Three out of four patients with metastatic breast cancer could be candidates for targeted therapy, but this possibility goes unnoticed in 60% of cases, according to the results of an innovative clinical trial promoted by the Solti research group. The HOPE study highlights the need to offer widespread access to diagnosis through blood and tissue sequencing tests. “Without knowing the alterations, we would never be able to treat them. HOPE has corroborated that each tumor is a different disease and that its sequencing is essential to find a treatment that expands the therapeutic options in each case," explains researcher Tomás Pascual to La Vanguardia, who yesterday presented the study at the congress of the European Society of Medical Oncology.
Exactly four years ago, researchers started HOPE with the idea of working on the implementation of a molecular diagnostic program for metastatic cancer patients. It was conceived as “the first patient-led study for the genomic analysis of metastatic breast cancer”, so that, unlike conventional trials, it was separated from hospitals. In this way, regardless of her place of residence, any Spanish patient could register through an app. Recruitment was much better than expected. In three weeks, 380 people had registered out of the 600 planned, a circumstance that “denotes the patients' need to access molecular diagnostic techniques,” says Pascual, scientific director of Solti and oncologist at the Hospital Clínic.
During the process, tumor samples from 334 cases were studied and 386 liquid biopsies were performed. The patients themselves collected the tumor samples in their hospitals, sent them to the Clínic and from Barcelona they traveled to a German laboratory to undergo a sequencing study using the foundation one test, which studies alterations in more than 300 genes. On the other hand, blood samples were sent to California (USA) to determine circulating tumor DNA (when cells die the tumor releases DNA into the blood, whose analysis can identify alterations in tumor genes). “Thanks to these tests, the number of patients who now have information that could help them guide their oncological treatment has multiplied by 5,” says Solti, emphasizing the need to promote patient access to these diagnostic techniques “to be able to “extend precision oncology to the entire territory.”
A patient-centered molecular screaming program is feasible and practical, and is the way to bring personalized medicine closer to patients, concludes Dr. Pascual. In 75% of the cases, the researchers observed an alteration that is susceptible to receiving targeted therapy (in the remaining 25%, no alteration was described that had a therapeutic alternative). This alteration was only previously known in 14% of cases. That is, in more than 60% of the patients the existence of mutations or biomarkers that could guide treatment was unknown. 10% of the cases were identified as potentially treatable and have received therapy and the rest are being followed up within the study. One of the limitations of genomic studies that specialists propose to implement widely is the economic cost.
Solti has planned a second edition of this study in metastatic breast cancer patients and apply the HOPE recruitment model to a trial on prostate cancer centralized in the Vall d'Hebron.
In Spain, around 35,000 new cases of breast cancer are diagnosed each year. Between 20 and 30% will have a relapse. The objective of the research, in the short term, is to make this disease chronic and increase survival.
