Various research indicates how to improve the effectiveness of current standard therapy to delay relapses and extend patient survival. a type of cancer that may disappear
since 1999 that for the care of cervical cancer no noteworthy progress is being made. Now, after almost a quarter of a century, we are finally at a turning point, so much so that two different studies were presented during the congress of the European Society of Medical Oncology (European Society for Medical Oncology, Esmo) in Madrid. Both studies concern the patients most in difficulty: those with an advanced stage of cancer, for whom the current standard therapy is unable to achieve healing. In fact, over the course of two or three years, many face a relapse and the new treatments have proven effective in significantly delaying this relapse. In our country, cervical cancer still represents the fifth most frequent tumor in young women, under 50 years of age, with approximately 2,400 new diagnoses and 500 deaths recorded each year. Even though it is a type of cancer that could disappear completely (thanks to a vaccine) and be diagnosed early on with a Pap test or HPV-DNA test.
A tumor that could disappear
Cervical carcinoma it could disappear completely thanks to the Papillomavirus or HPV vaccinewhich is the main culprit, but in Italy and in the rest of the world the opportunity is still exploited too little – he recalls Nicoletta Colombo, director of the Gynecology Oncology Program at the European Institute of Oncology (Ieo) in Milan —. Thus the numbers of this neoplasm remain important: every year there are 600 thousand new diagnoses globally and over half of women, around 340 thousand, die. Mortality rates are particularly high in low-income countries, where both vaccines and early detection screening are much less widespread. Pap test and HPV-DNA test, capable of identifying precancerous lesions which can thus be eliminated before they develop into cancer. Statistics in hand, 99.7% of cases are caused by a persistent infection Papillomavirus (HPV) for which there is a vaccine offered free of charge in Italyto 12-year-old males and females (and not only, also useful in adults).
Symptoms and therapies
If discovered in the early stages, cervical cancer can be successfully treatedallowing patients to recover completely – he underlines Saverio Cinieri, president of Aiom, the Italian Association of Medical Oncology —. Pre-cancerous lesions take many years to develop into cancer and, thanks to early diagnosis with Pap test and HPV-DNA testthey can be identified and removed in time, with various strategies available today. In addition to the vaccine and screening checks, which save lives, you need to pay attention to symptoms such as abnormal discharge or bleeding not linked to the menstrual cycle, pain in the pelvis or back, sudden weight loss. In these cases, it is better to always speak to a gynecologist without delaying too much. In general, early stages of the disease (tumors smaller than 4 centimeters confined to the cervix) can be treated with surgery alone, while locally advanced ones require an integrated approach of concomitant radio-chemotherapy with the use of platinum-based regimens. , followed by brachytherapy. In Italy, around 68% of women are alive five years after diagnosis — continues Cinieri —. This neoplasm mostly strikes young people, women in the midst of working life and with small children. This is also why it is so important to have finally made some progress.
Hopes for recovery
A first experimentation, presented at Esmo 2023 by the Italian Sunday Lorusso, principal investigator of the study, was conducted in 30 countries and 176 different centres, for a total of over one thousand patients enrolled with newly diagnosed, locally advanced, high-risk cervical cancer. Half of the participants in the KEYNOTE-A18 trial received the standard treatment (i.e. a mix of radio-chemotherapy, followed by brachytherapy) and the other half were treated with the addition of immunotherapy drug pembrolizumab, followed by maintenance therapy with the same medicine for 15 cycles for 6 weeks – explains Lorusso, who is responsible for clinical research programming at the Gemelli University Polyclinic Foundation in Rome and professor of gynecology and obstetrics at the Humanitas University of Milan -. The results show that the pembrolizumab-based regimen reduced the risk of progression or death by 30% compared to standard therapy. 68% of patients who received immunotherapy were still cancer-free after two years, compared to 57% of those who received the current treatment. the first study of phase 3 (the last before the final approval and entry onto the market of a medicine) in which immunotherapy demonstrated improved progression-free survival. In short, it is about a strategy that is destined to change current clinical practicewith the hope of being able to permanently heal a growing number of women.
The other studies
The results of the INTERLACE trial were illustrated during a presidential session of the Spanish conference, the most important one. The type of patients similar to that of KEYNOTE-A18, are always women with locally advanced carcinoma — he clarifies Nicoletta Colombo, professor at the Department of Medicine and Surgery of the University of Milan-Bicocca —. one was tested induction chemotherapy (composed of two different chemotherapy drugs: carboplatin and paclitaxel) administered before standard treatment (i.e. always the combination of radio-chemotherapy). And the results obtained are important: five years after treatment, 73% of women treated with induction therapy were relapse-free (compared to 64% with traditional care) and 80% were still alive (compared to 72%). The trial involved 500 patients, aged 46 on average, followed up for just over 5 years. Induction chemotherapy was for almost all at least five cycles and then the traditional treatment began about a week later. These are encouraging results also by virtue of the fact that they are a simple and inexpensive regime, which can be easily applied in developing countries where this tumor is more frequent, especially in the advanced stages concludes Colombo. Other research has given positive results in patients with metastatic or relapsed cervical cancer, both by adding immunotherapy to traditional therapy atezolizumab (which has been shown to reduce the risk of death and delay relapse), and with the conjugated antibody tisotumab vedotin which has been shown to be able to extend survival, delay relapse and reduce the size of the tumor more than chemotherapy alone.
October 25, 2023 (modified October 25, 2023 | 08:36)
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