Research Lines

Coordinators: Mattia Boeri, Sabina Sangaletti 

Description: 
This research area focuses on cancer prevention, with an emphasis on: 

1. Primary prevention, aimed at assessing how environmental factors, diet, lifestyle, endocrine-metabolic factors, and genetic predispositions influence cancer risk, and implementing intervention studies to modify these factors and reduce cancer incidence. 
2. Secondary prevention, aimed at developing and implementing highly sensitive molecular tests for use in screening programs and early diagnosis of at-risk individuals. This includes studying altered molecular mechanisms and the tumor-host interaction landscape to guide the most effective intervention strategies, with the goal of reducing cancer incidence and progression. 

INT has a long-standing tradition of epidemiological and clinical research in screening and both primary and secondary prevention. Prevention plays a key role in reducing cancer incidence, enabling early diagnosis with greater therapeutic success, and promoting healthy lifestyles to support healthier, more sustainable aging. Preclinical and clinical studies have highlighted the crucial role of nutrition in preventing obesity and metabolic diseases, as well as avoiding a chronic pro-inflammatory state, which—together with other risk factors such as smoking and genetic, epigenetic, and immunological alterations—may contribute to cancer development. Advances in omics analyses and the identification of biomarkers are paving the way for increasingly early diagnoses, enabling assessments of tumor aggressiveness to support more targeted and effective precision medicine approaches. 

Research projects in this area aim to improve population health outcomes in relation to cancer, promote prevention through awareness and adoption of healthy lifestyles, and reduce the risk in individuals exposed to predisposing factors or with a family history of cancer. Early diagnosis remains the most effective strategy for treating otherwise highly aggressive tumors. The development of robust and reliable risk, diagnostic, and prognostic biomarkers—detectable non-invasively in biological fluids—forms the basis for effective screening and diagnostic programs. Thanks to new technologies that generate and interpret omics data, it is now possible to identify common molecular alterations across various tumor types. This enables optimization of preventive interventions, rational use of therapies (including agnostic approaches), and toxicity prevention. The results of these studies can inform public health decisions on cancer prevention and help optimize resource allocation. 

Objectives: 

• Observational studies to identify risk factors. 
• Clinical development of pharmacological, dietary, and lifestyle-based prevention programs. 
• Identification and clinical validation of diagnostic, prognostic, and predictive biomarkers. 
• Screening and early diagnosis programs for healthy individuals, high-risk populations, or patients in complete remission. 
• Outcome data from screening programs, early diagnosis, and pharmacological and non-pharmacological prevention strategies for major cancers (lung, colorectal, breast), whose pathogenesis is associated with known risk factors (e.g., smoking, obesity, metabolic dysfunction, dysbiosis), as well as studies on the association between known and unknown (genetic, epigenetic, immunological) risk factors and cancer onset/progression, as evidenced by publications and presentations. 
• Development of robust diagnostic-prognostic-predictive molecular screening tools, establishment of biobanks, collection of clinical, epidemiological, genetic, and molecular data for future studies, and participation in international projects on primary and secondary prevention. 

Coordinators: Luca Agnelli, Tiziana Triulzi 

Description: 
This area aims to explore, through a multidisciplinary approach, the new frontiers of precision medicine and innovative diagnostic-therapeutic technologies using a reverse translational strategy. Starting from relevant clinical questions, translational research brings laboratory results to the patient’s bedside and, in the opposite direction, returns clinical outcomes and new questions back to preclinical research for further study. The focus is on investigating the interactions between tumor, host (microenvironment), and environment, as well as on the application of pharmacological (clinical trials) and non-pharmacological (diagnostics, imaging, innovative interventions) technological innovations. 

Precision medicine integrates established clinico-pathological criteria with data from multiple molecular analyses (omics) to guide medical decisions and suggest diagnostic and therapeutic strategies tailored to each patient. The identification of alterations and omics profiles that can be used as biomarkers, in parallel with the development of targeted therapies, has paved the way for precision medicine. This approach considers both the molecular characteristics of the tumor and the patient’s individual profile to allow diagnostic and therapeutic stratification, aiming to deliver the right treatment to the right patient at the right time. Technological innovation—both pharmacological and non-pharmacological—plays an increasingly important role, along with the use of non-invasive liquid biopsies for diagnosis and monitoring, and the study of tumor/host/environment interactions to modulate the immune response and epigenetics. 

