What a change in the approach to patients! In recent years, supportive care featured prominently in Congress. In 2017, it was a study relating to the monitoring of the side effects of treatments by the patients themselves which was presented at the opening session. Each week, patients treated for advanced cancers of the breast, of the’uterus or kidney completed an online questionnaire to describe their condition. A nurse studied them live and, in three quarters of cases, had to initiate an intervention. Result compared to monitoring in consultation: better quality of life, less need for emergencies and increased survival!
Spectacular remissions for certain lung cancers
“More drugs have been approved in the lung cancer in two years than in the previous forty years. The aim is that, in the near future, people will live as with a chronic disease“. It is not a doctor who speaks, but an American, Bonnie Addario, survivor of lung cancer deemed inoperable in 2001! Yesterday, more and more patients beyond all therapeutic resources are experiencing prolonged remissions, especially in the melanoma and lung cancer. At the origin of these results, the treatments which correct the mutations discovered in the cancerous cells (targeted therapies) and those which stimulate the immune system (immunotherapy).
Confirmation of the benefit of immunotherapy
We now know that theimmunotherapy works, and that it is sometimes spectacular. “Nearly 20% of patients suffering from lung cancer are still there three to five years later,” said Professor Denis Moro-Sibilot, president of the IFCT (French-speaking intergroup of thoracic cancerology). “Patients who have had to stop their treatment do not relapse,” said Dr Aurélien Marabelle oncologist in Gustave Roussy (Villejuif). Others see a metastasis accessible, we remove it and they continue to do well. These results have led the United States to speed up the procedures for registering molecules. The usual ten years are over: authorizations were given in two and a half years. But immunotherapy only works in 20-30% of patients. We are therefore trying to do better: no less than 1,000 studies concerned trials of immunotherapy associated with other treatments.
Make way for therapeutic associations
The immune system is very complicated. Lymphocytes, these white blood cells responsible for eliminating cancer cells, do not always manage to approach them. Treatments are therefore combined: two immunotherapies (anti-PD-1, PD-L1, Ido inhibitors), or one immuno and one chemotherapy, or an immuno and an antiangiogenic (preventing the formation of new vessels). In metastatic breast cancer, immuno increases survival by 15%. With the additional chemo, we go to 30%. And an abnormality called MSI, found in 5-10% of advanced cancers, regardless of the organ, responds well to immunotherapy. The future of oncology is undoubtedly here, experts said: treating abnormalities in cancer cells and the immune system, regardless of the organ in which they developed. For now, this approach only concerns relapses.
The hope of genomics
Long reserved for research, the analysis of the genome of tumors is now entering practice. Dr Olivier Tredan (Lyon) presented the results of the genetic analysis of metastatic tumors in 2,000 people, mostly from the Rhône-Alpes region. In 676 of them, mutations were found and 143 were able to benefit from treatment correcting them. With very encouraging results. This study tested 69 genes. Foundation Medicine offers the analysis of 315 genes in ten days. With the development of targeted therapies and immunotherapies, it becomes essential to know which abnormalities to look for and which treatment combinations are the most relevant. Individual medicine is on the move.
3 good news
New in breast cancer
• Conduct a pregnancy after cancer does not increase the risk of recurrence. A study is even underway to verify whether it is possible, without loss of luck, to stop thehormone therapy, have her baby and resume after.
• Add a second treatment against the receptor HER2, found in 30% of breast cancers, decreases the risk of recurrence. The gain is modest, because the first anti-HER2 treatment (trastuzumab, or Herceptin®) is already very effective. But, thanks to this association, we could approach 90% of women who have been successful.
A breakthrough in prostate cancer
• The study presented at the inaugural session by Prof. Karim Fizazi (Gustave Roussy) showed that hormonal treatment with abiraterone (an antienzyme which opposes the secretion of androgens by the adrenal glands) decreases the risk of death of 38%. This would make it possible to avoid chemotherapy. The drug (4 tablets per day) is taken at once, in addition to the classic hormonal treatment, which removes androgens from the testes (monthly or quarterly injection). Well supported, it is aimed at very advanced forms.
Nanoparticles to boost radiotherapy
• NBTRX3: under this acronym perhaps hides a revolution. Before the radiotherapy, a dose of hafnium nanoparticles is injected into the tumor, which boosts its effect. Incorporated into cancer cells, these particles allow them to absorb nine times more energy from rays. The interest of this method proposed by the Nanobiotix laboratory: delivering more rays to be more effective or reducing the doses to be better tolerated. The results presented concerned 12 patients treated for cancers ENT very serious. In addition to the local effect (melting of the tumor), there seems to be an immune stimulation which would explain the prolonged effect, sometimes for more than a year. If these results are confirmed, this strategy could be applied to many radiotherapies. Almost 69% of cancer patients receive radiation.
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ASCO 2016: 10-year hormone therapy for breast cancer reduces risk of recurrence
Cancer: very promising therapies!