New treatments for Her2+ breast cancer, the experts gathered in Bologna
At the center of the meeting, promoted by Roche, neoadjuvant and subcutaneous therapies
BOLOGNA – In Italy, approximately 20% of breast cancer cases are of the Her2+ type, a particularly aggressive form because it is more capable of recurring and spreading to other organs. To treat it, there are new treatment opportunities that can generate a significant impact on survival, on the quality of life of patients and on the efficiency of hospital centers for the healthcare system. These innovations were discussed today at the Bologna stage of the Dual Answher2+ meeting cycle promoted by Roche, which brought together experts and specialists in a day of studies at the Nh Hotel de la Gare, after touching on the in recent days also Milan and Rome. Focus of the meeting, the evolution of treatment paths in breast cancer, including technological and therapeutic innovations: among these, neoadjuvant therapies and subcutaneous formulations, increasingly “key” elements, were examined in particular which contribute to improving treatment paths.
In particular, the reimbursement of the combination of trastuzumab and pertuzumab plus chemotherapy has recently changed the therapeutic decision-making process for Her2+ breast cancer in the pre-surgical neoadjuvant context. Known as double blockade, it improved survival in patients at high risk of recurrence. The introduction of subcutaneous formulations represents another important opportunity to optimize the treatment path. Compared to the intravenous formulation, it reduces setup, administration, observation times and direct and indirect costs, with benefits both for the organization of the hospital center and for the patients’ quality of life.
“Neoadjuvant (pre-surgical) therapy is now the standard in Her2+ tumors – explains Claudio Zamagni, director of breast and gynecological medical oncology at the Ircss Policlinico Sant’Orsola in Bologna – the complete disappearance of the tumor or the its reduction at the time of surgery are informative elements for the patient’s prognosis: this allows the treatment to be modulated after the surgery, with the aim of avoiding recurrences after the therapy is still necessary to document the complete pathological response with histological examination, butwe already imagine the day when, instead of surgery, a series of biopsies will be doneOn the other hand, that of anti-therapies Her2+ is a story of great results: there are metastatic patients who, having started treatment over twenty years ago, are alive and well”.
Confirming how this innovation is revolutionizing treatment paths, positive trends are being recorded: today high-risk patients who access a neoadjuvant treatment are 54% of the total women with Her2+ cancer in the early phase, a percentage that increases to almost all (85%) if compared to the high-risk sub-population, for which the combination is specifically indicated. At a macro-regional level, in Emilia Romagna, Veneto, Friuli Venezia Giulia, Trentino Alto Adige and Marche, there is a percentage in line with the national average (51% out of 54%), but “which can be further improved”, in light of the benefits clinical findings that can be obtained: almost 60% of patients who benefit from this opportunity have a complete pathological response.
However, the situation is different with respect to the opportunity of the subcutaneous formulation, with paths that can still be optimized, to fully grasp all the advantages that this option offers, allowing a real and profitable evolution of the System, only if desired by all. “Recent innovations in the treatment of Her2+ breast cancer demonstrate how precision oncology and the optimization of resources can improve clinical outcomes and the quality of life of patients– comments Fabio Puglisi, director of the Structure complex operation of Medical Oncology and Oncology Prevention of the Oncology Reference Center of Aviano (Pordenone) – neoadjuvant anti-Her2 therapies, with trastuzumab and pertuzumab, significantly improve the rates of complete pathological response and long-term survival, allowing personalized therapeutic strategies At the same time, the subcutaneous administration of these drugs offers significant advantages for patients and the healthcare system. It drastically reduces treatment times and time in hospital, improving patients’ comfort and quality of life , including work-related ones, preventing ‘financial toxicity’. Furthermore, it optimizes the use of hospital resources, reducing costs and freeing up space in oncology drug administration units.”
A key factor to guarantee optimal access to new pathways is represented by the multidisciplinary team or Breast Unit. According to Annalisa Curcio, director of the Forlì-Ravenna breast surgery complex operational unit of the Romagna AUSL: “The path of neoadjuvant therapy is the clinical area in which the importance of a multidisciplinary approach is highlighted to the maximum.
The The need to integrate biological and oncological radiological data makes the path of neoadjuvant therapy essential from the shared evaluation of the radiologist, pathologist, surgeon, oncologist and radiotherapist. Teamwork and the integration of clinical and scientific skills offers the patient constant references and guarantees of responses to her clinical needs and needs, as a patient and as a woman. Surgery is still an important step, but the effectiveness of the therapies and the high rate of complete pathological responses obtained thanks to these new paths, constitute, for the future, the possibility of increasingly conservative interventions up to the desirable omission of surgery”.
Alfredo Santinelli, director of the complex operational unit of Pathological Anatomy of the Ast Pesaro-Urbino Marche Region, explains: “The multidisciplinary team was a fundamental step for contemporary oncology and the role of the pathologist is at the basis of the whole work, because the work of the other members of the team, the oncologist and surgeon first and foremost, is calibrated and organized on his diagnosis. In Her2+ tumors, the weight of the pathologist has been increasing, because his report is essential for targeted or targeted therapies. The pathologist establishes the targets, typically proteins and gene mutations, and the oncologist establishes how to target them. The pathologist comes into play before and after surgery, because he provides as precise an identity card as possible of the needle biopsy neoplastic tissue taken by the radiologist, before, and of the neoplasm removed by the surgeon, afterwards. And now, with neoadjuvant therapy, the possibilities for intervention are even more perfect.”
Breast cancer is the most common neoplasm among women and, with almost 56,000 new cases every year, it is confirmed as the most diagnosed cancer in 2023 in Italy. At a global level, the statistics are equally significant: every 20 seconds a new diagnosis is recorded (for a total of 1.67 million new cases) and every 5 minutes more than three women die from breast cancer, for over 500,000 deaths per year. Approximately 20% of patients have Her2+ breast cancer, a particularly aggressive form because it is more likely to recur and spread to other organs: in the majority of cases it can be diagnosed when the tumor is in the initial stage, for a total of 8,200 women with Her2+ breast cancer in the early stage in Italy.