Focusing research on precision medicine is a concrete need to provide appropriate care for citizens and patients. Clinical studies on highly stratified cohorts, molecular characterization of patients, and investigation of pathological mechanisms represent the path to achieving real impact on both patient care and the healthcare system, in terms of adequacy and cost-effectiveness. Projects in this area aim to personalize every aspect of medicine—from diagnosis to rehabilitation and supportive care—fostering an innovative concept of personalized medicine. As a Comprehensive Cancer Center, INT is in a privileged position to contribute significantly to precision medicine, thanks to its multidisciplinary approach, expertise, and network-based activities, enabling the planning and implementation of truly reverse translational research. 

Objectives: 

• Stratify patients to provide appropriate diagnostic, therapeutic, and rehabilitative options, optimize treatment response, and minimize toxicity. 
• Use multiple approaches to identify, develop, and validate biomarkers, therapeutic targets, and diagnostic, surgical, and medical technologies, and to generate outcome databases and biobanks. 
• Use liquid biopsies and in vitro and in vivo models to identify and validate biomarkers and integrated molecular signatures for monitoring treatment efficacy and toxicity. 
• Design and conduct clinical trials for advanced therapies, innovative drugs, and non-pharmacological interventions. 
• Design and validate clinical pathways (PDTA). 
• Organize multiple databases in a data warehouse. 
• Test advanced technologies in medicine, radiotherapy, surgery, and diagnostics. The results of these studies will generate scientific publications and provide data for managing omics, clinical, dosimetric, and outcome databases, with direct applications in healthcare. 

Coordinators: Andrea Ferrari, Elena Jachetti 

Description: 
This research area addresses the complexity of oncological diseases through a multi- and interdisciplinary approach, focusing on rare and genetically, molecularly, clinically, and socially complex tumors. It considers issues related to access to care and healthcare inequalities, particularly for patients with chronic conditions, the elderly, pediatric patients, and long-term survivors. Studies on rare tumors, hereditary cancers, and pediatric oncology aim to increase knowledge and improve both available and innovative therapeutic approaches. Research will support the comprehensive management of complex patients through clinical, epidemiological, and interventional studies, as well as health service and system organization research. 

INT coordinates the national professional network "Rete Tumori Rari" (RTR) within the new "Rete Nazionale Tumori Rari" (RNTR), and leads two of the ten domains of the European Reference Network on rare adult solid cancers (EURACAN). INT has coordinated the Joint Action on Rare Cancers, and its experience in developing innovative solutions for rare cancers has led to the coordination of a new Joint Action for the definition of Networks of Expertise across Europe. 

INT is a global reference center for certain rare diseases and major epidemiological projects. In pediatric oncology, INT provides multidisciplinary care that includes diagnosis, treatment, psychological support, and a survivorship program. The Progetto Giovani (Youth Project) is recognized internationally as a model and leads programs for adolescent and young adult patients. 

Oncological diseases are multifactorial in nature and require an integrated approach that addresses the illness itself as well as its associated complexities. Therefore, rare cancers, pediatric tumors, and vulnerable populations (elderly patients, those with chronic conditions, long-term survivors) are key focal points in the management of complexity, which INT approaches through a multidisciplinary lens. Rare tumors encompass around 200 different cancer types, collectively accounting for one fifth of all new cancer cases and showing poorer overall survival outcomes compared to common malignancies. 

The increasing effectiveness of treatments has led to the chronicization of cancer, along with a higher risk of second malignancies and other complications (e.g., cardiotoxicity) in long-term survivors. This makes it essential to develop recommendations for personalized follow-up and models of care to improve quality of life. Chronic oncological conditions require complex interventions and new organizational solutions to ensure continuity of care (e.g., symptom control, management of treatment-related toxicities) and promote quality of life. 

The Foundation has chosen to maintain two broad programs dedicated to the complexity of rare cancers and vulnerable patients, building on its unique excellence and expertise in these areas. 

