Were you able to dress yourself today?
Were you able to have breakfast?
Did you manage to go for a walk?
The questions could continue, but they suffice as an example of what patients with advanced cancer who participate in clinical trials answer to measure how they live their daily lives.
Thus, the effectiveness of the new drugs investigated is measured both by how much they manage
to reduce the tumor
and by the benefit they bring to the
quality of life
.
This line includes an innovative drug against lung cancer, the second most prevalent in men behind prostate cancer.
Among the large number of new drugs available against cancer (more than 100 in the last five years) patients with
a specific type of lung cancer
, in an advanced or metastatic state, now have
amivantamab
, an approved monoclonal antibody, in Argentina.
by Anmat that prolongs life by almost two years.
The key to this generation of cancer treatments is
precision
.
Drugs designed to hit the target.
In this case, the target is a
non-small cell
cancer that presents a
genetic alteration
known as a mutation in the EGFR exon 20 insertions, when the disease progresses during or after platinum-based chemotherapy.
Diego Kaen, president of the Argentine Association of Clinical Oncology, explained that “this is a population that until now
did not have effective treatment
, with the exception of chemotherapy.
The arrival of this medication is truly new.
"Patients who have this alteration in their tumor DNA can respond to this drug."
How many patients will benefit from this therapy?
“There are not many, but beyond the number we must understand that
each patient is 100 percent of one
, and each of them will now be able to have a therapeutic alternative that they did not have before,” Kaen responded to
Clarín
's query. .
Color scanning electron micrograph of a cell from a common type of lung cancer, called non-small cell cancer.
Photo: Science
This logic for measuring
the scope of new
anti-cancer drugs is inherent to their very nature, as they achieve increasingly specific targets.
Alterations in EGFR are common genetic mutations in non-small cell lung cancer, while alterations in EGFR exon 20 insertions are the third most prevalent primary EGFR mutations, accounting for up to 10 percent of cases. themselves.
Amivantamab, developed by the Johnson and Johnson laboratory, demonstrated its effectiveness in the Chrysalis clinical study.
There it was observed that in
37 percent
of the patients the tumor shrank, while in
74 percent
the disease managed to stabilize so that the patients improved their quality of life.
The median overall survival was
23 months
, something
unprecedented for this type of tumor
.
New generation testing
The logic of therapeutic massiveness lost at the cost of effectiveness is faced with
two obstacles
.
The first and most obvious is that the
costs of innovative drugs
are higher, making coverage more difficult in a health system in crisis.
The second obstacle, less traveled but also vital, is that to gain access to this type of treatment,
genetic testing
is key .
However, 50 percent of patients with this alteration
are not detected
through genetic testing carried out with the usual techniques (PCR), which undermines the indication of the most convenient treatment.
Next-generation DNA sequencing tests are needed to achieve an accurate diagnosis of the disease.
“Only
40 percent
of patients with metastatic lung cancer access these tests,” Kaen warned.
Manglio Rizzo, head of the Clinical Oncology Service at the Austral University Hospital, emphasized that the molecular analysis of tumors is
increasingly necessary
: “To date, we know that about half of lung cancer patients have a tumor with a molecular alteration that would allow a specific, personalized treatment.
And we also know that those who receive this type of treatment have
better results
than those who do not.”
Kaen, who is also head of the Enrique Vera Barros Regional Hospital in la Rioja, added that today “it is practically
an obligation
that patients with lung cancer
can be molecularly tested
before indicating treatment.
Molecular testing is part of the diagnosis: just as we stage the tumor, perform a tomography and a blood test on the patient, molecular testing must also be performed.”
The lack of access to molecular testing could begin to ease if an initiative succeeds so that
the laboratories manufacturing
the new therapies finance these studies, something that they would then recover with the drugs they are interested in selling.
But the plan, although it is an advanced project, is not yet closed.
This genetic map is like a compass for the specificity of tailored drugs, which have made lung cancer survival
increasingly longer
.
"Until recently, patients achieved a survival of about 6 months, but there has been a significant change and today between 30 and 40 percent of patients are still alive five years after being diagnosed, something unthinkable before," Kaen said.
Rizzo added that “statistics show that lung cancer patients
are living longer and longer
.”
This trend has increased in recent years and will become increasingly pronounced.
Certainly, seeing the progress that has been made in recent years, one can be optimistic and project a promising future.”
P.S.