Despite the many advances that have made it possible to extend survival for the majority of women with breast cancer, caution is still required when the cancer is metastatic. In these cases, it becomes even more important to have access to advanced diagnostic tools capable of identifying details of the disease and then personalizing the treatment. Like the liquid biopsy which, just like the Hubble Space Telescope which has revolutionized our understanding of the universe thanks to its ability to see beyond the limits of terrestrial telescopes, allows us to “see” beyond the limits of traditional biopsies, providing a more detailed and in-depth study of the molecular characteristics of tumors. For this reason, from its XXV National Congress which is taking place these days in Rome, the Italian Association of Medical Oncology (Aiom) is calling for liquid biopsy to enter daily clinical practice to identify certain mutations of advanced or metastatic breast cancer. The oncologists’ warning is that it be used not only in the large medical oncology centers of our country but also in the more peripheral ones.
In Italy there are over 37 thousand women with metastatic cancer and survival rates are still low, although improving in recent years. “Treatments must also be personalized thanks to mutational tests. Based on the expression of specific receptors present on the surface of the cells, the tumor can be divided into different subtypes,” he explains Saverio Cinieri, president of Aiom. HR+/HER2- is the most widespread form and is treated above all with the administration of endocrine therapy. It aims to reduce hormone levels and thus inhibit the cancer’s ‘supply’ pathways.”
Unfortunately, a non-negligible number of patients develop resistance to hormone therapy due to specific genetic mutations. “This contributes to making the prognosis more severe and decreasing survival rates for advanced or metastatic forms of cancer. Today, however, we are witnessing the revolution of precision medicine, even in oncology. The research has managed to identify new therapeutic targets that we can successfully address through more targeted approaches,” he comments Fabio Puglisi, director of the Department of Medical Oncology at the IRCCS CRO of Aviano, and full professor of Medical Oncology at the University of Udine. “Breast cancer is characterized by a high level of heterogeneity – he continues Puglisi. The in-depth study of the different genetic and molecular alterations represents the key to understanding the notable progress we have recorded in this disease. Research must persevere in its commitment to develop increasingly personalized therapies. In fact, it is a neoplasm that is constantly and significantly growing in almost all Western countries.”
A painless but very precise test
Liquid biopsy represents a new method of studying a neoplasm, but is currently little used in the management of patients with breast cancer despite being a minimally invasive test with no complications. But how is a liquid biopsy carried out? “It consists of a simple blood sample and a subsequent analysis of the tumor DNA circulating in a liquid sample,” he replies Antonio Russo, National Treasurer of the Aiom who adds: “From this we can obtain a series of important information. In the specific case of breast cancer, it allows us to identify predictive biomarkers of response or resistance to treatment. Approximately 40% of all ER+/HER2- advanced or metastatic tumors have mutations in the ESR1 or Estrogen Receptor 1. For this subgroup of cases, new target therapies have been developed.” The liquid biopsy can be repeated several times over time to monitor the molecular evolution of the oncological pathology.
Applications for other tumors
Liquid biopsy can be used for the most advanced forms of breast cancer and also in colorectal cancer. “They are the first two most widespread oncological pathologies in our country and every year they register over 100 thousand new cases – he continues Russian -. Finally, scientific evidence has shown that it can also be useful in non-small cell lung cancer and in a very dangerous and insidious skin tumor such as melanoma.”
The Aiom project
As part of the National Congress, Aiom presented the new project Metastatic Breast Cancer, the importance of Mutation Tests and the Role of Liquid Biopsy which aims to raise awareness among clinicians, institutions and patient associations of the importance of new predictive tests on liquid samples. A series of initiatives are planned including a monthly scientific update newsletter for oncology specialists, talk shows and video interviews broadcast on AIOMTV the Scientific Society’s web channel, webinars for patients, distribution of brochures and other information material. All this will be supported by an intense campaign on AIOM’s official social media. The initiative is made possible with the non-conditional support of Menarini Stemline Italia. “We want to spread 360-degree messages and reach all stakeholders involved in the treatment of the most advanced forms of breast cancer – he states Saverio Cinieri, President AIOM. “We are proud to support AIOM in this new educational project – concludes Dr. Nicola Bencini, General Manager of Menarini Stemline Italia -. We consider the collaboration with AIOM and the Italian oncology community of great value to improve the diagnosis and treatment process of patients suffering from breast cancer”.