Metastatic breast cancer: 'Time to make liquid biopsy available'

To finally make the extension of the use of liquid biopsy in the treatment of metastatic breast cancer effective, an extra weapon for the 53,000 women affected by this cancer every year and for the 15,500 patients with metastatic breast cancer. The novelty that has yet to be implemented is already envisaged thanks to an amendment approved in the last budget law and of which Elena Murelli, Senator (Lega), Secretary of the Presidency, member of the Health, Labour and Social Affairs Commission and President of the Parliamentary Intergroup on Genetics and Genomics, was the first signatory. Since the beginning of the parliamentary term, Murelli has been working closely with scientific societies and patient associations on this very front.

But what are the benefits for patients? "We wanted to give new hope to women affected by breast cancer. With an amendment, with my first signature, we allocated part of the health fund for prevention provided for in Article 64 to the extension of genomic tests, on liquid biopsy samples, to detect ESR1 mutations in cases of locally advanced or metastatic breast cancer positive for oestrogen receptors (ER) and negative for HER2. The aim is to intervene earlier and more effectively in one of the most difficult moments of the disease in the metastatic form, i.e. progression'. But why can liquid biopsy be a breakthrough in these more severe cases? 'Precision medicine, personalisation of treatments and research,' Murelli emphasises, 'are changing the prospects for treatment. With certain genomic tests we can analyse the circulating tumour DNA and this allows a better selection of therapies. These benefits must be guaranteed to all women in need of cancer treatment. Liquid biopsy, for the detection of ESR1 mutations, is indeed a clinically relevant tool to appropriately guide treatment choices. It can improve the effectiveness of treatments and contribute to a more efficient management of healthcare resources'.

The crux of the matter, however, is now to make the test available, and it is now up to the Ministry of Health and the regions to really implement this new opportunity, as Murelli also confirms. He emphasises that the task of the Ministry of Health is to write the implementing decrees of the Budget Law: 'It has to be put in black and white how these tests can be offered nationwide. The measure must be submitted to the State-Regions Conference and then be made operational in the 21 different regional health services. The entire implementation process must be completed quickly so that the resources allocated are actually available and can be translated into uniform access to the test throughout the country'.

For the senator, it is necessary to continue investing in oncology and especially in the identification of new diagnostic and therapeutic tools because 'research and innovation are crucial if we want to defeat widespread cancers such as breast cancer. Diagnostic tools are of great importance, particularly in the early detection of the disease. I believe very much in these new tests and, in fact, I am President of the Parliamentary Intergroup on Genetics and Genomics. Tests that study our DNA are now indispensable because every person is different and therefore every patient has their own characteristics and peculiarities. If we want to move towards personalised medicine, genetic and genomic tests and advanced diagnostics are the tools to start with'.

For Murelli, it is then necessary to invest in preserving an excellence of our national health service such as oncology, under which there are some inefficiencies and the need for reorganisation: 'It is necessary, for example, to implement and make operational all the Regional Oncology Networks as soon as possible. There is also a need for greater interaction between the various cancer registries at the regional level, which must be able to feed their data into the National Registry. This has not yet been possible also because of some IT problems, as the Istituto Superiore di Sanità reported at a recent conference. These are problems that must be resolved as soon as possible. More generally, however, Italian oncology is an excellence of the national health service and this is demonstrated by many statistics that place our country at the top in Europe for cancer cure and survival rates'.