“Paradoxically” the availability of targeted therapies against some types of cancer, such as ovarian cancer, are not actually accessible because “there is no access to molecular testing” to identify people sensitive to the treatment. On this “it is precisely the culture that must change. In the approval of these treatments, unfortunately, in some regions, since a biomarker is not considered mandatory, there is “de facto” no access to the drug” which, however, “enters the Lea”, essential levels of assistance, “because it is considered obligatory. There would need to be a coupling between the test and the drug.” This was explained by Umberto Malapelle, Associate Professor, Director of the Laboratory of Predictive Molecular Pathology, Department of Public Health, University of Naples Federico II, in the Neapolitan capital, participating in the event ‘Ovarian cancer in Campania: Let’s change course’, organized with the patronage of ACTO Campania, Alliance against ovarian cancer, and the sponsorship of GSK, dedicated to the virtuous example of the Region.
“This decoupling between test and drug – continues Malapelle – has caused an impasse in access to treatment over the last 18 years due to the lack of approval” of the research “of the marker attached to that treatment. Fortunately, the Campania Region, despite all the difficulties, has succeeded in coordinating the oncology network and in forming a cultural common sense on the importance of genomic testing. It was an important effort at a regional level, but it is an example of how the will of the people, in a Region, was able to reverse the trend for access to the test”, eliminating “the bottleneck for access to treatment ”.
In ovarian cancer, as in inherited tumors, the genomic and genetic profile can make a big difference in terms of treatment, prevention and prognosis. “The first big difference between a genomic profile and a genetic profile is that the genomic profile belongs exclusively to the tumor – clarifies the professor – the genetic one can be transmitted to the family. Intercepting a genetic alteration in a genomic analysis identifies two different paths. The first has a predictive value, we want to find, with a genomic alteration, that category of patients who will be able to obtain the most benefit from a certain type of treatment. Instead, in the genetic part, the path is preventive: it involves identifying a mutation that gives you the possibility of preventing the development of cancer in that patient’s family.”
“Before the genomic profile – warns Malapelle – there is the morphological characterization”. This step opens the way to the prescriptive appropriateness of the genomic test. In the context of patients with ovarian cancer”. With “genomic profiling, mechanisms are identified that determine “an instability that makes the tumor component more ready to respond to molecularly targeted drugs” such as PARP inhibitors, an “extremely effective therapy – he concludes – which maximizes the response and minimizes the effects collateral”.
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