Lung cancer, still today, is the most lethal cancer in Italy and with 41 thousand new cases in 2020 one of the most frequent. Very easy to prevent: it would be enough not to smoke, since 85% of cases are due to tobacco. Very difficult to detect early, when it would be easier to cure and the chances of healing would be greater: more than 70% of patients are diagnosed too late because the malignancy shows no obvious signs of its presence until now in an advanced stage. Thus, unfortunately, five years after the discovery of the disease only about 18% of patients live, even if in recent years scientific research has made important progress, as evidenced also by two studies presented during the Congress of the American Society of Clinical Oncology (Asco ), in progress until June 8 in virtual form.
First-line immunotherapy in metastatic cancer
The outcomes of the phase three CheckMate -9LA study show improvements in both overall and progression-free survival (i.e. the time before the tumor starts to grow again) in patients with The most common form of lung cancer, the non-small cell one. The trial involved more than 700 patients with metastatic neoplasia and showed that immunotherapy, as a first line of treatment, associated with limited courses of chemotherapy (i.e. two instead of the classic four) reduces the risk of death by 28% and the risk of disease progression by 33%. Not only that, 38% of patients who received dual immuno-oncology therapy (consisting of nivolumab plus ipilimumab) in combination with two courses of chemotherapy were alive at two years compared to 26% of those treated with chemotherapy alone. This trial has an innovative design – explains Cesare Gridelli, director of the Department of Onco-Hematology of the Moscati Hospital of Avellino awarded at Asco 2021 precisely for its studies on lung cancer -: first of all the combination of two immuno-oncological molecules, nivolumab and ipilimumab, allows to obtain a complete and synergistic mechanism of action, because it is headed for two different checkpoints (PD-1 and CTLA-4). The further advantage of this therapeutic scheme is the use of limited courses of chemotherapy, which allows to reduce side effects. This is a great benefit to patients, even from a psychological point of view, because chemotherapy is still scary. The patient, in less than a month, finishes chemotherapy and continues treatment with immunotherapy.
The hope of healing in third stage patients
Other good news always concerns patients with the same type of cancer, non-small cell lung cancer (which accounts for about 85% of all new cancers detected each year), but at a less advanced stage and not yet. metastatic. In fact, during the conference, the five-year update of the results of the phase three PACIFIC study was also illustrated, which enrolled over 700 patients with an unresectable stage III neoplasm and that did not progress after chemo-radiotherapy. Even after a five-year follow-up, the data exposed at Asco 2021 confirm the potential of immunotherapy as a therapeutic approach in the treatment of this category of patients. Giorgio Scagliotti, director of the Department of Medical Oncology of the University of Turin -. The overall survival of the participants was 42.9% (compared with 33.4% for patients treated with placebo after chemo-radiotherapy) and c ‘ a reduction in the risk of death of about 30% for patients treated with durvalumab. In addition, one in three patients who received durvalumab immunotherapy (33% compared to 19 with placebo) did not progress, a particularly relevant result in terms of disease control and which further confirms the possibility of offer curative treatment in this setting.
Symptoms not to be underestimated and controls for smokers
The results also indicate that the median survival was 47.5 months for durvalumab (already approved in Italy for this patient category) compared to 29.1 months for placebo. The locally advanced stage of non-small cell lung cancer a complex and clinically heterogeneous setting, where in the past, however, only 15-25% of patients survived five years after chemo-radiotherapy – he concludes Richard Umberto, director of the Department of Oncology and of the University Complex of Radiotherapy of the City of Health and Science of Turin -. The data presented at the Asco conference further confirm the possibility of offering locally advanced patients a treatment (immunotherapy) capable of increasing the chances of treatment and optimize the effectiveness of chemo-radiotherapy, an opportunity that cannot ignore the involvement of an adequate multidisciplinary team, which includes oncologist, surgeon and radiotherapist for an adequate diagnostic-staging framework and for a correct selection of patients to whom to offer the best therapeutic option. In order to be more likely to heal, the fundamental early diagnosis: for this it is necessary to pay attention to what could be the first symptoms of lung cancer, share them with your doctor and, where appropriate, proceed with specialist visits and appropriate tests: unfortunately they are non-specific signs and could be confused with those of others respiratory diseases, but cough is one of the most frequent, shortness of breath (dyspnea) or wheezing, wheezing of the voice. Equally important would be, for heavy smokers, to perform a control spiral CT scan that allows to identify very initial silent carcinomas.
June 6, 2021 (change June 6, 2021 | 12:10)
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