What does it mean today to ‘cure’ a tumor? Can we hope to heal? Some answers come from Asco which closes today and where many studies concern drugs to be administered at an early stage because the goal is no longer to extend the life of patients by a few months but rather to make them ‘tumor-free’. And the data seem to justify such an ambition. Today, in Italy, about 3.6 million citizens are alive after being diagnosed with cancer, an increase of 37% compared to 10 years ago. At least one in four patients (nearly one million people) has returned to the same life expectancy as the general population and can be considered cured. Important results, obtained thanks to increasingly effective therapies and prevention campaigns, which however, due to the pandemic, have suffered a setback as well as screenings. But the research does not give up and has never stopped not only to find effective therapeutic weapons against Covid-19 but also to make the tumor increasingly weak and winnable. In this interview Cristian Massacesi, Senior Vice-President, Head of Oncology Research and Development for Advanced Development at AstraZeneca, a medical oncologist now guiding 1100 people in various countries around the world, explains how his company aims to beat cancer and what ‘lessons’ they have learned from Covid-19.
How did you participate in this American Society of Clinical Oncology Congress which closes today? What impact the data presented will have?
It is a very important edition and it is extremely rich for us because for the third consecutive year we present studies in plenary session, the forum in which the studies considered capable of changing clinical practice are presented. This tells us how important science is in our company and what we want to do is radically change the status quo. In particular, in the plenary we presented the OlympiA study on our Parp inhibitor olaparib (ed co-developed by AstraZeneca and MSD), currently approved for metastatic disease, used in an early stage of breast cancer. We have tested it on patients with Brca genetic mutation who are generally very young so much so that girls of just 20-25 years old with an average age of 50 also participated in the study. The results obtained could really change clinical practice because previously these patients had only chemotherapy as an option while now they can take advantage of a target therapy for their Brca gene mutation. Certainly it represents 5% of all patients with breast cancer, therefore a small group but nonetheless not negligible given that breast cancer is the most common among women.
At Asco you also presented the data from the Pacific study for stage 3 lung cancer considered practically incurable until a few years ago. Today, therefore, can it be said – with due caution – that all cancers are curable?
The Pacific is a study of patients with stage 3 non-small cell lung cancer, i.e. inoperable but who can have chemotherapy plus radiotherapy. Until now this disease was considered incurable, but the data presented to Asco tells us that we have obtained an average survival of 47 months, more than 40% of patients are alive at five years and more importantly 1 in three patients after 5 years has not yet had disease progression. Here, now we begin to ask ourselves if we can consider these patients cured. We don’t really know, but with the progress we are making we can aim for this goal. Change the patient’s perspective. We have understood that through different mechanisms of action, in particular by manipulating the immune system to act against the tumor, we can control the disease for longer and sometimes, in a still small number of patients, the immune system together with other treatments. specific can eradicate the tumor. This happens, for example, in melanoma, lung and kidney cancer in which the immune system plays a primary role. But what has changed and can really make a difference is the switch made in the early stages. It is no coincidence that the common thread of this year’s Asco are the data and studies of many companies in various types of cancer, from breast, lung, kidney, which show increasingly important benefits in early stage patients who can act to prevent the disease from returning. The idea is to bring the therapy to the patient as soon as possible because in this way the chances of getting well are even greater.
But for these effective drugs to be administered as soon as possible, diagnosis must be early and for many cancers this is not the case, even more so during the pandemic. It’s like having blunt weapons: what role do you play?
The diagnosis must gallop as quickly as possible, but unfortunately Covid has put a stop to it. In the United States, for example, we had 10 million fewer diagnoses than in the pre-Covid period for breast, prostate and colon cancer. But the pandemic will pass by leaving us some ‘lessons’ not to be forgotten, starting with the possibility of being helped by technology precisely to make diagnoses in a different way, also using new technological approaches with genomic screening carried out with a simple blood sample that can predict and increase the early stage diagnosis. As a company we are working to encourage early diagnosis with an integrated approach. It will be essential to work together with the scientific community to give women with early stage cancer the opportunity to access genetic testing because currently testing for the Brca mutation is a custom in advanced disease for which drugs are approved. The problem will be creating the culture and guaranteeing access to genetic testing even in the initial disease, but now that we have this data we will do everything possible to expand access.
The Covid-19 pandemic has had strong implications on the entire patient care pathway, from diagnosis to treatment. What implications did you think have on clinical research in oncology and what lessons have we learned?
As AstraZeneca we managed to overcome the pandemic very well, especially in oncology: more than 80% of all cancer programs went ahead without delay. We had to work with individual countries to develop projects that could give a concrete hand. For example, by shipping the drug that the patient took during the trial home instead of sending it to the hospital, or by setting up a remote system for monitoring the patient’s condition. We have learned a lot and will treasure both the digitization and the simplification of research processes.
What will the research focus on in the near future?
Our strategy is based on three keywords: early, harder and smarter. That is, to get therapy in the early stages because there we can make a difference and treat patients, develop drugs that really make a difference and that are based on strong molecular targets developed to inhibit specific targets and finally take that extra step by developing the medicine of precision, identifying new subgroups of patients. We have a large portfolio in breast cancer oncology, we want to become the first pharmaceutical company in this sector. We also have new studies in lung cancer in both small cell and lung microcytoma; we are developing hematology in an important way and we have other products and many studies in progress for bladder, gastric and liver cancer.
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