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The analysis of genetic mutations carried out for free at the Department of Oncology of the University of Turin at Luigi Gonzaga in Orbassano will allow patients (Italian and European) to access experimental clinical protocols.

Knowing whether or not your tumor has a certain genetic mutation can make a big difference. It is also on the basis of this information, in fact, that therapy is now decided for many types of cancer: oncologists opt for a drug or a combination of drugs precisely on the basis of the so-called “molecular profile” of the neoplasm. , the necessary tests are carried out to identify the presence of any mutated genes both because in many cases they are not reimbursed by the health service, and because very sophisticated equipment is required to perform this type of analysis. For this WALCE Onlus (Women Against Lung Cancer in Europe -Women against lung cancer in Europe) promotes the European project EPROPA, European Program for ROutine testing of Patients with Advanced lung cancer, a support program to offer equal access to molecular tests, drugs and clinical studies to patients suffering from lung cancer in Europe, within the countries that request it.

Personalized medicine
It was once used to classify tumors based on the area of ​​the body where they developed, but research has allowed us to understand that each mutation of the DNA and genes involved makes each tumor unique and in recent years many molecular biomarkers have been found which have allowed a better definition of the tumor and determined a change in the therapeutic approach, which has become more targeted and personalized. “Knowing whether or not your tumor has a certain genetic mutation can make a big difference – explains Silvia Novello, President of WALCE Onlus and Full Professor of the Department of Oncology of the University of Turin-. It is also on the basis of this information, in fact, that therapy is now decided for many types of cancer: oncologists opt for a drug or a combination of drugs precisely on the basis of the so-called “molecular profile” of the neoplasm . However, the tests necessary to identify the presence of any mutated genes are not always carried out, both because in many cases they are not reimbursed by the health service, and because very sophisticated equipment is required to perform this type of analysis. This is why WALCE promotes the European EPROPA project and it is important that clinicians are aware of the opportunity to join the program free of charge and that patients can talk to their oncologist if they learn about it from other channels “.

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The best cure is only by looking for genetic mutations
The evaluation of the tumor molecular profile has, according to experts, become a fundamental and indispensable aspect in the therapeutic decision-making process of advanced non-small cell lung cancer (NSCLC) because it has been widely demonstrated that patients with genetic mutations receive targeted therapy drugs based on molecular target have a benefit in terms of survival and quality of life significantly highercompared to those treated with chemotherapy. “To date, most patients newly diagnosed with advanced non-small cell lung cancer must be candidates for a tumor molecular profile assessment that includes at least EGFR, ALK, ROS1, and BRAF genes, for which there are drugs available in clinical practice. Furthermore, recent studies have made it possible to identify a growing number of molecular alterations in additional genes (including KRAS, MET, RET, NTRK, HER2), for which molecules are now available in the context of clinical or clinical trial protocols. of extended access programs – adds Stefania Vallone, Walce’s secretary – . The test method that should be adopted is next generation sequencing, but in factin Italy only about 25% of centers are used and this means that in some cases (due to non-availability of material, inadequate material, centers not specifically dedicated to lung cancer and more) the molecular profile is not complete. Furthermore, in most European countries, molecular tests are not reimbursed so it is all the more necessary to have a service like the one provided by the EPROPA project ». 

Non-refundable tests
The problem, in short, is twofold: molecular tests that include such emerging biomarkers are rarely reimbursed and next-generation sequencing platforms are rarely available in common molecular pathology laboratories. Thus, the assessment of the molecular profile is carried out in a restricted way in the majority of patients, often precluding their access to clinical trials.with molecularly targeted drugs that could significantly improve survival and quality of life. “The EPROPA project aims to create a clinical and translational research platform for the complete characterization of the molecular profile of tumor tissue, with the aim of facilitating the identification of” rare “molecular alterations and optimizing the access of patients with advanced NSCLC to the experimental protocols that include molecular targeted therapies available in Europe “explains Novello who is also responsible for the Pulmonary Oncology of the San Luigi Gonzaga University Hospital. The EPROPA project consists of two phases: in the first, WALCE together with the University of Turin offers free molecular profiling to patientswith advanced non-small cell lung cancer; in the second phase, in case of molecular alterations for which in the center where this patient is followed there is no specific clinical trial or drug available, WALCE also offers economic and logistical support for the patient and the caregiver to access clinical trials specific out of country or out of region.

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How to access the EPROPA program
«WALCE has already sent a communication to the network of Italian and European doctors with whom it collaborates to make the initiative known and communicate that it will start shortly – explains Stefania Vallone -. Ad hoc materials have been created for doctors and patients (in paper and digital format in 9 languages) to explain what EPROPA is, how it works and what needs to be done to access it. Information is then shared on the WALCE website with a link that leads directly to the page created to provide more details to the clinician and the patient . “In practice, the patient who knows about the project talks about it to the clinician, who can write to WALCEfor more information and to ask to be registered through a personal account on a platform, created to be able to enter all patients and collect their data. Patients, therefore, can ask their oncologist to be included in the EPROPA program and have the opportunity to have their biopsy analyzed to understand if the diseased cells have specific characteristics (presence of mutations), which may lead the oncologist to propose a personalized treatment. For doctors EPROPA offers the possibility to consult the national reference centerto receive information on the program, but only with the accreditation provided by the promoter Center (WALCE onlus) it will be possible to share clinical and molecular data and send the tissue samples to the Molecular Biology Laboratory of the San Luigi Pathological Anatomy SCDU for screening Clinicians and patients can find more information on the page dedicated to the program: www.epropa.eu or by calling the Secretariat of WALCE Onlus (011-9026980)

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