Tumours, increasingly effective treatments thanks to 'combo' therapies: novelties for breast, stomach and bladder

In the ever-building mosaic of cancer treatments, research is adding a series of pieces that reveal how and to what extent there is room for improvement in treatment. The pieces that fit into this jigsaw puzzle start with conjugated antibodies, designed to act selectively on specific tumour cells by releasing a potent and targeted chemotherapeutic agent into them, and end with immunotherapy, which, as the fourth 'leg' of cancer treatment, is finding ever greater scope even for particularly difficult-to-treat neoplasms. The hopes for increasingly effective and targeted therapies, thus reducing potential side effects, are shown by many of the studies presented at the European Society of Medical Oncology (Esmo) Congress in Berlin.

Metastatic triple-negative breast cancer represents one of the most complex challenges to be faced, but there is no shortage of good news. Information from the Phase 3 Ascent-03 study shows a statistically significant and clinically relevant improvement in progression-free survival (Pfs) with sacituzumab govitecan compared to chemotherapy alone as first-line treatment of patients with metastatic triple-negative breast cancer in patients who are not candidates for treatment with PD-1/PD-L1 inhibitors.

I risultati, che sono stati pubblicati anche su New England Journal of Medicine, dicono che la Pfs migliora, con una riduzione del 38% del rischio di morte o di progressione di malattia con sacituzumab govitecan rispetto a chemioterapia. «Le pazienti con tumore della mammella triplo negativo metastatico non eleggibili all’immunoterapia presentano una prognosi sfavorevole, con opzioni terapeutiche limitate e una rapida progressione di malattia – spiega Giuseppe Curigliano, presidente eletto Esmo, professore di Oncologia medica all’Università di Milano e direttore divisione Sviluppo di nuovi farmaci per terapie innovative allo Ieo di Milano - Sacituzumab govitecan, il primo farmaco anticorpo coniugato diretto contro Trop-2, si è già dimostrato efficace nel migliorare la sopravvivenza sia nel tumore della mammella metastatico triplo negativo che in quello HR+/HER2-, la forma più diffusa di carcinoma mammario».

In addition to confirming the value of the association between the antibody conjugate and pembrolizumab immunotherapy in metastatic PD-L1-positive breast cancer, data from the phase 3 Tropion-Breast02 trial were also presented, showing that datopotamab deruxtecan offers a statistically significant and clinically relevant improvement in the two primary endpoints, overall survival and progression-free survival (Pfs), compared to investigator-guided chemotherapy for the first-line treatment of patients with locally recurrent, inoperable or metastatic triple-negative breast cancer for whom immunotherapy was not indicated.

Pembrolizumab, an immunotherapy drug, plus enfortumab vedotin, administered before and after surgery (radical cystectomy), reduce the risk of occurrence of new events by 60% and the risk of death by 50% compared to surgery alone, the current standard of care, in patients with muscle-invasive bladder cancer who are ineligible for or have refused platinum-based chemotherapy.