For many years, just hearing a diagnosis of malignancy in most people’s minds equated to a bad ending.
Fortunately, however, in recent years, many weapons have been added to the quiver of oncologists, and great progress has been made in the treatment of all malignancies.
In fact, developments in anti-neoplastic treatment now exceed the predictions of previous years, with an increase in life expectancy, improvement in the quality of life of sufferers, optimization of treatments with the use of targeted agents and immunotherapy and in many cases offering a complete cure.
“As is known, the immune system is very important, because on the one hand it constitutes the body’s natural defense against hosts and on the other hand it contributes to the treatment of cancer cells. Immunotherapy is treatment that uses specific parts of the patient’s own immune system to fight diseases such as cancer. This can be done in two ways: either by inducing or forcing the immune system’s own natural forces to discover and attack the cancer cells, or by making biological molecules in the laboratory that are exactly the same as the immune system components used in the improving the mode of action of the defense mechanism against cancer cells”, explains Mr. Nikolaos Kentepozides, MD, MSc, PhD, Pathological Oncologist, Director of the 4th Oncology Clinic Metropolitan General.
Although biomolecule therapy was initially applied to malignancies such as lung cancer, bladder cancer and melanoma, it is now being extended to more and more forms of cancer, such as gastrointestinal malignancies.
This category includes esophageal-stomach cancer, colon and rectal cancer, pancreatic cancer and liver and biliary tract cancer. These are different categories of neoplasms, but with a common denominator: the reduction of incidence and mortality in countries of the Western world, both in men and women.
In everything to do with developments in gastrointestinal cancers, the molecular profile of these tumors plays an important role. In recent years the testing of biomarkers such as MSI, PD-L1 and TMB have added immunotherapy to the treatment options with encouraging results.
In particular, moving to each category, in esophageal-stomach cancer, both immunotherapy and treatments targeting the HER-2 gene are now applied. In fact, in esophageal cancer, pembrolizumab has now been approved in the first line in combination with platinum and 5-FU in patients who are not suitable for surgical excision or radical chemo-radiotherapy.
In colorectal cancer, immunotherapy has gained approval in the first line of patients with metastatic colorectal cancer who display microsatellite instability, increasing both progression-free interval (PFS) and overall survival (OS).
In addition, in addition to molecular screening with KRAS, NRAS and MSI, screening for HER-2, BRAF and NTRK expression has been added to daily practice, so the corresponding targeted or targeted therapies are also applied.
In pancreatic cancer, a disease with few therapeutic options to date, the control of microsatellite instability, as well as the control of BRCA 1 and 2 gene mutations have now offered additional therapeutic solutions with the application of immunotherapy and PARP inhibitors respectively in these patients.
In liver cancer, now in the first line the combination of immunotherapy (Atezolizumab) together with the monoclonal antibody bevacizumab has increased both the progression free interval (PFS) and the overall survival (OS) compared to sorafenib, which for many for years it was the predominant treatment for this particular disease.
Finally, in biliary cancer, beyond the administration of immunotherapy, the rearrangement control of the FGFR gene has offered an additional therapeutic option to these patients with the oral administration of the substance pemigatinib.
“In conclusion, we see that in the era of personalized treatment, our therapeutic options have increased, but there is an urgent need to find the appropriate biomarkers, so that in the future we will be able to administer the appropriate drug to the appropriate patient,” concludes Mr. .Centeposides.
Written by:
K. Nikolaos Kentepozidis, MD, MSc, PhD, Pathological Oncologist, Director of the 4th Oncology Clinic Metropolitan General
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