What is the good newsthat researchers around the world, gathered for the second year – virtually – for the congress ofAmerican Society of Clinical Oncology (the Asco which, for years, was held in Chicago), they can give to those thousand people who fall ill with cancer every day in Italy and, more generally, to those two million and 250 thousand Italians who are already living with a diagnosis of cancer? Despite the difficulties linked to the Covid emergency, which has upset medicine and health care all over the world, research on new cancer therapies have continued and have borne fruit. And the most important news, which emerged at Asco, concern precisely the most frequent cancers: that of the prostate (the first for spread among men) followed by that of the lung. Which, for women, in third place, with the breast one in the first place (in the middle there is the colorectal one).
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Prostate radiopharmaceuticals
Let’s start with a particular form of prostate cancer, the one that has already metastasized and does not respond to chemical castration, that is, the use of hormonal treatments that can reduce the levels of testosterone (the hormone that promotes growth). The Vision study showed that the administration of a radiopharmaceutical, Lutetium increases patient survival (we are talking about a few months, ed), confirmed Giuseppe Procopio, of the Tumor Institute of Milan. But how does it work? In practice, the radiopharmaceutical recognizes a molecule on the surface of cancer cells that only they have, binds to this and carries the radioactive substance inside the cells that destroys them, explains Sergio Bracarda, of the Santa Maria di Terni hospital.
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Breast cancer
Also new for breast cancer. The challenge today is that of genomic tests, that is, capable of identifying particular genetic characteristics of the tumor that can avoid unnecessary chemotherapies. Specifies Francesco Cognetti of the Regina Elena Cancer Institute in Rome and President of Insieme Contro il Cancro who conducted an interesting study on the subject: Usually oncologists rely on some biological data of the tumor to decide whether or not to do chemotherapy in women with breast cancer, after surgery. But it turns out that they don’t always decide for the best, with the “old” parameters. Instead, genomic testing can suggest better strategies and reduce unnecessary chemotherapies by 36 percent. Unfortunately, to date these tests, in Italy, are reimbursable only in some regions, reports Saverio Cinieri, oncologist in Brindisi and President-elect of AIOM (Italian Association of Medical Oncology). But there is more it adds, Giuseppe Curigliano of the European Institute of Oncology in Milan (Ieo). In patients who have genetic alterations (to be clear, the genes of predisposition to breast cancer Brca1 and 2 and also of the ovary, are the famous genes of Angelina Jolie, ed) it has been seen that, after surgery, giving a drug called Olaparib as adjuvant therapy decreases the risk of the cancer coming back. (The study published simultaneously in the New England Journal of Medicine). We come to the third big killer: lung cancer.
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Less chemo for the lung
The idea is that of reduce, in patients with the most common form of lung cancer (non-small cell) in its metastatic forms, the use of chemotherapy – comments Cesare Gridelli, oncologist at the Moscati Hospital of Avellino -. And to associate it with immunotherapy. It works like this: patients are given a combination therapy with two immunotherapy drugs (nivolumab plus ipilimumab) associated with only two courses of chemotherapy, instead of four. And the results show that survival improves in these patients, with fewer side effects. (Incidentally: immunotherapy drugs are those that stimulate the body’s immune system to defend itself against tumors).
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Tumore outsider
But let’s get out of the most frequent cancers for a moment to get to the news concerning an outsider, a rare cancer, that oflate stage esophagus. Here too there is good news. The combination of immunotherapy plus chemotherapy and dual immunotherapy (i.e. with two immunotherapy drugs, ed) can change clinical practice in the treatment of advanced stage esophageal cancers, comments Stefano Cascinu of the San Raffaele Hospital in Milan and of the University Vita and Health of San Raffaele.
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Three solutions for the future
The messages that the Asco researchers are sending us at the moment are few, but important and take into account the fact that treating a tumor, today, is more and more complicated. The first consideration is that we are moving towards an increasingly personalized therapy. This is why genetic tests, which identify the genetic alterations of cancer cells on which a therapy can be built, are becoming increasingly important. The second is that we need to reduce the burden of chemotherapy, because these are effective, but they also have important side effects. Here is the effort to reduce them and there is even talk, in the near future, of chemo-free lung cancer. The third is that the real revolution in anti-cancer therapies, that is, those that use immunotherapy drugs (which work by stimulating the body’s immune system to defend itself against tumors) can be combined with each other (the so-called combo therapies), even with those with a molecular target (which act on genetic alterations) and with the classic chemo. In practice, precision medicine is increasingly refined and the possibility of combining all new therapies in a more effective way for patients Cancer in its many facets is becoming an increasingly difficult disease to cure, expert people, multi-disciplinary teams.
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June 4, 2021 (change June 4, 2021 | 19:59)
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