Barbacid: «If I were 20 years old, I would be more in favor of working on early cancer diagnosis than on therapies»

The director of the National Cancer Research Center explains that an advanced tumor with metastasis has 3.000 mutations and it is "complicated" to deal with them.

The director of the National Cancer Research Center, Mariano Barbacid, has stated that, without wanting to be pessimistic, "if I were 20 years old now, I would be more in favor of working on early diagnosis techniques, rather than on therapies" because an advanced tumor with metastasis It has 3.000 mutations and although only "five or six are relevant" it is "complicated" to deal with them.

For this reason, he stressed, if a tumor is detected in time, before it spreads to other organs, it can be removed with surgery. This is how he spoke during the question time at the conference 'Oncology of the 21st century: from personalized therapies to immunotherapy', which he gave on the YouTube and Facebook channels of the Cultural Activities Service of the University of Zaragoza, within of the 'Cajal Lesson' activity.

Barbacid has highlighted the "complexity" of cancer since "no two are alike" since it covers "more than 150 different diseases" depending on the organ, the type of cell that causes it and the mutations that cause it.

He added that if the difference between a protein mutated by cancer and a normal one could be seen in a photo, "we would practically not distinguish them", so that although the mutation "causes a very important functional change, structurally they are practically the same" and That is why it is difficult for a drug to block the oncogenic protein and not affect the normal one, in addition to the fact that pharmacology is limited to a few types of molecules and there are thousands of them in the body, which has 18.000 genes and "not all of them are pharmacologically affordable".

The specialist has therefore encouraged "eliminating risks" with healthy habits, such as quitting smoking, and has ruled out that psychological problems such as depression induce these mutations, although they can influence a person not to take care of themselves.

On the other hand, he has also recognized that, "unfortunately", the majority of cancers "do not give warning and when they do they are disseminated." In the case of precision medicine or personalized therapies and immunotherapy, he has stressed that they have been therapeutic strategies that have represented a "revolution" in the 21st century to treat tumors, with good effectiveness, but only in some cases.

Precision medicine

Barbacid has stated that precision medicine requires a molecular diagnosis that identifies the mutated genes "to know which is the most optimal drug", in addition to the fact that for now only a few or twelve specific inhibitors have been identified aimed at the mutated or mutated targets. not mutated, but that participate in the tumor process.

On the other hand, he mentioned agnostic tumors, "which are beginning to be introduced into the clinical setting, whose treatment is determined by the mutation, rather than by the anatomo-pathological or clinical characteristics" of the tumors.

In these cases, it is about developing drugs against oncogenes. Selective inhibitors have already been developed, for example, against oncogenes called 'TRK', "which appear very frequently in rare tumors and infrequently in very common ones", but "if you have this mutation" and given the appropriate drug, "you have a much better chance of being cured than if you use chemotherapy," the specialist has developed.

At this point, Barbacid has highlighted the importance of detecting these mutations "despite their infrequency" and has pointed out that there are companies that for a "reasonable" price sequence the most frequent genes, detect the mutation and even give a suggestion on the therapeutic options, something that he said will be implemented "little by little" because they can save lives.

Immunotherapy
The scientist has pointed out that in the case of immunotherapy, work was done with the so-called 'checkpoints', which tumors use to deactivate the immune system and "become invisible" to it. Researchers have sought to discover these 'checkpoints', to "prevent the tumor from deactivating the immune system."

For now, only two of those discovered have worked "in the clinic", with drugs that "block these inhibitors of the immune system", achieving in the case of the combination of two drugs a five-year survival of 60 percent in the case of squamous lung cancer, compared to 12 percent for chemotherapy.

He has stressed, however, that immunotherapy is not effective with most breast, colon and pancreatic cancers, and in those that are, melanoma and lung cancer, although "not all patients respond and it is unknown why some yes and others no", in addition to the fact that its cost is high, about 50.000 or 60.000 euros per year in Spain.

He has stressed that there is still a long way to go for science to work in these fields, he has predicted that more and more progress will be made in these therapies compared to chemotherapy, he has defended a national plan against cancer in Spain, as well as improving funding for science. .

At this point, he recalled that the Nobel Prize winner Santiago Ramón y Cajal, after whom this Monday's event is named, already said that a country without science and technology "is vulnerable." "It is sad that in the last hundred years it has not improved," Barbacid added.