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Cancer. With precision therapies doubling survival and saving more than 25%



This is highlighted by a Stanford University study that was discussed at the Aiom conference in Rome. The median survival of patients treated with precision oncology was 51.7 weeks compared with 25.8 weeks of treated patients. with standard chemotherapy. The difference in costs is also clear. Each week of treatment with precision oncology involved an expense of $ 2,720, compared with 3,453 with traditional care.

18 NOV – Precision oncology is capable of improving survival rates in the metastatic phase of the disease until it is doubled. Economies are also noteworthy, thanks to the use of therapies directed only at patients who can benefit from them, avoiding unnecessary toxicity and hospitalizations.

This is demonstrated by a study published in the journal Oncotarget in 2018, conducted by researchers at Stanford University.

The median survival of patients treated with precision oncology was 51.7 weeks compared with 25.8 weeks of patients following standard chemotherapy (or the best supportive treatment). The difference in costs is also clear. Each week of treatment with precision oncology involved an expense of $ 2,720, compared with 3,453 with traditional care.

The approach that is revolutionizing cancer treatment is at the heart of the 20th National Congress of the Italian Association of Medical Oncology in Rome.

"Tumor Molecular Plaques should be established as soon as possible, that is, multidisciplinary teams that can guarantee the integration and comparison between the different professional figures involved (oncologist, molecular biologist, geneticist, anatomist-pathologist and pharmacologist) who, thanks to their experience, allow a correct interpretation of genetic and molecular data and the choice of the appropriate therapeutic strategy ", explains Stefania Gori, National President of Aiom and Director of the Department of Oncology, IRCCS Sacro Cuore Don Calabria-Negrar Hospital.

"The creation of a Molecular Tumor Board," adds the president of Aiom, "is the first step in ensuring the patient's multidisciplinarity and access to personalized treatments." The concept of precision oncology requires that specific changes to a genetic sequence become the goal based on the precise selection of the patient in relation to the molecular characteristics of the neoplasm, there is the potential for greater clinical benefit and longer compared to the treatment with classical chemotherapy. tumor based on the organ from which it originates and the histological type, based on the molecular profile ".

In the study published in the Oncotarget, a separate analysis of costs related to 1,814 terminal patients was also performed to verify the trend in the last 3 months of life. To further confirm the savings achieved with targeted therapies, in the 93 people treated with these weapons, there was a 6.9% lower spending compared to chemotherapy. In this work, patients were selected by performing a gene profile thanks to a new technology, the next generation sequencing (NGS).

"Advances in the field of genomics are possible thanks to the recent development of new platforms that allow the sequencing of a larger number of genes than the previous methods, with reduced time of analysis and increased sensitivity, with the aim of identifying corresponding mutations to specific molecular targets to target drugs – he says Antonio Marchetti, professor of pathological anatomy and director of the Center for Predictive Molecular Medicine at the University of Chieti. The potential of these platforms in clinical practice is linked to the analysis of cells in tumor tissue and some tumor components (circulating tumor cells and circulating tumor DNA), which can be isolated from peripheral blood and biological fluids. "

It is the so-called liquid biopsy. "Tissue biopsy has some limitations because it is an instantaneous image, limited in time and space – underlines Antonio Russo, member of the National Council of AIOM and Professor of Medical Oncology at the University of Palermo. In fact, the tumor evolves, acquiring new mutations that make it even more aggressive. Therefore, it is essential to develop new minimally invasive techniques that allow better patient follow-up. "

"In this context," continues Russo, "liquid biopsy is a valid option. Its main field of application today is the identification of molecular biomarkers in patients with advanced tumors and the only clinical application currently available concerns the detection of sensitivity and resistance mutations Epidermal Growth Factor Receptor (EGFR) gene) in non-small cell lung cancer. In the future, the possibility of using liquid biopsy will extend to other neoplasms. "

In 2018, 373,000 new cases of cancer are estimated in Italy. Non-small cell lung carcinoma with EGFR mutations or with ALK or ROS1 translocation, breast or stomach tumors with HER2 amplification, cutaneous melanoma with BRAF mutations, colorectal carcinoma without KRAS or NRAS or BRAF mutations are examples of molecular subgroups of neoplasms, for which specific treatments are already available that significantly modify the course of advanced or metastatic disease.

Immuno-oncology, which is based on strengthening the immune system against cancer, is also part of the concept of precision oncology, thanks to the use of biomarkers capable of identifying patients who can respond more positively.

"Adequacy is a central theme in oncology," he explains. Roman DanesProfessor of Pharmacology at the Department of Clinical and Experimental Medicine at the University of Pisa. The diagnostic tools used today in precision oncology allow to select the patient and classify it according to the ability to respond. It is important to define the various aspects of the therapeutic use of drugs, and among these, resistance monitoring is particularly important, against which progressively evolved medications are developed that find specific indications according to the patient of drug interactions in therapies. combination and risk of toxicity, which, despite considerable improvements in recent years, still affects the patient's life. The efforts are aimed at introducing into clinical practice, according to oncologists, tests that may determine the risk of toxicity of a drug. "

"The new diagnostic-therapeutic approach to neoplasia, which integrates clinical-pathological criteria with molecular analyzes, is also reflected in conducting clinical trials – concludes the president Gori -. The classification based on the molecular profile causes a segmentation of neoplasms in numerous molecular subtypes, in which very few subgroups of patients fall. Therefore, new clinical trial designs were developed (the so-called basket test and umbrella study), in which patients are recruited based on the genetic and molecular characteristics of the neoplasia, with the aim of administering the treatment only to potentially more patients responsive. , reducing the use of ineffective and otherwise ineffective drugs, as well as the time of development of new therapies and associated costs. "

November 18, 2018
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