Objectives: 

• Study the diagnostic, therapeutic, and rehabilitative complexity associated with rare tumors and tumors affecting vulnerable populations (children and young adults, long-term survivors, elderly with comorbidities). 
• Comprehensive management of frailty, complications, and comorbidities. 
• Research on cancer predisposition, rare tumors, and descriptive/analytical epidemiology, including monitoring of healthcare inequalities. 
• Omics studies, diagnostics, surgery, and clinical trials in subpopulations, hereditary cancers, and tumors in pediatric and adolescent/young adult (AYA) patients. 
• Psychological support, rehabilitation, palliative care, and end-of-life care. 
• Development of clinical pathways (PDTA) and guidelines. 
• Research on healthcare organization and services. 

This area also includes: 

• Molecular signatures of rare, hereditary, and pediatric tumors. 
• Outcomes from clinical studies and diagnostic-therapeutic interventions in rare and pediatric cancers. 
• Support for the humanization of care (quality of life, patient satisfaction, patient-reported outcomes). 
• Epidemiological data for reference cohorts. 
• Psychological, palliative, and rehabilitative support for patients and vulnerable populations. 

The resulting information will contribute to scientific publications and dissemination of findings to citizens, support the management of clinical and real-world studies on rare, hereditary, and pediatric tumors, drive patient-centered programs for pediatric, adolescent, and young adult patients, and inform the development of clinical pathways (PDTA) and guidelines. 

Coordinators: Arsela Prelaj, Giorgio Bogani 

Description: 
This research area encompasses observational, interventional, and organizational activities aimed at generating evidence on the effectiveness of healthcare interventions, collecting clinical, biological, and outcome data, and organizing them into accessible databases that can be harmonized with other sources such as electronic health records (big data). It evaluates the impact of prevention, diagnosis, treatment, and rehabilitation activities, assessing their value in terms of utility and cost-effectiveness in clinical practice. This area includes clinical pathways (PDTA), outcome and organizational impact assessments in the real-world setting (RWE, RWD), health technology assessment (HTA) of innovative interventions and technologies, testing of sustainability models, and patient-reported outcomes (PROs). 

Healthcare research within an IRCCS represents the natural progression from preclinical and clinical research. At the same time, it gathers health-related questions and "unmet needs" from the real world, feeding them back into laboratory research and clinical studies in a bidirectional translational approach. This virtuous cycle ensures that research discoveries are translated into interventions that are useful to patients in real-life settings. Experimental oncology studies, prevention and early diagnosis programs, and applications of innovative technologies generate large volumes of data—so-called "big data"—which must be organized and digitized to be usable and informative, including through record linkage methodologies. 

Analyzing outcome data, along with systematic literature reviews and the implementation of innovative management models, makes it possible to assess the real impact of healthcare interventions on population health, institutional organization, and healthcare expenditure. The often-quoted claim that healthcare is better where research is conducted can be verified by analyzing outcome data and implementing models and indicators to assess the appropriateness of clinical pathways (PDTA). 

Projects in this area collect, organize, and analyze clinical, dosimetric, toxicity, and omics data from preclinical studies, clinical trials, prevention programs, and pharmacological and non-pharmacological interventions to assess their effectiveness and cost-utility. The organization and management of cancer care can benefit from models that evaluate the real-world impact of treatments and healthcare services, particularly through the collection and analysis of patient-derived data, such as quality of life assessments and patient-reported outcomes on toxicity, effectiveness, and complications from comorbidities. 

The rationale of this research area lies in the applicability of its results to therapeutic decision-making in real-world settings and healthcare planning in oncology at the territorial level. 

Objectives: 

• Development and validation of predictive algorithms for outcomes and toxicity (tertiary prevention). 
• Clinical studies and models for managing short- and long-term complications. 
• Care pathways for patients with multiple comorbidities. 
• Quality of life assessments and analysis. 
• Collection and analysis of patient-reported outcomes (PROs). 
• Development of guidelines and validation of clinical pathways (PDTA). 
• Post-marketing pharmacovigilance. 
• Systematic reviews and meta-analyses. 
• Cost-benefit assessments of selected interventions. 

Projects in this area will provide insights into the outcomes of pharmacological and non-pharmacological treatments, particularly regarding medium- and long-term complications, quality of life, patient-reported outcomes, cost-effectiveness and cost-utility of treatments and diagnostic-therapeutic technologies, and the effectiveness of treatments in both experimental and real-world settings. Results will be disseminated through scientific publications, publicly available databases for further analyses, clinical studies, systematic reviews and meta-analyses, and evidence-based treatment guidelines.