Every year in Italy over 31 thousand new cases of cancer are linked to alterations in genes involved in the onset and development of neoplasms. For this reason it is necessary to adopt new technologies to perform genetic tests more efficiently, with a reduction in test execution times and less inconvenience for patients and their families. And it is necessary to improve the “personalization” of anti-tumor diagnostic and therapeutic tools. These are the themes at the center of the 4th Italian Summit On Precision Medicine, an event that opens today in Rome, with over 150 participants from all over Europe and the United States to discuss the future prospects of precision oncology and above all its application in the real world .
“Precision medicine is a surprising innovation and must change our approach to over 200 oncological diseases”, explains Paolo Marchetti, president of the Foundation for Personalized Medicine (Fmp), presenting the meeting.
“The impact of cancer is increasingly strong in the various national health systems”, underlines Marchetti. In Italy alone “it represents the second cause of death and 29% of all deaths. Overall it affects more than 3 million people who currently live after a diagnosis of cancer. If survival rates are improving it is also due to personalized medicine and precision. The identification of pathogenetic variants of some genes is important in all phases of the disease, from diagnosis to metastatic phases, without forgetting that some of these alterations can guide more effective and efficient prevention paths, often focusing high-cost investigations. in people at risk of disease onset due to the presence of specific genomic alterations”.
In short, in this way, adds the expert, “it is possible to obtain effective prevention with early therapeutic interventions and also a more accurate selection of therapies. It is now possible to combine better medical care with the guarantee of sustainability of health systems “. At the meeting in Rome “there are three most important innovations that we see and which will lead to a real revolution in the coming years”, continues Marchetti. The first concerns “the redesign of clinical trials also through the use of artificial intelligence. We are able to acquire and analyze an enormous amount of information to obtain new knowledge of the interactions between complex systems, on which to base new therapeutic opportunities”.
The second novelty, adds Giuseppe Curigliano, professor of medical oncology at the University of Milan, “is represented by conjugated antibody drugs. They have a mechanism of action that functions as a 'Trojan horse' in which the drug is linked to an antibody that recognizes selectively tumor cells. They are usually well tolerated therapies, and are used for very widespread pathologies. This is the case of breast cancer which alone represents a third of all female tumors. New clinical studies are focusing on the possibility of using new antibodies or on the combination of different anti-neoplastic drugs”. The last frontier of precision medicine, concludes Marchetti, “is the study of the interactions between 'complex systems'”. With new analysis systems, based on machine learning and artificial intelligence, further information may emerge to evaluate resistance mechanisms.
Immunotherapy, for example, “is often effective against complex pathologies such as melanoma, lung cancer or bladder cancer. In other cases, however, it proves useless: it can depend on many factors, including the role of the microbiota or the administration of other drugs for concomitant diseases would require ad hoc phase 3 studies, but it is impossible to conduct clinical research for every single variable. Even in this sector, help comes from artificial intelligence which will be able to bring out the various interfering factors”, indicates Marchetti.
Even “the dose of therapy – underlines Curigliano – must be tailored to the individual patient. Since the 1950s the use of anti-cancer drugs has revolved around the concept of 'maximum tolerated dose'. We are now moving on to that of 'optimal biological dose' which must take into account, as much as possible, all the specific individual conditions at both a clinical and psychological level”.
“Precision medicine, therefore – concludes Marchetti – is radically changing oncology research, creating many expectations. At the same time it is generating technical, scientific, ethical-legal and even economic problems. We are witnessing a slowdown in the transposition of the principles of medicine personalized in everyday clinical practice, it is necessary to develop evidence-based guidelines and recommendations for specialists as soon as possible.
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