One of the coordinators of this project is Dr. Dolores Isla, Chief Medical Officer of the University Hospital Clinic Lozano Blesa (Zaragoza), who explains the main principles of Consensus. We also met Dr. Javier de Castro, President of ICAPEM.
Pregunta. How do you believe it is necessary to establish this Consensus on the diagnosis and treatment of patients with CPNM with EGFR mutation?
Respuesta. Dolores Isla. Our main objective is to optimize the diagnostic and therapeutic strategy of our patients in Spain and to help in the decision-making process in clinical practice. Currently, the clinical guidelines are always considered in all the possible clinical situations, by which a position of Spanish experts in pulmonary ante scientific evidence is established regarding diagnostic aspects, the most characteristic features are result of great interest.
Why did ICAPEM really want to encourage the creation of this Consensus?
Javier de Castro. From the association impulsive the research on the biological and ambient characteristics that provoke gender differences in pulmonary cancer. The CPNM with EGFR mutations is preferably female. For this reason, from ICAPEM we will carry out a revision analysis that will be updated with the clinical guidelines. In recent years, he has introduced therapeutic innovations of great value to patients and we will facilitate their access to the same.
How did you reach this Consensus?
DI If a Scientific Committee is formed, formed by six oncologists who specialize in pulmonary cancer, among whom are the coordinators, the doctor Óscar Juan-Vidal, adjunct physician of the Service of Oncology Medical Hospital of the University of La Fe (Valencia) and yo misma. From the Committee, 33 establishments have been established regarding the diagnosis and treatment of this pathology. Through the selection of a panel of experts from 31 oncologists also specialized in the subject, some assessments are evaluated according to the degree of agreement or disagreement. It is clear that the degree of consensus was very high.
What are the most relevant conclusions of this document?
DI. In view of the treatment of patients with advanced CPNM and carriers of the EGFR mutation, there is a high degree of consensus to consider osimertinib as the best option in the first line of treatment of patients with mutations that increase libido to perfection. global survival in comparison with other TKI-EGFRs of first and second generation.
In terms of diagnostics, the most important conclusion was the need to know the state of the EGFR Independent mutation state and the inclusion of the liquid biopsy as a molecular diagnostic alternative when the biopsy was performed. I also have a consensus on the importance of testing images of the central nervous system at the time of diagnosis.
Why is it important to perform a molecular diagnosis of pulmonary cancer?
JC Knowing the state of the EGFR mutation in this type of patient, as well as conducting a biomarker analysis is fundamental to marking the treatment strategy. The discovery of the EGFR gene is one of the most important advances in pulmonary cancer because it allows us to apply therapies that act directly on this mutation, thus increasing the patient’s response to months to years, with a clear benefit in survival. It is actually a model of personalized medicine and precision therapy.
Indeed, the advances in diagnostics are very relevant, as the most recent innovations in CPNM have been produced in the age of guided therapies. It is vital to carry out an exhaustive revision of the biomarkers at each stage of the procedure to apply in each case the therapeutic strategy appropriate for each type of patient. It’s appealing to the degree of personalization that medical oncology is experimenting with in the last few years and it is inconceivable that we will incorporate it.
According to this Consensus, what kind of recommendation in the case of progression of illness?
DI Following the extended consensus, in the case of oligoprojection both with first-line osimertinib, it is recommended to maintain this treatment and add another local progression of the unacceptable toxicity, number and how to recover it.
In case of progression of the disease, it is recommended that a new biopsy be performed and that it be prioritized to include the patient in a clinical trial.
Do patients suffer from pulmonary cancer?
JC It’s the most common tumor in the world. In Spain it is the most frequent quarter, representing 10% of all cancers. Además, is the one that produces a mayor mortality: a 20% of all cancers in Spain. Specifically, the CPNM represents between 85% and 90% of all pulmonary cancers, since adenocarcinoma is the most common subtype. In our tumor, EGFR mutations are approximately 10% -12% of patients with adenocarcinoma. Although we know that this type of mutation is most common in non-smokers, women and Asians it is important to be able to present to any patient with this condition, which requires a dedicated biomarker study.
What hope to have with this Consensus?
JC We hope to find in a study that can help Spanish oncologists improve their treatment strategies for non-microcessive pulmonary cancer and, above all, focus on the importance of molecular diagnostics to optimize treatment. All in all, a major boost for the quality and life expectancy of patients.
DI Health care professionals need to be informed and preoccupied with providing the ultimate advancement to patients who are better adjusted to their situation. We are aware that we are able to increase the life of patients with an increase in their quality of life. As the Coordinator of this Consensus, you are satisfied to be able to contribute as a support in the decision-making process in your patients’ attention.
It is hoped that by 2040 there will be 40,000 new cases of pulmonary cancer, of which 25% will soon be in women.
JC In the last few years, a remarkable amount has been detected in cases of pulmonary cancer in women. One of the most preoccupied estates is in the case of the young. There are biological and clinical differences in the cancer of men and women, and there is much that an investigator has to say.
Since ICAPEM we have been working to make these needs visible and we are very proud to be able to take a number of initiatives like this and with the collaboration of a oncology laboratory like AstraZeneca.