The figures give an idea of what Maria Ines Colnaghi, the AIRC Scientific Director, considers to be a titanic task. The four new programs, financed by the 5 per thousand tax return funds aimed at early diagnosis and presented recently to the press, are to be added to the first 10 programs regarding clinical molecular oncology therapies, launched in 2010 in order to complete an ambitious project: use 154 million Euros, thanks to contributions given by one and a half million citizens, to recruit over one thousand researchers throughout Italy, or to have them come back from abroad, with the aim of leaving a tangible sign in treating cancer with greater success.
Why diagnosis after the cure
«It may seem strange that the first notice has been dedicated to the cure, which conceptually comes after, while the second call is aimed at improving diagnosis and prevention,» explains Maria Ines Colnaghi. «However we followed the research's needs: when we promoted the first notice the Italian oncology was already working on molecular targets that could have led to new drugs and new therapies, but funds were lacking to accomplish the mission. Now however it is the world of early diagnosis, through genetic markers - and not only these - to be in ferment and investing in this direction is the right thing to do».
The last to arrive could overtake those launched in the first phase thus producing a practical impact that is faster and more immediate on the cure even though the first are already producing some important results. «Thanks to new technology, the innovative therapeutic approaches that we expect to see from the ten initial projects can reach the patients much more quickly in comparison to the past» says Pier Paolo Di Fiore, the programmatic 5 per thousand Commission coordinator. «But in the meantime the fine-tuning of other early diagnosis methods launched in the four new programs will maximize the results of the treatments we already have available, mainly the surgical ones which can intervene when the tumor is still limited with less consequences and better results».
Finally a woman at the top
There is finally a woman among the leaders of the four new programs. It's Anna Falanga, of the Ospedali Riuniti in Bergamo, who will be looking into the significance of hyper-coagulable blood that can be seen in cancer patients, but above all will try to determine whether hemostasis markers can become tools for early cancer detection and whether they can predict future developments. To do this thousands of samples from healthy blood donors will be examined. With regard to the prognostic aspects patients with breast, lung, stomach or intestine cancer will be examined.
«If this screening approach ends up being valid, its applicability will be immediate» says the researcher whose origins are Neapolitan, «because the coagulation tests are already being carried out on a routine basis in all laboratories.»
A tough one: the pancreas
Aldo Scarpa too is Neapolitan but he is working at the ARC-NET research center at the Università degli studi in Verona. He will be coordinating a program aimed at analyzing one of the most difficult tumors to be treated: pancreas cancer. «Nowadays this aggressive form of cancer is detected when it is still operable in less than one in ten patients,» the researcher explains. «As we wait to find efficient therapies, an early diagnosis could already make a difference in many cases. It will help us to plan sustainable screening strategies on high risk populations». The most innovative aspect of Scarpa' project, which is made up of eight operative units and 120 researchers, is that it will not only rely on the markers produced by the tumor cells but also on the signals launched by the tissues surrounding the tumor.
Spies around the tumor
Marco Pierotti, who is the head of the Tumor Institute in Milan task force along with a group from the University of Palermo, is interested in the so-called micro-environment as well: «This project's aim is to verify the hypothesis, which is already supported by experimental evidence, that the micro-environment where the neoplastic transformation takes place interacts with the transformed cells and it amplifies the signals and it makes them identifiable in the blood» he explains. « The main objective of this project is thus to study the reciprocal influences between the tumor, the stromal cells and the extracellular matrix in order to identify, by way of a molecular and genetic characterization, the nature and the role of the specific interactions with the micro-environment that take place during the development phase of breast, lung, prostate, colorectal and melanoma tumors. The molecular mediators of these interactions identified in plasma represent bio-markers that are useful for diagnosing a tumor in its early phases and to establish its aggressiveness and sensibility to molecular drugs».
Diagnosis at home using nanotechnology
The last project belongs to Giuseppe Toffoli of the Oncology Reference Center of Aviano, in the province of Pordenone. It is the last one literally because as Toffoli explained in a news conference, he managed to press the “send” key on his computer to the AIRC at 23.55 on the last day of the notice! «One of the peculiar aspects of our work will be to combine various skills: engineers and physicists working alongside doctors» he adds, «to fine-tune portable and miniature nanotechnology devices to be used even at home by the patients in exactly the same way diabetics measure their blood glucose».
The purpose in this case isn't just the early diagnosis, which can be obtained by monitoring the tumor marker's progress even in very low amounts: whether they be classic bio-markers such as the PSA in prostrate cancer, the CEA in colon cancer and the alpha-fetoprotein in hepatocarcinoma; or those recently discovered such as circulating tumor cells present in blood, in VEGF and in cadherin. « Further to this, thanks to new technology, we want to develop a simple and innovative system that will monitor the amount of drugs in the patients' blood thus reducing the side effects and increasing its effectiveness» concludes Toffoli. Toffoli, like his colleagues, is an example of a medical researcher that the Program, financed by the 5 per thousand, aims to promote in order to build a bridge between laboratories and hospital wards. So that amongst the test tubes we know which research has priority in order to establish as quickly as possible the results of the experiments with reference to the patients' needs.