Antonio Rossi | Senior Medical Director, Oncology Center of Excellence, Therapeutic Science & Strategy Unit, IQVIA, Milan, Italy, and Editor–in–Chief for EMJ Respiratory.
Citation: EMJ Respir. 2022; DOI/10.33590/emjrespir/10135215. https://doi.org/10.33590/emjrespir/10135215.
We are honoured to share our EMJ Respiratory 2022 in review interview with Antonio Rossi, Senior Medical Director, Oncology Center of Excellence, Therapeutic Science & Strategy Unit, IQVIA, Milan, Italy, and Editor–in–Chief for EMJ Respiratory.
Throughout 2022, we have published a lot of articles on COVID-19 in EMJ Respiratory. Understandably, this has become an important aspect of contemporary respiratory research since the pandemic began. What direction do you think future COVID-19 research will take in the coming year?
In the 2 years since the World Health Organization (WHO) declared COVID-19 a pandemic, more than six million people have died worldwide. Since then, many steps forward have been taken, and the overcoming of many obstacles. Two years after the emergence of SARS-CoV-2, antiviral drugs to be administered early after diagnosis in patients at risk of developing severe disease and therapies to improve outcome once severe disease has developed, have been made available. Further research in this setting is ongoing to optimise the efficacy of these antiviral drugs. In a single year, a vaccine was developed and approved, with its administration to millions of people around the world. Further steps are being taken in this setting so that we can become more efficient in creating new vaccines. Increased understanding of the most effective dosage and scheduling of COVID-19 vaccines to be adapted to specific population and age groups; learning how to enhance the durability of vaccine-induced immunity; and new technologies and vaccine platforms in order to rapidly combat new viral variants, should be the main future directions in the management of this pandemic.
In September 2022, you published an article entitled ‘Maintenance or consolidation therapy in small-cell lung cancer: an updated systematic review and meta-analysis’. Can you describe the key findings of this research, and why they are important to the field of respiratory oncology?
Small cell lung cancer (SCLC) is characterised by an aggressive behaviour and poor prognosis. In the last few decades, no dramatic improvements have been made in the treatment of SCLC, notwithstanding it is a strongly chemo-sensitive disease. Only recently, the introduction of immune checkpoint inhibitors for the first-line treatment of extended disease SCLC has led to a prolonged benefit, but only in a limited number of patients. Given this, several strategic treatment approaches have been evaluated, with the aim to improve these disappointing results. Among these, the maintenance/consolidation approach has always been considered an appealing strategy. We previously performed a first systematic review and meta-analysis, including 21 randomised controlled trials testing this strategy, failing to demonstrate an overall outcome benefit. In the recently published article, we provide an updated systematic review and meta-analysis of the role of maintenance strategy in SCLC, 12 years after our previous work, including nine recent randomised controlled trials. Unfortunately, the current updated systematic review and meta-analysis does not demonstrate a benefit for this approach in SCLC, with only a progression-free survival benefit for immunotherapy. These data underline that understanding the intrinsic molecular landscape, together with clinical characteristics, is crucial to improve treatment outcome in SCLC, also in view of an optimisation and improvement of the immunotherapy results.
What is the most exciting clinical breakthrough or piece of research that you have seen in the fields of respiratory oncology and respiratory medicine over the last 12 months?
The landscape of respiratory oncology dramatically changes thanks to the continuous availability of innovations which shift the paradigm of cancer treatment in general, and lung cancer in particular. Also, in this last year, several exciting novelties have been reported in the field of targeted therapy and immunotherapy with precision medicine, defined as the right drug to the right patient at the right moment, becoming the cornerstone of lung cancer treatment.
Asthma and chronic obstructive pulmonary disease (COPD), which affects millions of people worldwide, are areas of respiratory medicine in which improvements in understanding the pathophysiology of both conditions, and improvements in device technology, are in continuous development. Precision medicine is also a goal being pursued in these settings. The importance of patient partnership in determining the care plan, including the choice of device technology and treatment, and the regular monitoring of adherence to treatment for patients, have recently emerged as important aims to address in future research.
These are only some of the main breakthrough research developments seen this year in these fields of respiratory oncology and medicine, that set the basis for further exciting research advancements in the future.
Following on from this, what direction do you anticipate thoracic cancer research will take in the coming years?
