The main research goal of the IRCCS Regina Elena National Cancer Institute is the translational management of cancer patients (PRESa in carico Traslazionale del paziente Oncologico - PRESTO). What does this mean? It means that the cancer patient is always placed at the center of our research objectives and with this focus, we aim to understand the distinct alterations of patients’ tumors within the perspective of personalized and precision medicine; and then to transfer our research results to the patients’ bedside in order to provide rapid answers to their health needs through scientific and technological innovation.

Today, providing care to cancer patients is essentially based on having several vital contributing facilities. IRE has therefore armed itself with a series of indispensable tools, from a modern and equipped biobank storing tissue and liquid samples deriving from cancer patients up to a number of the most recent technologies for “omics” analysis as well as for surgery such as robotic surgery, stereotactic radiotherapy, imaging and so non. Our Institute is the only facility in Lazio where these facilities combined with the necessary expertise (know how) are all physically concentrated in the same logistic area and dedicated to cancer patients’ care. This allows us to apply all the standards of the state-of-the art modern medicine to implement a more personalized approach towards the patient, not only considering their clinical characteristics, but also the expression of molecular determinants which are increasingly fundamental in improving diagnostic, prognostic, predictive and therapeutic performance.

It is now crucial to manage cancer patients by evaluating the expression of molecular biomarkers with cutting-edge “omics” technologies that allow to stratify patients that are able to respond or not to certain types of therapies. Even if it appears to be more challenging at first, obtaining knowledge, understanding and clinical management of these parameters provides us with an unquestionable advantage and together with the results generated can drastically improve the clinical picture (survival and quality of life) of the patient. By applying this modern approach towards cancer patient care it is also essential to increase the number of early diagnoses, which are now often possible due to the very high resolution in diagnostic imaging equipment provides, thus avoiding falling into making frequent errors in over-diagnosis and over-treatment.

The future of cancer care and patient medical records will therefore have to contain, in addition to the results of routine investigation, also a series of metadata (genomics, transcriptomics, metabolomics, proteomics, microbiomics, radiomics, etc.) that concern the molecular aspects of single neoplasms which provide the basis for an advanced prognostic / predictive / therapeutic approach. The objective is to obtain a personalized clinical report capable of highlighting the biological and clinical relevance of each identified molecular alteration. In fact, these methodologies allow identifying therapies and clinical studies that include potentially effective drugs (targeted therapy, immunotherapies and experimental therapies) that are best for each individual patient.

It is therefore important that the data provided by the most modern technologies are managed by a multidisciplinary team that includes not only oncologists, but also biotechnologists, molecular biologists, geneticists, pathologists, biostatistics, bioinformatics, etc.

PRESTO is summarized in the diagram above (Fig1). It is divided into four macro-areas which are highlighted by distinct colors: advanced diagnostic / prognostic research (in Orange), precision surgery (in Purple), precision medicine (in Green) and advanced clinical research (in Blue).

In the following sections the features of each macro-area will be described as well as short and long-term objectives. All together these sections constitute the elements of the research strategy, represent the research footprint of the institute and characterize its specificity in the context our national clinical cancer research.

It has to be pointed out that Regina Elena National Cancer Institute works in close collaboration within national and international networks, in first instance is one of the founders of the larges organization of clinical research cancer centers in Italy called Alliance Against Cancer (Alleanza Contro il Cancro -ACC). Furthermore, it is member of OECI, the Organization of European Cancer Institute where it has been given the highest level of accreditation as comprehensive cancer center, and finally has established strategic collaborations with prestigious research centers outside Italy such as the Weizmann Institute in Israel. All these network collaborations help the realization of the strategic plan but we have decided not to specifically mention them in the following sections.