Breast cancer, anticipating target therapy reduces the risk of recurrence

In recent years, a class of drugs has revolutionized the treatment of metastatic breast cancer: target molecules that selectively target diseased cells. Is it possible to anticipate this benefit to before metastases form, to further increase the time patients can live without the disease returning? Yes, they tell us the results of a study presented at the Congress of the American Association of Clinical Oncology (ASCO) underway in Chicago. An important result because these drugs work in the most common breast cancer, the one that responds to HER2 negative hormones in the initial stage, which represents 65-70% of the over 55,000 new diagnoses that are made every year in Italy. “The data presented, although preliminary, are very positive because they demonstrate that the addition of ribociclib in the adjuvant phase decreases the risk of tumor recurrence by 25%,” says Michelino De Laurentiis, Director of the Breast and Thoracic-Pulmonary Oncology Department , National Cancer Institute IRCCS Foundation ‘G. Pascale’ of Naples.

Despite the constant increase in breast cancer cases, mortality decreased by 6.8% from 2015 to 2021, not only due to the effect of early diagnosis through screening programs, but also due to the effectiveness of adjuvant therapy. “In fact, 5-year survival reaches 88% and places our country at the top of Europe. There are three adjuvant treatments: chemotherapy, hormone therapy and biological therapy, offered to patients based on the study of the individual case, the characteristics of the tumor and the physical conditions of the woman”, explains Saverio Cinieri, President of AIOM (Italian Association of Medical Oncology). “Unfortunately, however, for many patients in general there are no effective tools to substantially reduce the risk of recurrence”. That’s why, according to experts, this study has the potential to change clinical practice. “Furthermore, reducing recurrences means containing the considerable cost for the health system in terms of drugs, visits and hospitalizations necessary when the disease becomes metastatic, as well as the negative consequences on quality of life”, adds Cinieri.

Reduce recurrences

To reduce the risk of the disease coming back, patients with hormone receptor-positive, HER2-negative early breast cancer take standard hormone treatment for 5 to 10 years, with or without chemotherapy. In the Natalee study, which involved over 5,000 patients, both men and women, ribociclib was given for 3 years together with hormone therapy. “In this way, the risk of recurrence was reduced by a further 25%, in a very large patient population, which also includes women without lymph node involvement. We hope that the therapy will become available as soon as possible, because we will be able to offer an effective therapeutic opportunity to a large number of patients”, says De Laurentiis. In Italy, women who could benefit from this therapy are about 20 thousand every year.

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“Patients with hormone receptor-positive, HER2-negative early-stage breast cancer remain at risk of recurrence, with the disease recurring in a third of cases initially in stage II and in half of those who started in stage III. Furthermore, 90% of the recurrences that develop within 5 years lead to metastatic disease”, underlines Fabio Puglisi, Director of the Department of Medical Oncology at the IRCCS CRO of Aviano, Full Professor and Director of the School of Specialization in Medical Oncology at the University of the Udine Studies. The evolution of the disease from the initial stage to metastatic has negative repercussions not only on survival, but also on the quality of life of patients. “The data from the Natalee study represent a further step towards healing more patients. These results may have a greater impact than what was obtained in the past in adjuvant treatment with chemotherapy or aromatase inhibitor-based hormone therapy,” concludes Puglisi.