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Lung cancer, the hope of a cure is growing for those who take a new drug after surgery

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One of the headline news from the annual conference of the American Society of Clinical Oncology (Asco), which is underway in Chicago, is the data from the ADAURA study, which has already been the focus of experts’ attention during the conference of 2020. «Three years ago, the first results were illustrated as particularly promising in the plenary session, the most important – he recalls Philip de Marinis, director of the Department of Thoracic Oncology at the European Institute of Oncology (IEO) in Milan and principal investigator of the study for Italy —. We said that the foundation was laid for a change in therapy which until then was considered standard in the initial stages of the disease. With the updates presented today in Chicago, again in the plenary session, we can say without any doubt that the groundbreaking change has happened and that it is really important: 85% of patients treated with osimertinib are alive five years after diagnosis and the goal of recovery is not far off». An even greater progress if we consider that lung cancer is still the most deadly in Italy today and, with 41,000 new cases per year, one of the most common.

Sick candidates for recovery?

682 patients with early stage non-small cell lung cancer (IB-IIIA) with mutations in the epidermal growth factor receptor (EGFR). More than 80% of new lung cancer cases registered each year in Italy are non-small cell carcinomas and about 15% have EGFR mutation. «We are talking about about 6,000 people in our country who receive this diagnosis every year – continues de Marinis – and the results shown at Asco indicate an unprecedented result as an adjuvant therapy, ie postoperatively: the drug osimertinib given for three years after radical surgery reduced the 5-year risk of recurrence by 77% and that of death by 51% (compared to those on chemo or placebo). Five years after diagnosis, 88% of patients are alive and free of disease, compared to 78% of those who received a placebo. For the first time, we have succeeded in obtaining both a benefit in disease-free survival and an extension of overall survival in radically operated patients.” Disease-free survival is about five and a half years (65.8 months) for those taking this drug, compared to nearly two and a half years for those taking the placebo. In addition, over time, osimertinib reduces the risk of central nervous system recurrence. Can we talk about healing? « With all the caution with which we usually speak of recovery from cancer, especially lung cancer, it is clear that if 85% of stage II and IIIA operated patients survive beyond 5 years, we are very close to being able to use this term for patients with a common mutation of the EGFR gene (mostly non smokers) radical surgery» replies the expert.

The new drug is already available in Italy

Lung cancer is a subtle disease it produces no symptoms until it is already advanced or metastatic, so only 30% of people are operable when they discover the neoplasm. However, nearly half of patients diagnosed are stage IB and three quarters of patients are stage IIIA relapse within five yearsdespite the surgery. «Until a few years ago, this type of patient (patients with stage IB-IIIA non-small cell carcinoma) was a candidate for postoperative chemotherapy to avoid possible recurrences, with unsatisfactory results – explains de Marinis -. For example, at the end of 2022, given the results of the ADAURA study, the Italian Medicines Agency (Aifa) approved the reimbursement of osimertinib, which has now become the standard therapy for three years. A cure that is comfortable to take (in tablets) and with excellent tolerability: the most common side effects are acne, diarrhea and chronic fatigue in the first months of treatment, but overall the quality of life is optimal».

Search for the mutation and match the most effective drug

This news confirms how crucial it is to investigate whether and which genetic changes are present in each patient’s tumour. “It’s information that can make a big difference,” he recalls Silvia Novelloprofessor of medical oncology at the department of oncology at the University of Turin and head of the thoracic oncology structure at San Luigi Gonzaga in Orbassano —: in fact, it is also on the basis of possible DNA mutations that for many types of cancer today decide on therapy. Oncologists choose a drug or combination of drugs based on the so-called “molecular profile” of the neoplasm. Genetic testing, especially Next-Generation Sequencing (NGS), is a key tool not only for a correct diagnosis, but also for a personalized approach to therapy.” In recent years, several genetic mutations have been discovered that play a key role in lung cancer (such as ALK, EGFR, KRAS, BRAF, ROS) “and consequently several new drugs have been developed that can block or slow its advance, helping patients gain months and years of life – concludes de Marinis -. Further steps in this direction are being illustrated at Asco 2023, emerging from the results of several experiments with immunotherapy, targeted therapies and novel drug-conjugated antibodies».

Source: Corriere

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