Posted Sep 13, 2022, 1:09 PM
Oncology leaps and bounds . The annual congress of the European Society of Medical Oncology (Esmo), which has just been held this year in Paris, recalled the importance of “targeted” therapies, which combat genetic mutations in diseased cells.
The latter cause only a part of cancers. But when this is the case, targeted therapies can hit the mark. And since mutations are common to cancers of different organs, “we are focusing more and more on the mechanism of action, rather than on a given tumor”, notes Dana Vigier, vice-president oncology at AstraZeneca France.
Long term survival
Thus, the Lynparza, a flagship of AstraZeneca and the American Merck MSD, targets the BRCA genetic mutation present in cancers of the ovary, breast, pancreas (less often) and prostate. A Lynparza study unveiled at Esmo has shown, for the first time, long-term survival with this class of targeted therapies that act on DNA to prevent cancer cell repair.
The results are convincing. In ovarian cancer, seven-year survival is 46.5% for the placebo group once morest 67% for those who had Lynparza. “The possibility of curing cancer was mentioned in these situations of tumoral genetic mutations, by the presenters and participants at Esmo”, emphasizes Dana Vigier. The BRCA mutation, which condemned its victims ten years ago – hence actress Angelina Jolie’s decision to have a preventive mastectomy – has become a chance.
25% of ovarian cancers have a BRCA mutation. But it is part of a larger group of so-called HRD mutations (50% of ovarian cancers) for which similarly, the five-year survival is 65% with Lynparza associated with a classic anti-cancer drug from Roche (l ‘Avastine).
Results never seen
Among the most spectacular results presented at Esmo is a study of the 15% of colorectal cancers with the MMR mutation. “There was a standing ovation! enthuses Pascal Pujol, onco-geneticist at Montpellier University Hospital and president of the French society for personalized medicine. Of 107 patients with advanced but non-metastatic cancer, only 7% improved with conventional chemotherapy before surgery, compared to 95% with major improvement by combining two products from the Bristol-Myers Squibb (BMS) laboratory, including its flagship drug Opdivo ( 7.5 billion dollars in sales last year), which targets the mutation. “67% no longer had a tumour, on advanced cancer. Never seen ! says Pascal Pujol.
The interest of targeted therapies is no longer debated. At this stage, there are 122 authorized in France. It remains to have access to it. They involve testing to find out if cancer is due to genetic mutations and which ones. However, for lack of support for the tests by Health Insurance, “some French people are not tested. For them, it’s a real loss of chance, ”denounces Pascal Pujol.
Deprived of tests
Only tests for known genetic mutations before 2015 are supported. In 2015, it was decided to finance the tests on a separate envelope, pending the opinion of the High Authority for Health (HAS) on reimbursement. Since then, nothing has changed, not even the annual budget. The envelope therefore no longer finances the tests at more than 45% or 50%.
The institution requesting the test pays the rest. Hard for small hospitals. As well as for private establishments, which in oncology treat half of the patients. “This leads to a double inequality in oncological care: territorial and according to the type of establishment”, underlines Pascal Pujol.
Notice in October
This and a lack of ongoing training by some oncologists means that many patients who should be tested are not. Thus, “in breast, ovarian and prostate cancer, therapies once morest the BRCA mutation being effective, all metastatic patients should be tested. There are no figures but we know that we are far from the mark, ”comments Pascal Pujol. There are 30,000 BRCA tests per year, and ovarian cancer is well monitored because we know that the mutation is often hereditary, but 30,000 tests are missing given the number of new metastatic cancers or poor prognosis in the breast and prostate. (10% BRCA mutation).
To treat the approximately 300,000 new French patients per year, at this stage, “we have 44 markers of genetic mutations, including a dozen in lung cancer for example. It would take around 500,000 tests per year, ”estimates Pascal Pujol. The High Authority of Health must decide in October and the professionals are in the starting blocks.
