by 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 achieve shrink the tumor as for 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 cancerin an advanced or metastatic state, now have in Argentina the amivantamabmonoclonal antibody approved 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 cancer of non-small cells which presents a genetic alterations known as 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 there was no 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 youand each of them will now be able to have a therapeutic alternative that they did not have before,” Kaen responded to the question. Clarion.
That logic to measure the scope of new drugs against cancer is inherent to its own nature, by achieving 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 is observed that in the 37 percent of the patients the tumor shrank, while in the 74 percent The disease managed to stabilize so that patients could improve their quality of life. The median overall survival was 23 monthssomething unpublished for this type of tumor.
New generation testing
The logic of therapeutic massiveness lost at the cost of effectiveness is in the way with two obstacles. The first and most obvious is that the drug costs innovative ones are higher, which makes 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, the key is genetic testing.
However, 50 percent of patients with this disorder no children 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 specific, personalized treatment. And we also know that those who receive this type of treatment have best results than those who don’t.”
Kaen, who is also head of the Enrique Vera Barros de la Rioja Regional Hospital, added that today “it is practically an obligation that patients with lung cancer Can they be tested molecularly? 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 tests could begin to ease if an initiative to make them manufacturing laboratories of the new therapies those who finance these studies, something that they would later 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 achieved survival in lung cancer. ever increasing sea. “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 patients with lung cancer they live 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.”
