We are used to defining tumors based on the organ in which they are formed. So we speak, for example, of colorectal tumor, lung, prostate or breast liver. But perhaps, in the future, this taxonomy is destined to change. Because perhaps, in terms of organizing oncology and above all of the clinic, it will be necessary to move the diagnostic-therapeutic center of gravity from organ locations to molecular profiles.
Need for targeted tests
“The so -called agnostic approach to therapy, which chooses cure on the basis of the molecular mutation and not to the origin of origin, can change the history of the disease. But why this happens a cultural revolution in the classification of tumors”.
It is with these words that Giuseppe Curigliano, full professor of Medical Oncology at the University of Milan and director of the early development division of the drugs of the European Institute of Oncology (IEO) in Milan, an institution associated with alliance against Cancer, addressed the theme on the occasion of the tenth annual network meeting of Verona. The expert thus argued this theme and above all the need to analyze the cells with molecular tests. Which means optimal management of these resources. Note Curigliano:
“The change in the classification of metastatic cancer will not be possible if it does not increase access to the tests that detect molecular alterations”.
How to improve
There are three joints that can allow this development. Let’s go to order, the scientific indications in this regard are clear. Since 2020, international scientific societies, including ESMo (European Medical Oncology Society), recommend multigenical tests for all patients with advanced lung cancer. Still, an analysis of about 38,000 US medical records (diagnosis 2010–2018) shows only 22% with results of documented molecular tests – percentages consistent with other international studies. In short, there is still a lot to do.
Second theme: the economic aspect. Compared to some time ago, the costs of costs also appears outdated. In the US, a molecular panel can cost around $ 3,000, while in Europe we are around $ 1,000 per test.
The third theme is related to accessibility to this technology, also in order not to create disparities that are reflected on the sick. Even in this sense, economic data are more than comforting. The complete sequencing of the genome fell to about $ 330 (from over $ 1,100 a few years ago). In addition, more and more centers perform in-house analyzes and, in perspective, artificial intelligence will be able to extract genomic signals from standard histological showcases, further reducing times and costs and making testing sustainable even in low and medium income countries.
What could change
The Italian study Rome, mentioned in the Lectio Magistralis of Curigliano, demonstrates the clinical feasibility of the “agnostic” approach in daily practice: a path in which the therapeutic choice is guided by target and action biomarker alterations rather than by the Istotyss or the characteristics of the tissue (and therefore of the organ) of origin.
“Classifying tumors according to their molecular characteristics will accepted access to effective therapies for millions of people and will lay the foundations of a real precision oncology”
Curigliano reiterated. On the other hand, this cultural passage could also prove to be of great importance for the patient, even if the transition to a molecular taxonomy does not end in the test: it is necessary to integrate more information levels – genomic of the tumor, lines of the patient’s germ cells, number/dimensions of the lesions, biological aggression (gene expression), clinical status and symptoms (e.g. fatigue, weight loss) – to orientate in a personalized way diagnosis, therapy and monitoring. But the road appears marked.
