Targeted therapy for each individual breast cancer patient can avoid chemotherapy
Experts call it "precision medicine". It is the path that leads to using targeted treatments on a case-by-case basis, in the challenge of breast cancer, choosing among the different therapies available. And it can also help you avoid the unwanted effects of chemotherapy in cases where it is not needed.
To work, however, this approach must be "guided" through tests that determine the right path to take. It is a fundamental safeguard, given that in some types of patients equal to about 10-20 percent of the total, they allow to predict the risk of relapse and, therefore, to exclude chemotherapy in addition to hormone therapy, avoiding unnecessary toxicity .
The word of the experts
"Precision is the key word in oncology" – explains Saverio Cinieri, President-elect of the Italian Medical Oncology Association (AIOM) and Director of Medical Oncology and Breast Unit of the Perrino Hospital in Brindisi. "Today we have the opportunity to identify the most appropriate therapy for each patient, exploiting specific alterations of the genes or proteins found in the individual tumor, which become the target of individualized therapy. In order for the patient to receive precision treatment, an accurate diagnosis and a definition of the molecular profile of the disease with specific tests are necessary ”.
"In this sense, genomic tests are able to support the oncologist in the personalization of therapies in some types of patients with early stage breast cancer. Genomic tests evaluate groups of genes expressed in a specific tissue, studying their functions and the ways in which they interact with each other. That is, they provide the personalized molecular profile of a tumor. Genomics applied to breast cancer makes it possible to better characterize the tumor tissue and to predict the probability of recurrence after surgery and the response to therapies ".
"In short, the test can limit a less than optimal use of chemotherapy, when obviously this is not necessary, with two aspects to underline: it can have a clinical benefit for patients who are no longer exposed to an excess of treatment and the relative risk of immediate and late toxicity and a favorable impact on healthcare expenditure, which represents a fundamental element, which clinicians must also deal with ".
"Furthermore, in this phase of health emergency due to Covid-19, saving patients from chemotherapy also means avoiding them traveling from home to the hospital for treatment" – underlines Giordano Beretta, National President of AIOM.
"In recent years, important progress has been made in the treatment of this neoplasm" – underlines Lucia Del Mastro, AIOM National Executive Member and Head of the Breast Unit of the IRCCS San Martino Polyclinic Hospital in Genoa. "In 2020, in Italy, a 6% drop in mortality is estimated compared to 2015 and 87% of patients are alive 5 years after diagnosis. The merit is due to increasingly effective therapies and screening programs ".
“However, it should be considered that breast cancer recurrence can occur up to 20 years after the initial diagnosis, especially in women with hormone receptor positive carcinoma. Adjuvant chemotherapy treatment, ie performed after surgery, reduces the risk of relapse, and the decision about whether or not to carry it out is traditionally based on the characteristics of the patient and the tumor ".
"While for breast cancers expressing the HER2 protein and in triple-negative ones, which do not have any of the receptors (estrogen, progesterone, HER2) used as a target in available therapies, adjuvant chemotherapy is often indispensable and the benefit is evident, in tumors that express estrogen receptors but not the HER2 protein (ER + / HER2-), on the other hand, the advantage of adding adjuvant chemotherapy to hormonal therapy is in some cases controversial ".
“Most women with breast cancer have early stage disease, with no involvement or minimal involvement of the axillary lymph nodes, which expresses the estrogen receptors but not the HER2 protein. In these cases, after surgery, the therapy involves hormonal treatment, which can be associated with chemotherapy in cases deemed to be at greater risk of relapse. Genomic testing is an extremely important tool for deciding which of these patients chemotherapy needs to be added ”.