Liquid biopsy, how much women with advanced breast cancer need it and why there is room for improvement

The perceptions of patients and caregivers make it possible to delineate current issues and, above all, to map out the future. Even and especially when it comes to advances in cancer diagnosis that heavily impact the therapeutic approach, case by case. In this sense, liquid biopsy represents a paradigm of what science can offer and how important it is to offer patients the test, obviously when appropriate. Unfortunately, according to the perceptions of patients with endocrine-responsive and HER-2 negative metastatic breast cancer and their carers, the numbers are not yet fully satisfactory. Only one in ten women would have undergone liquid biopsy. This is stated by a survey promoted by the AIOM Foundation (Italian Association of Medical Oncology) among patients and caregivers as part of the national Metastatic Breast Cancer and ESR1 Mutation campaign. The data were presented, which also included activities to raise awareness and knowledge among patients and pathways for oncologists, at the end of the project, which was made possible with the unconditional sponsorship of Menarini Stemline.

In Italy, there are more than 50,000 cases of metastatic breast cancer. Approximately seven out of ten cases are patients with hormone receptor positivity and HER2 receptor negativity, for which the focus is on endocrine therapy aimed at slowing down the 'fuel' for tumour cells. Unfortunately, according to experts, resistance to treatment develops in certain cases due to specific genetic mutations. "One of these is ESR1, but today targeted therapies have been developed that also work for metastatic stages of the disease," emphasises Saverio Cinieri, Past President of the AIOM Foundation. "However, innovative diagnostic tests such as liquid biopsy are essential. By means of a blood sample, the test can highlight the presence of certain mutations from which it is then possible to verify the possible usefulness of administering specific drugs. Every year in Italy there are more than 7,800 patients with breast neoplasia who could benefit from a test that produces advantages both for the individual sick woman and for the entire national health system. However, the blood sample must only be analysed in laboratories with appropriate instrumentation to ensure that certain quality parameters are met'.

Again according to the AIOM Foundation, 22% of oncologists do not make regular use of liquid biopsy, although more than four-fifths of specialists think it should be prescribed more frequently. "It is a test that is becoming more and more important, and not only in the treatment of breast cancer," continues Alberto Zambelli, Director of Medical Oncology at the Papa Giovanni XXIII Hospital in Bergamo and Associate Professor of Oncology at the University of Milan-Bicocca. "One of the next challenges for our national health service is to guarantee advanced diagnostics to all women as quickly as possible. The test also appears important in light of the development of increasing new therapeutic possibilities even for the metastatic phase of the disease. Therefore, more and more women in Italy and Europe will need the liquid biopsy, which should thus enter daily clinical practice, to detect certain mutations in advanced metastatic carcinoma. It can also be repeated without problems over time and thus allow continuous monitoring of the evolution, in real time, of the tumour. 'There are, in some regions, good organisational models that are able to deliver the test fairly quickly,' Zambelli concludes. They can also be taken as an example by other territories that are currently experiencing difficulties in guaranteeing access to the test'.