With these innovative medicines it is possible to reduce the risk of disease progression or patient death. Among the innovations exhibited at the Esmo conference are also those to reduce the risk of relapses in early-stage tumors
They are called conjugated antibodies and promise to change for the better the treatment of many types of tumors that still cannot be treated effectively, such as breast cancers that are inoperable from diagnosis or metastatic. Two large studies with these innovative drugs have, in fact, been at the center of the attention of the experts gathered in recent days in Madrid for the congress of the European Society for Medical Oncology (Esmo) with promising results for specific subtypes of breast cancer. What is it about? Practically are drugs composed of two parts: a monoclonal antibody designed to specifically recognize and bind to a very specific target, present only on cancerous cells and not on healthy ones, which it carries with it a powerful chemotherapy — he replies Saverio Cinieri, president of the Italian Association of Medical Oncology (Aiom) —. On the one hand, this allows for great therapeutic efficacy, because the chemotherapy transported and “released” on the target to be hit has great destructive power; on the other hand, however, the toxicity for normal cells (and therefore for the patient’s organism) is very low given that the treatment is targeted.
The TROPION-Breast01 study
The results of the TROPION-Breast01 trial were illustrated during the presidential session of the Esmo conference, the one dedicated to the most important innovations: they indicate that the conjugated antibody datopotamab deruxtecan it reduced the risk of disease progression or death by 37% compared to chemotherapy. The trial (phase three, the last before the final approval and entry onto the market of a medicine), enrolled 732 patients with inoperable or metastatic breast cancer hormone-positive (HR), HER2-low or negative, previously treated with hormonal therapy and at least one chemotherapy. In Italy there are approximately 52 thousand people with metastatic breast cancer – he says Michelino De Laurentiis, director of the Department of Breast and Thoracic-Pulmonary Oncology at the National Cancer Institute IRCCS Fondazione Pascale in Naples —. Despite the initial benefits of endocrine therapy, most patients with HR-positive and HER2-low or negative metastatic breast cancer experience progression of the disease, which requires further treatment with chemotherapy. The results show thatdatopotamab deruxtecan it reduced the risk of disease progression or death in patients by more than a third and, overall, it had fewer serious treatment-related side effects than standard chemo, thus showing its potential to become a new standard of care in a therapeutic context where there is an unmet clinical need.
The DESTINY Breast 04 study
Similar results were also recorded by DESTINY-Breast04 trial with the conjugated antibody trastuzumab deruxtecan and from TROPiCS-02 trial with sacituzumab govitecan: For now we do not have information that helps us understand which of these three conjugated antibodies should be given to each patient and whether it could be useful to use them in sequence with each other comments Sarat Chandarlapaty, oncologist at Memorial Sloan Kettering Cancer Center in New York. Updated data from the DESTINY Breast 04 study were also illustrated in Madrid which compared 557 patients (again with a inoperable or metastatic HER2-low type carcinoma) standard chemotherapy or trastuzumab deruxtecan: at an average follow up of 32 months, survival was almost 23 months for those who received the innovative drug, compared to 17 for chemowith a 42% reduction in the risk of death.
The monarchE study
New confirmations arrive, then, for those who have an early stage tumor. In particular, for hormone receptor-positive (HR+), human epidermal growth factor receptor type 2 (HER2-), lymph node-positive, early stage breast cancer at high risk of recurrence, updated data were presented. five years into the monarchE trial. The trial evaluated the use of abemaciclib for two years in combination with endocrine therapy compared to hormone therapy alone. The five-year period is a consolidated reference point for breast cancer studies in the adjuvant (post-surgery) phase and represents an important milestone for patients and clinicians in this setting with the aim of recovery — he explains Lucia Del Mastro, director of the Medical Oncology Clinic of the IRCCS Policlinico San Martino Hospital, University of Genoa —. The results demonstrate an effect that goes beyond the completion of two years of treatment with abemaciclib, with the curves of survival free from invasive disease and of survival free from distant recurrence that continue to separate, confirming confidence in the role of abemaciclib as an adjunct to endocrine therapy for patients at high risk of relapse. And the benefits tend to continue even after the end of the treatment, which lasts two years – he continues Valentina Guarneridirector of Oncology 2 of the Veneto Oncology Institute IRCCS in Padua —. The effect is very evident on local and distant relapseswhich are responsible for metastatic disease: avoiding them implies not only extending survival, but also increase the chance of recovery. The evolution of the disease from initial to metastatic stage in fact has negative repercussions on the survival and quality of life of patients. The 5-year data from the study represents a further step forward in bringing a greater number of people to recovery.
The NATALEE studio
In 2022, in Italy, 55,700 new cases of breast cancer were estimated, the most frequent in the entire population – recalls Cinieri -. Approximately 15% of HR+/HER2- breast tumors are at increased risk of developing metastasesThis is why effective solutions are needed to reduce the risk of relapse. An objective that can also be achieved with the drug ribociclibas highlighted by the latest results of an analysis of the NATALEE trial: After nearly 28 months of follow-up, invasive disease-free survival benefits with ribociclib as an adjunct to endocrine therapy remain constant. From the latest observations the risk of relapse appears decreased in all subgroupsincluding patients with stage II cancer, those with negative sentinel lymph node or those over 65 years of age.
November 8, 2023 (modified November 8, 2023 | 07:59)
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