“The immune system prevents us from generating many tumours throughout life. It is said that, if we did not have an immune system, we would develop a tumour every 5 or 15 years. When we have a cancer, it is because, unfortunately, this has not worked well. We try to make the system more efficient when it has ceased to be, which is when we detect the tumour“, explains Manel Juan, head of the Immunotherapy section of the Hospital Clínic of Barcelona.
According to this specialist with almost 30 years of experience, chemotherapy poses several problems. The main one is that, while attacking the tumour, it also attacks the immune system, which causes strong side effects. In addition, 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 get a quick response, it was not valid. This paradigm was a break in the initial research on immunotherapy, because it gets more indirect and slower responses. This is because immunotherapy does not consist in using a toxic agent to kill the tumour, as in the case of chemotherapy. “On the other hand, with immunotherapy you have to first get the immune system to recover and then kill the tumour“, clarifies Juan. Fortunately, the evidence presented by experts (scientifically endorsed by the Nobel winners the current 2018) show that the criteria have changed in the last decade, which has opened the doors to this new paradigm in research.
Even so, due to reasons of medical protocol, “for now, we can only treat patients with immunotherapy in which everything else has failed. The percentage of people treated successfully in many cancers is between 20% and 40%, but we should bear in mind that they are added percentages that occur when the rest of the therapies do not work”, the doctor points out.
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 investigating, among other lines CAR-T, the gene therapy that modifies lymphocytes T (a type of white blood cells responsible for the immune response) of the patient so that they can defeat their own tumour cells. And not only to continue investigating, but to treat patients in the same hospital. “It’s infuriating that people are pushed to go to the United States when we know it’s possible to do it here“. In fact, with these CAR-T, they have already treated 10 children and more than 20 adults who had been predicted a few months of life “with a positive response in most cases. We still cannot say that they are cured, because they only have a year and a half healthy, but when you work reinforcing your immune system, you have a lot of confidence that they will be”.
The main objective of the new Unit for Research in Immunotherapy of Clinical Cancer – “la Caixa” will be to develop personalized treatments for different types of cancer resistant to conventional therapies. “We want to offer immune therapy that attacks only the tumour. That is, a specific treatment for each patient“,says Manel Juan.
And to get it, Dr. Juan asks for two things. The first, that the immunological specialty, that has manifestly demonstrated its efficiency, plays an important role in the 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, so in many cases it is evaluated by the biochemist, the haematologist or another specialist. And it is very important that the centres have immunological specialists on their teams to treat cancer“.
The second is that the new cancer treatment should no longer considered a drug since, technically, it is closer to a transplant. “Having to follow the regulations of the drug multiplies the costs and the wait until it can be used. We need visibility, we need people to know about this situation and mobilize politicians to change the regulations and not take so long in something that could be done very quickly”, he says, convinced.
Dr. Juan is optimistic: “I think we will get to see cancer immunotherapy applied as a main therapy. And we could even get to preventive immunotherapy, the equivalent of a vaccine against cancer, which would be excellent news for families with a propensity to develop it”.
Text: Ana Portolés
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