Health visionaries: what do breast cancer and myeloma have in common? “Incredible Achievements in Medicine”

In recent years, there has been incredible progress in the treatment of cancer, which gives hope to patients. Today, more and more drugs are selected for the patient. In the future, a very accurate diagnosis will become the basis for choosing a treatment method, experts emphasized. However, there are still problems with its implementation. Despite the tremendous progress that is being seen in terms of access to new medicines, many patients are still waiting for optimal treatments.

Breast Cancer - Need for Improved Prevention and Diagnosis

Breast cancer is the infamous first place in terms of the number of cases among women and the second (after lung cancer) in the number of deaths. The problem in Poland is the growing morbidity, as in Western countries, as well as the still very high mortality, despite the fact that many new treatment options have recently appeared.

- 32 years ago I was diagnosed with cancer, at that time it was a taboo topic, so I left the profession and took up the Amazons. I liken our first decade to a freight train as we tried to educate women about prevention. In the second decade, the issue of a national cancer control program arose, it seemed that this would be a big acceleration. In 2013, 12 organizations called on the President, the Minister of Health and the Prime Minister to make oncology, including breast cancer, a priority.

There are new treatments; For treatment to be effective, it is necessary to detect cancer at an early stage, so we are still waiting for health lessons to be introduced in schools,” said Christina Wechmann, president of the Polish Coalition of Cancer Patients.

Anna Kupetskaya, president of the OncoCafe Together Better Foundation, also pointed out problems with diagnostics. – We try to educate women, but very often patients come to us and say: “If I only knew that such tests are necessary”… Tests for mutations in the BRCA gene are certainly too rare in Poland.

Most women do not have this diagnosis. Also, a sufficient number of patients is not covered by the preventive program for high-risk groups. Patients often do not know, and doctors often do not report the need for tests, says Anna Kupetskaya.

BRCA-dependent: a new subtype of breast cancer?

Carriers of the BRCA mutation have a much higher risk of developing certain types of cancer, such as pancreatic cancer, breast and ovarian cancer in women, and prostate cancer in men. People who have these mutations should have more frequent check-ups, and in certain situations, in the case of women, surgery to remove the breast and ovaries may be indicated.

- It turned out that in women who are carriers of mutations in the BRCA genes and who have breast cancer, it is worth using some drugs - PARP inhibitors, such as olaparib, which work only for them. Thus, testing for BRCA mutations is essential not only for prevention, but also for making therapeutic decisions. Therefore, it is important that such a test can be carried out quickly after the diagnosis of breast cancer, additionally as part of outpatient consultations, and not hospitalization, because taking a smear from the buccal mucosa does not require hospitalization, said Prof. Tadeusz Penkowski, President of the Polish Society for Breast Cancer Research.

PARP inhibitors are reimbursed in Poland for the treatment of breast cancer in women with a mutation in the BRCA gene, but only in the advanced stages of the disease. - They need to be used earlier, because their use in early breast cancer increases the chances of a cure, - said prof. Penkovsky.

However, a molecular test should be performed immediately after a cancer diagnosis. – Testing for a BRCA mutation is recommended especially for women with breast cancer at a young age, up to 40 years of age, who have triple-negative cancer, as well as women with a close family history of breast, ovarian, pancreatic, prostate cancer. If such a mutation has been identified, it is necessary to take care of all family members, regardless of gender. It would also be important to use a PARP inhibitor: adding it to the surgery would increase the chances of a cure or increase the time to progression,” said Prof. Penkovsky.

Triple negative breast cancer

This is an aggressive subtype of breast cancer that progresses rapidly and often affects young women. However, if detected early, it can also be cured.

Last year, new medicines for the treatment of this subtype of breast cancer entered the reimbursement system in Poland. – Another group of drugs that are effective in this subtype are immunological drugs that have long been used in many oncological diseases, including lung cancer and melanoma. Pembrolizumab has been shown to be very effective in the treatment of perioperative triple-negative breast cancer, prolonging patients’ lives, time to progression, and improving the chances of a cure. He is in the TOP-10 list, which is subject to a refund, - said prof. Penkovsky.