Several new approaches are being investigated for the management of lung cancer. Targeted therapy and immunotherapy are in continuous development, with new drugs reaching the market for the treatment of old and new gene alterations. These advancements are based on the deep knowledge of tumour biology and mechanisms of oncogenesis and the immune system, which will grant the singling out of several further molecular and immune checkpoint targets for lung cancer treatment. These approaches have been firstly used in metastatic disease and are now being investigated in early stages of the disease, with interesting results already reported, increasing the chances of healing.
Biomolecular analysis from blood drawn, the so-called ‘liquid biopsy’ and other less invasive diagnostic procedures for precision medicine are indeed an ongoing area for further developments. Technical knowledge has led to the development of radiotherapy machines able to focus treatment on the tumour, sparing the healthy tissue, which reduces side effects. Additionally, these are now faster than standard radiotherapy machines, resulting in reduced patient discomfort. Similarly, novel surgery approaches, such as robotic machines, have led to a minimally-invasive surgical technique that a surgeon uses through a computer to manipulate small tools attached to a robotic arm that can perform precise movements inside the chest cavity. The next few years will witness epochal changes in the treatment of lung cancer, also known as one of the ‘big killers’.
Do you feel that any areas of respiratory medicine were overlooked in the last year, and can you give insight into why this may be the case?
The cure of respiratory diseases is the main goal of scientific research. This is an important area that, given the improvements in all fields of research and technology, is reaching results unbelievable only a few years ago. Furthermore, another goal of paramount importance, and also in view of defining strategic approaches to the respiratory diseases, is prevention. Primary prevention is accomplished through the elimination of exposures that cause these diseases, among which smoking is the most frequent and the most common for COPD, asthma, and lung cancer. Secondary prevention involves early detection and intervention amongst asymptomatic people. For instance, for the diagnosis in very early stages of disease, screening for lung cancer in the high-risk population; people who smoke and are aged 55–75 years. Moreover, primary and secondary prevention of COPD is recommended by the WHO. Several components are involved in all these actions, such as the National Health Service (NHS), health professionals, scientific societies, the general population, and patients’ associations, and all should work in a coordinated and synergistic mode to pursue this common goal, representing also the challenge deserving more attention in the future.
Looking forward to 2023, what topic or topics do you expect to become the focus for the respiratory research community?
The involvement of the immune system in respiratory diseases and the COVID-19 pandemic have shown that the appropriate understanding in medical practice of the immune response might help in the fight against viruses, bacteria, and pathologies. The immune system plays an important role in respiratory medicine, from asthma and COPD to respiratory infections, lung cancer, and interstitial and rare diseases. The role of immune checkpoint inhibitors has already been clearly demonstrated in the management of lung cancer, and this should be the starting point for a deeper understanding of the role of immune response in respiratory diseases. We need to keep establishing strong collaborative links between academia and industry for this area of research due to commonalities in all respiratory diseases. We must not forget prevention, which is key in reducing the incidence of respiratory diseases, and the main weapon against the onset of these illnesses in the various grades of severity.
Is there any ongoing research that you are looking forward to hearing more about over the next year?
As a medical oncologist, my main field of interest being thoracic cancers, my attention is focused on the ongoing research performed in this setting. In particular, immunotherapy, which harnesses the power of the immune system to attack cancer cells. Immune checkpoint inhibitors directed against the programmed death-1 (PD-1) and its ligand (PD-L1) axis, and cytotoxic T-lymphocyte antigen 4 (CTLA-4), are already in clinical practice for the treatment of several cancers, including lung cancer, with impressive effectiveness. Several ongoing studies are trying to further improve these already striking results. Targeted immunotherapies, including other immune checkpoint inhibitors, monoclonal antibodies, treatment vaccines, immune system modulators, and chimeric antigen receptor T-cell therapies (CAR-T), are showing promising results for many types of cancer. My expectations from this research are very high, and I am confident that I will not be disappointed.
There has been a movement towards implementing artificial intelligence into clinical practice across specialties. How do you see this technology being implemented into respiratory medicine in the coming years?
Over the past few decades, technology and improvements in artificial intelligence have changed many areas of our daily activities, including the field of healthcare. Artificial intelligence may also find a role within precision medicine, adopting a delivery model focused on specific characteristics, improving disease diagnosis and management, and reducing the relevant burden of chronic respiratory diseases. Technological interventions have been proven to be tolerable to respiratory patients and physicians, making the everyday monitoring of the illness easier.
I am confident that with the improvements, and easy handling of potential new technology tools, the interaction between patient, health technology, and physicians, and the motivation of patients to take an active role in managing their condition, are all goals for the coming years. This will help to increase the spreading of this technology in the management of respiratory medicine.