Tumors, multidisciplinary teams and genomic profiling tests are needed for precision medicine
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Over 100 of the top Italian and European experts gathered in Rome for two days with the aim of creating a bridge between basic researchers, professionals who work with new technologies, doctors and health professionals. The occasion is given by the international conference ‘Italian Summit On Precision Medicine‘, the main national meeting dedicated to precision oncology, now in its fourth edition. Oncologists will discuss many topics, some of which are much closer to the real life of patients than one might think. Such as, for example, the role of the Molecular Tumor Boards, a sort of ‘table’ made up of experts in various disciplines who are responsible for analyzing the molecular characteristics of a patient’s tumor, in order to identify the most effective and personalized therapies.
Personalized medicine
In recent years, precision medicine has been revolutionizing the field of oncology, allowing for personalized care for each individual patient. “Thanks to innovative genetic sequencing techniques, such as Next Generation Sequencing (or NGS), we have a large amount of information available on a single neoplasm – he says Paolo Marchetti, scientific director of IDI of Rome, full professor of Oncology at the La Sapienza University of Rome and president of the Foundation for Personalized Medicine. “Precision medicine is assuming a fundamental role in the fight against tumors but it cannot be considered only as the search for molecular targets to associate with therapies”.
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The role of Molecular Tumor Boards
One of the fundamental tools in this area are the Molecular Tumor Boards. For now, only 20 of these multidisciplinary groups are active in Italy in which the cases of patients who can benefit from the selection of anticancer treatments through molecular profiling tests are discussed. There is a strong disparity in the levels of guaranteed assistance and there is no uniform coverage of the national territory because they are not present in all the Regions as instead established by a Ministerial Decree. “One of our objectives – continues Marchetti – must be to understand the reasons why a patient does not respond positively to a treatment even in the presence of a target and a related active drug. Also for this reason the Molecular Tumor Boards are fundamental, but they must not become a useless bureaucratic burden. Instead, they can give concrete support to favor a more appropriate therapeutic choice”.
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The ‘therapeutic reconciliation’
It is essential that the Molecular Tumor Boards work with an interdisciplinary approach. Therefore, individual specialists (oncologists, geneticists, molecular biologists, pathological anatomists, IT technicians, big data managers, engineers and physicists) must collect as much information as possible which is then processed and integrated with each other, based on individual skills, to allow the patient to receive the best and most effective treatment possible. “Precision medicine cannot remain an abstract principle but become a reality in the daily clinical practice of oncologists – he continues Joseph Curigliano, director of the New Drugs for Innovative Therapies Division of the European Institute of Oncology (IEO) and professor of Medical Oncology at the University of Milan. “Medical-scientific research has made great strides in recent years and we must increasingly take into account many aspects of the biological and molecular nature of various tumours. We know more in depth some mechanisms, intrinsic to cancer cells, which are able to regulate the evolution of the disease and possibly also the resistance to treatments. Often our patients have chronic comorbidities and therefore take drugs for the treatment of other diseases. There is therefore the absolute need to obtain the so-called ‘therapeutic reconciliation’. Then there are complex systems such as the microbiota which plays a fundamental role in the mechanisms of resistance or sensitivity to immunotherapy”.
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The agnostic approach
Another theme on which the oncologists gathered for the Rome summit will discuss is that of the agnostic approach to cancer treatment. “’Agnostic’ drugs – he continues Curigliano – represent the new era of therapies and do not affect a single type of tumor, as most current medicines do. They target a group of mutated genes potentially responsible for the development of the disease. These are ubiquitous genes, that is, they are common to various tumors, regardless of the organ in which they originate. Patient access to these new therapies must begin with the execution of a genomic profiling test, continues with the interpretation of the data to finally arrive at the therapeutic choice”. “It is a totally new approach and an excellent demonstration of the extraordinary results obtained from precision oncology – he concludes Marchetti. The key point of this process is represented by genomic profiling and therefore the selection of patients, to whom genomic tests are to be carried out or not, is fundamental”.
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