnosed at a very early stage, surgery is not indicated. This type of neoplasia is characterized by small cells, which under the microscope take on the typical appearance of an oat grain. Non-small cell carcinoma (NSCLC), which represents approximately 85% of lung cancer cases, includes an increasingly growing share of tumors characterized by a molecular alteration, which can be treated with targeted therapies. For some years, the Puglia Region has equipped itself with a Diagnostic Therapeutic Assistance Pathway (Pdta) for the management of all forms of lung cancer. Shared rules have been established and methods and times have been defined to take charge of patients promptly and effectively. There are some aspects to improve, including strengthening the network of specialized centers that operate in a Region that covers a very large territory, over 400 kilometers. In particular, the regional hub, represented by the Giovanni Paolo II Cancer Institute in Bari, is a first-level healthcare facility, where over 40 experimental clinical trials are active”.

“Excellence in lung cancer” hosted in Bari, is the first of three national events in which experts will discuss the most recent therapeutic innovations introduced for the treatment of lung cancer and the results they are bringing. “Two of the most important therapies in recent years have been the introduction of Atezolizumab and Alectinib – adds Cesare Gridelli, from the San Giuseppe Moscati Hospital in Avellino – In the first-line treatment of extensive-stage small cell lung cancer, the standard of care is chemo-immunotherapy. The Imbrella A extension study demonstrated for the first time the possibility of obtaining a durable five-year survival benefit with Atezolizumab, an immunotherapy drug approved for this indication, in combination with Ce (carboplatin and etoposide). This benefit was observed in cases of extensive small cell lung cancer, where a five-year survival rate of 12% was recorded. This is encouraging data and the next challenge will be to be able to identify, with greater precision, which patients can benefit from the treatment. Recently, the European Medicines Agency (EMA) has made Atezolizumab therapy available also in the subcutaneous formulation, an innovative administration method that allows for more personalized management and therefore an optimization of the treatment pathway”.

Important milestones have also been achieved thanks to molecular targeted therapies, particularly in Alk fusion-positive NSCLC. “Alectinib is the first targeted therapy that offers a therapeutic opportunity even for patients diagnosed in the early stage after surgery, reducing the risk of disease recurrence by 76% compared to standard therapy, as demonstrated in the Alina study. For advanced-stage translocated Alk disease, Alectinib now represents a therapy with a consolidated experience in clinical practice, which confirms the efficacy data and the good tolerability and manageability profile that emerged in registration and real-world studies,” continues Galetta. “The greater knowledge in lung oncology leads us to a more extensive use of this molecule both in the treatment of advanced-stage translocated Alk disease and in the early phases, and all the data we have obtained so far lead us to think of a change of pace with good prospects for our patients.”

“The world of precision medicine and targeted therapies for lung cancer is set to grow,” says Silvia Novello, University of Turin Aou San Luigi Gonzaga, Orbassano -. The greatest challenge for this type of treatment will continue to be the study of resistance mechanisms in order to offer better opportunities to patients. As for immunotherapy, the real revolution has been its adoption in the early stages of the disease, both in the perioperative setting, that is, before and after surgery, and in the adjuvant setting – that is, after surgery. This type of treatment is part of a new scheme, which sees the combination and integration of the two types of treatments. Update events like this one that opens today in Bari are of fundamental importance because scientific innovations are many and pressing and constructive discussion between different specialists is now essential”.