"The immune system prevents us from generating many tumors throughout life. It is said that, if we did not have an immune system, we would develop a tumor every 5 or 15 years. When we have cancer, it is because, unfortunately, this has not worked well. We try to make the system more efficient when it has ceased to be so, which is when we detect the tumor," explains Manel Juan, head of the Immunotherapy section of the Immunology service at Hospital Clínic de Barcelona.
According to this specialist with almost 30 years of experience, chemotherapies pose several problems. The main one is that, while they attack the tumor, they also attack the immune system, which causes strong side effects. Furthermore, until now, the system for validating oncological treatments was based on the speed with which the treatment achieved results. That is, it was considered that if the treatment did not obtain a rapid response, it was not valid. This paradigm led to a halt in initial research on immunotherapy, because it obtains more indirect and less rapid responses. This is because immunotherapy does not consist of using a toxic substance to kill the tumor, as is the case with chemotherapy. "On the contrary, with immunotherapy you have to first get the immune system to recover and then kill the tumor," Juan clarifies. Fortunately, the evidence presented by experts (scientifically endorsed by the Nobel winners this very 2018) has led to a change in criteria in the last decade, which has opened the doors to this new paradigm in research.
Even so, due to medical protocol issues, "for now, we can only treat with immunotherapy patients for whom everything else has failed. The percentage of people successfully treated in many cancers is between 20% and 40%, but let's keep in mind that these are added percentages that occur when other therapies do not work," the doctor emphasizes.
From now on, thanks to the agreement signed with "la Caixa", Dr. Juan and his team will have the stable research structure they needed to continue researching, among other lines, on CAR-T, the gene therapy that modifies the patient's T lymphocytes (a type of white blood cells responsible for the immune response) so that they can defeat their own tumor cells. And not only to continue researching, but to treat patients in the same hospital. "It is outrageous that people have to go to the United States when we know that it is possible to do it here". In fact, with these CAR-Ts, they have already treated 10 children and more than 20 adults who had been prognosed with only a few months to live "with a positive response in a large part of the cases. We still cannot say that they are cured, because they have only been well for at most a year and a bit, but when you work reinforcing their immune system, you have a lot of confidence that they will be."
The main objective of the new Clinic – "la Caixa" Unit for Research in Cancer Immunotherapy will be to develop personalized treatments for different types of cancer resistant to conventional therapies. "We want to offer an immune therapy that attacks only the tumor. That is, a tailor-made treatment for each patient," says Manel Juan.
And to achieve this, Dr. Juan demands two things. The first, that the immunological specialty, which has amply demonstrated its efficiency, plays an important role in oncological treatment in all hospitals. "We have always worked in specialties based on tangible structures —brain, lung…—, but the immune system is dispersed throughout the body, it is transversal, which is why in many cases it is evaluated by the biochemist, the hematologist or another specialist. And it is very important that centers have immunologist specialists in their teams to treat cancer."
The second, that the new cancer treatment stops being considered a drug when, technically, it is closer to a transplant. "Having to follow drug regulations multiplies the costs and times until it can be used. We need dissemination, for people to know about this situation and mobilize politicians to change the regulations so that we don't take so long for something that could be done very quickly," he says convinced.
Doctor Juan is optimistic: "I believe we will see cancer immunotherapy applied as a primary therapy. And we could even reach preventive immunotherapy, the equivalent of a cancer vaccine, which would be excellent news for families with a propensity to develop it."
Text: Ana Portolés
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