Lung Cancer, a New Targeted Therapy Instead of Chemo

No more chemotherapy, but a targeted drug that has proven to be much more effective in reducing the risk of recurrence. The news concerns a fairly rare form of lung cancer, the one that presents the mutation (or, better, the translocation) of the ALK gene, and which represents 3 to 5 percent of non-small cell lung carcinomas.

For these patients - who are often young and non-smokers - the drug alectinib, already used in metastatic cases, can now be prescribed in Italy also in early cases with a high risk of recurrence (stages IB-IIIA). This is the first approval by Aifa (Italian Medicines Agency) of a molecular target therapy as an adjuvant treatment for this form of cancer.

What it means to face a relapse

In 2024, it is estimated that lung cancer will affect almost 45 thousand people in our country. Of these, about 30% can be operated on. Depending on the molecular profile and the stage, however, there may be a high risk that the tumor will return: in the case of ALK-positive lung cancer, this occurs in about half of the cases within three years: "We know that even in the initial stages, despite radical surgery being the gold standard of treatment, the disease is not curable in one hundred percent of cases - says Silvia Novello, full professor of Medical Oncology at the University of Turin, director of Medical Oncology at the San Luigi Hospital in Orbassano and president of the Walce association (Women Against Lung Cancer in Europe) - What happens to that patient and that family when the disease returns? That is often the most difficult moment also on a psychological level, because the hope of having left everything behind after the surgery and the first treatments is very strong. Therefore, having a drug that is able to significantly reduce the percentage of recurrence in ALK-positive patients who have undergone surgery is a real change in the scenario of thoracic oncology, which leads to a real improvement in the recovery process. care, life expectancy and quality of life of patients”.

A targeted therapy against Alk mutations

The improvements Novello talks about - and on which Aifa's decision was based - had been demonstrated by the Alina clinical study: a 76% reduction in the risk of relapse or death compared to platinum-based chemotherapy. Added to this is a reduction or slowing of the appearance of brain metastases, which have a stronger emotional impact on the patient than those in other locations.

“The results of the Alina study demonstrated the superior efficacy of alectinib in reducing the risk of disease recurrence compared to standard chemotherapy, with a favorable tolerability profile. These findings offer a new therapeutic opportunity for patients in the early stages of translocated ALK disease,” confirmed Filippo de Marinis , president of the Italian Association of Thoracic Oncology (Aiot) and director of the Thoracic Oncology Division of the European Institute of Oncology in Milan. “Adopting a personalized approach, which takes into account the individual characteristics of the patient and the disease, represents a fundamental strategy in the early stages of the tumor.”

Genomic profiling from the earliest stages

Testing patients to identify any mutations, such as those of ALK, therefore becomes essential even in patients with early-stage disease, and not only for the metastatic phase. But how widespread is the use of these molecular tests? “If we talk about performing tests even before surgery, it is not yet a consolidated practice - responds Luisella Righi , associate professor of Pathological Anatomy at the University of Turin, San Luigi Gonzaga Hospital - Bridging the existing gaps is essential to guarantee all patients personalized and truly effective treatment from the initial stages of the disease”.

The approach must always be multidisciplinary

In short, surgery remains fundamental, but results are achieved only if it is inserted in a context of real multidisciplinarity. Which, for Francesco Facciolo , ????president of the Italian Society of Thoracic Surgery, is less widespread than it should be: "The availability of new pre- or post-surgery therapeutic options is strengthening the need for this synergy, but there is still room for improvement. It is essential - he concludes - to optimize the dialogue between the different specialists, especially between oncologists and surgeons, to ensure timely and truly integrated care of the patient".