NEW CHALLENGES FOR CANCER TREATMENT

Publication FEBRAURY 2023 | FRI COMMUNICATION

In 2018, James P. Allison and Tasuku Honjo were awarded the Nobel Prize in Medicine for their studies on checkpoint inhibitors, the foundation of innovative cancer immunotherapy, which is increasingly used to halt the progression of cancer, including in our country. In Italy, cancer continues to be a source of fear. In 2022, an estimated 390,700 new cancer diagnoses were made (compared to 376,600 in 2020), with 205,000 cases in men and 185,700 in women.

In just two years, there has been an increase of 14,100 cases. Expanding the perspective to the whole of Europe, each year 2.7 million people receive a cancer diagnosis, and 1.3 million EU residents die from cancer, with over 6,000 of them being children, teenagers, and young adults. It should not be forgotten that cancer exerts enormous pressure, including economic pressure, on healthcare systems, which becomes increasingly significant as life expectancy rises.

A new investment program to improve knowledge of oncological diseases is necessary to promote new initiatives and, hopefully, new relevant approaches to prevent, diagnose, and treat these diseases. To this end, Europe calls for strengthened collaboration among Member States to consolidate their support for research, aiming for a breakthrough in modern oncology and effectively tackling the growing burden imposed by oncological conditions. 

Thanks to this network, new drugs for cancer treatments are approved every year. In 2021, 79 new medicines were authorized at the European level, of which 36% were related to antineoplastics and immunomodulators for the treatment of autoimmune diseases and certain types of solid (such as lung, breast, and uterine) and blood cancers (such as myeloma, lymphoma, and leukemia).

However, public spending shows no signs of slowing down: the annual cost of cancer in Italy is €19.3 billion. Over an eight-year period (2014-2021), spending on oncology drugs in our country increased from €2.3 billion to €4 billion, representing a 73% increase. Despite the constant growth in cancer care expenditures, the five-year survival rate continues to improve, reaching 65% in women and 59% in men (compared to 63% and 54% in the previous assessment updated to 2015). 

Professor Giuseppe Curigliano, Director of the New Drug Division at IEO, also emphasizes the need to shorten the access time to new therapies. Currently, there is approximately a two-year gap between the authorization and evaluation process at the EMA (European Medicines Agency) and the actual availability of a new drug, which can greatly disadvantage patients. For example, two drugs for innovative CAR-T therapy (Kymriah by Novartis and Yescarta by Gilead) with a 40% cure rate were authorized by the EMA in recent months but are still pending approval by the pricing and reimbursement committee of AIFA.

The future challenge lies in achieving personalized prevention for each individual based on genetic risks, which cannot be modified solely through lifestyle changes. Only the development of personalized organization, therapy, and prevention can offer benefits that maintain the sustainability of the healthcare system while healing an increasing number of patients. “Precision oncology today includes effective weapons such as targeted therapies and immunotherapy, which can extend survival even in metastatic disease and, in some cases, turn it into a chronic condition,” concludes Professor Curigliano. Precision oncology also includes genomic tests, which can limit the use of chemotherapy after surgery in women with early-stage breast cancer. In July 2021, the implementing ministerial decree was published in the Official Gazette, unlocking €20 million from the dedicated fund for the free application of these molecular analyses, although their utilization is not yet uniformly implemented across the territory. 

To address these challenges, the Ministry of Health founded ACC, the national oncology network, in 2002. Its mission is to bring technological and organizational innovation from basic research to clinical practice, raising and standardizing the level of care and rehabilitation for cancer patients throughout the country. ACC plays a strategic role in areas such as governance, finance, logistics, and sustainability in the UNCAN project, funded by Horizon Europe.

Ruggero De Maria, president of ACC, comments on the importance of the project: “An extraordinarily important scientific initiative aimed at understanding the mechanisms underlying cancer development and improving prospects for treatment. I renew our total commitment, emphasizing the crucial nature of the activities that we, together with our partners, will carry out during the fifteen months of UNCAN.” 

The information collected within UNCAN will be used by various stakeholders in Europe and around the world to address urgent and critical scientific and medical challenges in cancer prevention, early diagnosis, treatment, and survival for men, women, and children. This effort conducted at the European level will lay the foundation for saving millions of lives and improving the quality of life for cancer survivors, benefiting both the individuals affected and those who care for them.

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Filippo Cammardella
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