Prof.. Assen Dudov, what are the plans for scientific activity of the Bulgarian Society of Oncology in 2021 g.?
The state of emergency continues and the year is unpredictable. Through 2020 r. we were able to hold some workshops before the restrictions. Despite everything, in March we managed to hold two work meetings live. In the first, we looked at the principles of treatment for lung cancer, aspects of diagnosis, treatment, new hybrid methods, which are also available in our country in some medical institutions. We went through the treatment with a focus on the latest developments in targeted and immune rehabilitation therapy.
The second meeting was dedicated to breast cancer. She was multidisciplinary, with an overview of current treatment options, histopathological aspects, which are quite important.
Until the end of 2021 r. we have identified more topics for meetings. Part of the communication with the company's doctors can be digitally based or with hybrid forms.
Are you able to follow the world innovations in oncology?
The news in oncology appears on the highest forums such as ASCO, events of the European Medical Oncology Association. Most colleagues were able to visit them. There was the challenge, that dozens are held simultaneously, even hundreds of smaller meetings and it was difficult to follow. Also make sense of all the information.
We will try to summarize the most interesting information from the international exchange for some localizations of cancer, to be presented and used by colleagues in the country.
Our company may be a debtor to the GP, therefore we plan to make short sessions for certain localizations, for these niches in their treatment, which we assess as unmet needs. We are talking about patients, who need protocols for aids to avoid complications from lying down at home, for prosthetics after removal of the mammary gland.
We are updating the company's website, opportunities to communicate with our members through it, there will be activities related to new drug opportunities. We facilitate the application process by young colleagues to the European Medical Oncology Association.
We also have more ambitious ideas – to create more visual information forms – records of sermons, videos for new medical devices or therapies in the field of oncology. We are also working on updating the medical standards in oncology.
I want to emphasise, that even in this situation oncologists have an interest in their work, give their best, to continue the scientific activity. There are many doctoral procedures, selection of habilitated persons is forthcoming.
What are the main therapeutic innovations in your field? Do they reach Bulgaria??
First of all, I will note the colossal successes of recent years in lung cancer. Decades ago, it was debated whether to treat these patients at all. There were recommendations that they should not be treated, but only to ensure their quality of life. We are already talking about third-line therapy and years of survival, even in advanced disease.
In colon and rectal cancer, there is also the possibility of a third line. There is a new drug, which is to be reimbursed in Bulgaria, once already registered. It is a liposome form, which minimizes toxicity and is given in higher doses in patients with metastatic or inoperable pancreatic cancer. It opens up extremely great opportunities for them.
Most of these modern therapies are based on knowledge of the genetic, the biological basis of cancer. Literally for a few days, we already have a new first line in targeted treatment of primary liver cancer, which is reimbursed by the NHIF. It has two more unique application possibilities – one is in iodine-sensitive thyroid cancer, who has exhausted the possibilities of treatment with radioactive iodine. He is not resistant to classical chemotherapy. This small molecule from the group of tyrosine kinases is registered in Western Europe for thyroid cancer and kidney cancer..
Is immunotherapy being developed??
In immunotherapy, new steps began with skin cancer – melanoma. For many years there were no adequate therapies there either. It was pretending to be quite heavy, absolutely pointless prevention – – dacarbazine, platinum, with BCG in moments of remission. It was in this difficult-to-treat localization that he tested the new immuno-oncological treatment with fantastic results. Gives years of survival in patients with multiple melanoma metastases. There are now several types of immunooncological treatment. It came into practice, as in Bulgaria it can be reimbursed for tumors of the head and neck, in urothelial cancer – the superficial epithelium of the bladder and renal pelvis, when the cancer starts right from them in the urinary system. It has also found great application in lung cancer.
Who are these new drugs suitable for??
These new therapies are key, for which there must be "locks" – certain biomarkers in tumor tissue. For example, pathologists look for PD-L1 programmed cell death factor or other genetic changes, when it needs to be treated with small molecules. Many people come across medical information about new therapies, they want the best treatment, but it is not always suitable for them, even when they have the same disease.
Detailed research is the basis, on which the therapy is assessed comprehensively, which is always individual. Research on biomarkers is done in our country by molecular biologists and geneticists.
Patients should be explained very carefully and patiently, if necessary - several times. They are under stress from the diagnosis, hear from colleagues different fragments about the treatment. They leave an impression, that they are being told different things, in fact, these are different aspects.
It needs to be explained, that therapies in oncology are strictly individualized. The assessment is made by Oncology Commissions, they develop this sequence of methods and therapies for the particular patient according to the type of tumor, its spread. There are other details, which we did not consider until years ago, that they matter.
The pandemic has forced many people to postpone examinations. Are cancer patients late for the diagnosis??
Really, the diagnosis of cancer patients suffers greatly in a pandemic. Through 2020 r. at first people were scared. They interrupted the diagnostic process, associated with milder symptoms. In the summer they did not come for the tests again, they wanted to compensate for the closing time. In the autumn, the cases of quite delayed patients began to grow. In some of them, the tumors were significantly advanced. However, there was psychological resistance from fear, that they can be fatally infected with the coronavirus. We explain, that they urgently need to start treatment, but they are worried.
The situation is similar in other chronic or severe diseases. There are patients with tumors, who also have diabetes, hypertension, remained totally out of control! I used to look for an emergency place for a patient with blood sugar 30 millimoles.
Let me think, what will happen, when the pandemic passes. The health system will be flooded by patients with exacerbated chronic diseases, which will require expensive treatment. Unfortunately, such patients will have increased disability. This will be a big test for the health system – as capacity, equipment and financing.
Source: Credoweb
