Pharmaco-prevention of breast cancer is an evidence-based strategy that uses drugs to reduce the risk of disease in high-risk women. However, the use of this strategy remains modest due to concerns about toxicity, low awareness and difficulties in patient selection.

In this TJ Talks podcast, together with Prof. Andrea De Censi, director of the Breast Unit at the Champalimaud Foundation in Lisbon, Portugal, here in conversation with Prof. Antonino Musolino (director of the Medical Oncology Unit at the IRCCS-Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Forlì-Cesena), we will examine what practical solutions can bridge the gap between pharmacological prevention, indication and adoption, with a look at the future perspectives in this setting.

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Stories of foreign cancer patients who ask to return to their country at the end of their lives: their deep desire to see their loved ones one last time is intertwined with medical, legal and financial issues that seem insurmountable. In this TJ Talks, Dr Sergio Defendi, director of Palliative Care and Home Care at Asst Crema, who has been providing assistance with end-of-life travel for years, discusses this issue together with Dr Luca Zambelli, from the Palliative Care Unit of the IRCCS National Cancer Institute Foundation in Milan.

How should the responsibility for end-of-life repatriation be managed? Clinical uncertainty, the legal issue of the use of certain drugs, and the protection of patients and accompanying doctors should be addressed in guidelines or care pathways that deal with this sensitive issue. This is the next challenge for the oncology community.

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Storie di pazienti oncologici stranieri che chiedono di tornare nel loro Paese per il fine vita: attorno al desiderio profondo di rivedere ancora una volta i propri cari si intrecciano questioni mediche, legali, finanziarie che sembrano insormontabili. A parlarne in questo episodio di TJ Talks è il dr. Sergio Defendi, direttore S.C. Cure Palliative e Adi di Asst Crema, che da anni si occupa di dare assistenza nei viaggi per il fine vita, insieme al dr. Luca Zambelli, dell’Unità Cure Palliative Fondazione IRCCS Istituto Nazionale dei Tumori di Milano.

Come gestire la responsabilità di un rimpatrio per il fine vita? L'incertezza clinica, la questione legale dell'uso di alcuni farmaci e la tutela dei pazienti e dei medici che li accompagnano dovrebbero trovare spazio in linee guida o percorsi di cura che affrontino questo delicato problema, destinato a crescere. Una prossima sfida per la comunità oncologica.

Buon ascolto!

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Looking forward to the future, the trends and challenges regarding the increasing utilization of real-world data and single-arm trials in the oncology drug approval pathway by European Medicines Agency (EMA) is very important, especially in the context of personalized medicine that will become the future.

Dr. Francesco Pignatti, Scientific advisor for Oncology in the Human Medicine Division of the European Medicines Agency, is the guest of this TJ Talks episode - led by dr. Luca Moscetti, Adjunct Professor in Oncology at the Residency Program in Oncology at the University of Modena Reggio Emilia - that addresses the relevant question for cancer patients about the EMA’s position on the use of real-world data in drug approvals.

It emerged during the thick TJ Talks that for big changes in the use of real-world data much will also depend on the uncertainty one is willing to accept in a specific situation. Single-arm trial, for example, comes with a lot of uncertainty, mostly about the time related endpoints like survival, then you have to you tend to accept them more where you have high unmet medical needs.

The goal of the scientific community is to focus the efforts on what really matters, trying to be more efficient, cleverer and to design quality criteria that are fit for purpose and that are proportionate to the objectives. Regulators, academics and the sponsors need to facilitate this type of research, maximising the opportunities that come from its data.

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Le parole del prof. Paolo Marchetti restituiscono il quadro complesso dell’oncologia di precisione con il ritmo epico delle grandi imprese di frontiera. E’ lui - Professore Ordinario di Oncologia Medica dell’Università degli Studi di Roma “La Sapienza”, Direttore Scientifico di IDI-IRCCS, Presidente della Fondazione per la Medicina Personalizzata e promotore dello studio clinico Trial Rome - grande esperto dell’oncologia di precisione in Italia, l’ospite di questo episodio di TJ Talks, condotto dal prof. Giancarlo Pruneri.

Un concetto ampio quello dell’oncologia di precisione, basato sullo studio del genoma delle cellule tumorali, per illustrare il quale il prof. Marchetti sottolinea i vantaggi clinici che l’applicazione di questo percorso comporta, senza dimenticare quei fattori perturbanti la possibile risposta a un determinato farmaco: come le interazioni, le modificazioni del microbiota, stili di vita e attività fisica. Un quadro complesso che promuove il confronto tra clinici, biologi molecolari, patologi e genetisti su un numero crescente di dati eterogenei.

E l’intelligenza artificiale? Fondamentale per gestire i dati provenienti da studi clinici a livello europeo, o presenti in piattaforme nazionali; indispensabile per comprendere i potenziali meccanismi di resistenza ai farmaci e per la sintesi delle conoscenze più appropriate e personalizzate per la cura del paziente.

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In this episode of TJ Talks, the guest is Professor Paolo Marchetti, a well-known expert in precision oncology in Italy, Full Professor of Medical Oncology at the University of Rome "La Sapienza", Scientific Director of IDI-IRCCS, President of the Foundation for Personalized Medicine and promoter of the Trial of Rome clinical study.

Precision oncology is a broad concept based on the study of the genome of tumour cells and Prof. Marchetti – interviewed by Prof. Giancarlo Pruneri - highlights the clinical advantages of applying this path, without forgetting the factors that interfere with the possible response to a given drug: such factors include interactions, alterations of the microbiota, lifestyle and physical activity, making the scenario even more complex and fostering comparison among clinicians, molecular biologists, pathologists and geneticists on an ever-increasing number of heterogeneous data.

In precision oncology, the role of artificial intelligence in managing data from clinical trials is essential to understand potential mechanisms of drug resistance and synthesize the most appropriate and personalized knowledge for patient care.

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If we were to stop at a first glance, the use of liquid biopsy would be limited in the clinical practice of colorectal cancer to cases where tumour tissue is unavailable or insufficient. In reality, we are at the beginning of a pathway where the true potential of liquid biopsy is developing rapidly in several directions. This is confirmed by the research results of Prof. Andrea Sartore Bianchi - Director of the Division of Clinical Research and Innovation in Medical Oncology at the Grande Ospedale Metropolitano Niguarda in Milan. One of the most promising applications of liquid biopsy is the detection of minimal residual disease, a potentially game-changing application for oncologists in the field of colorectal cancer, that guides the choice of the most appropriate treatment for patients.

Find out how liquid biopsy is absolutely the new goal of precision oncology, capable of technologically and culturally revolutionising clinical practice, in this TJ Talks podcast, hosted by Prof. Giancarlo Pruneri.

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The field of bioinformatics is rapidly evolving, shaping the future of biomedical research and precision medicine. From cutting-edge advancements in computational biology to AI-driven solutions, what will the landscape look like in Italy in the coming years, and what opportunities will emerge for young bioinformaticians?In this TJ Talks event, the Bioinformatics Section Editor of Tumori Journal, Prof. Lorenzo Ferrando - Research Associate of Applied Medical Technology and Sciences, Department of Internal Medicine, University of Genoa - guides us through a discussion on the key trends and career prospects in bioinformatics. Joining him is Prof. Matteo Benelli, Associate Professor of Biochemistry at the University of Florence and Co-Principal Investigator of AURORA, an international research program dedicated to uncovering the molecular mechanisms driving therapy response and resistance in recurrent metastatic breast cancer.

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