“Patients today are educated, they want to be treated well. This can be seen from the number of donations: in our database there are more than 70 patients who themselves are trying to collect for such treatment in order to enjoy life longer. We are all waiting for the new options to be included in the returns. Patients learn in organizations, in social networks, they know perfectly well which drug will be optimal for them. We would love to see new treatments introduced as soon as possible,” said Magdalena Cardinal, president of the Omealife Unlimited Breast Cancer Foundation.

Trojan horse for HER2 positive breast cancer patients

Women with HER2-positive breast cancer are still waiting for a new treatment option. - Trastuzumab derukstecan - a drug called a Trojan horse: a cytostatic is attached to trastuzumab, which penetrates the cancer cell, destroys it, and also damages neighboring cancer cells.

This drug deserves a refund as soon as possible, because its impact on the fate of patients is very important. In addition, the drug has low toxicity, - said prof. Penkowski, stressing that the results of new studies clearly show that the drug is effective in both women with high expression of HER2 receptors and those with low expression, and its introduction would be a huge breakthrough in the treatment of a large group of women.

Women’s Health Coalition

“Women want to be examined, it’s in us that we want to take care of ourselves. However, in order to take care of ourselves, we must have the right information, such as where we should get a mammogram, when to get a preventive examination, and what kind. Such information should be in the POZ, in the AOC. We want to improve women’s health, starting with breast cancer, said Irena Rey, president of the Farmacja Polska Chamber of Commerce, which, together with several women’s organizations (including the OncoCafe Together Better Foundation), established the Women’s Health Foundation.

One initiative that could bring results is the expansion of preventive mammography screening, which has been promoted by, among others, the Polish Cancer Coalition and the OncoCafe Foundation, and now also by the Coalition.

Myeloma: help needed for refractory patients

March is Awareness Month for Myeloma, which is the second most common hematological malignancy and at the same time a disease that has been revolutionized in recent years in terms of access to medicines.

- Myeloma is a slightly different disease than all the others, by definition it is an incurable cancer, but it can be treated consistently for many years. However, any therapy, even the best, will at some stage be stable, and additional avenues of treatment will have to be applied. Patients function well even if they are treated in the fifth or sixth line, so access to additional treatment options is important.

The life of a myeloma patient is made up of these building blocks, one after the other, one next to the other. The more drugs, the longer the treatment puzzle will be, said Prof. Dominik Dietfeld, President of the Polish Myeloma Consortium.

Many changes have been made to the January list of reimbursable drugs for people with myeloma. “If I had to say what is most lacking today is the protection of patients with this more advanced form of the disease being treated in downstream lines. Such a drug is isatuximab, a monoclonal antibody registered for pomalidomide and dexamethasone, and the same therapy registered for carfilzomib and dexamethasone. These three drugs are recommended for patients resistant to lenalidomide, bortezomid, emphasized prof. Ditfeld.

The ministry is working to make new treatments available.

Mateusz Oczkowski, head of the reimbursement section of the Department of Drug Policy, who was present at the debate, recalled that the Ministry reimburses more and more drugs, including oncological ones.

– We turned on this “locomotive” in 2019 and are accelerating more and more. In 2022, 115 new molecules were reimbursed. So far, in 2023, there are already 43 new molecular indications, including 30 in oncology alone,” said Mateusz Oczkowski.

He assured that both breast cancer and myeloma are among the priorities, as evidenced by the number of new returns. - Myeloma is a very specific disease, because we have access to three groups of drugs, there are many treatment combinations, which is a huge problem. In the process of reimbursement, we have 7 new molecular indications in breast cancer, said Chief Medical Officer Oczkowski. He also assured that the Ministry of Health is also working on solutions that will force more women to undergo molecular diagnostics.