Last year, 2018 was outstanding developments in the inquiry o & # 39; r cancer he's referring. These occurred in four areas: investigating the causes of the disease; diagnosed premature and more detailed; routine treatmentsReference is made to the specific mutations of all tumors; and reducing toxicity and unnecessary side effects, which have improved patient health.
Therefore, of fluid biopsies that allow the lung tumor to be identified early and monitor its sequence; to oncolytic viruses that are sprayed into poor and aggressive brain tumors, and strive to increase patient survival; going through the genetic modifications of the Lymphocytes, type of organism protection cells. They all move towards detailed or personal medication. And here are some of the most relevant:
1.- Treat patients based on the tumor genetics rather than their location. Towards detailed or personal medication.
Until recently, cancer therapies focused on the location of the tumor, the period of the disease and the analysis of cell morphology. Thanks to genome study and to its use massive genetic progression toolsIn recent years, it has been a lot better to have a very complete atlas of the characteristics of all types of tumors and the distribution of the disease. And that has opened the door to specific treatments for those mutations.
"In the case of breast cancer, we have identified eight sub-types," said Josep Tabernero, director of the Vall of Hebron Institute of Oncology (VHIO). "We have found that the tumor is vulnerable, what changes they have and which we can handle. And this has gone hand in hand with the advent of drugs targeted specifically at these changes," he added.
"Now we have an accurate picture of the genetic, genetic, proteomic changes of all cancer that we did not have from before. The challenge, from now on, is what it is and, All this information means to improve the patient's treatment, for example through drugs that have aimed at specific changes, "said Aleix Prat, head of the medical oncology service at Clínic Hospital.
In addition, in the diagnosis, artificial intelligence begins to disclose itself as a very useful tool, which can detect faster tummy faster in imaging tests, such as mammograms or CT scans. "It will help the surgery to increase its global quality," said Tabernero.
"We have found that the tumor is vulnerable, what changes they have and which we can handle and this has gone hand in hand with the appearance of drugs specifically targeted at these changes"
2.- Liquid biopsy
A trial that allows cancer diagnosis is faster and more efficient, as it can detect tumor cells that are circulating in the bloodstream or genetic material of the free tumor, known as DNA free circulation. "A proof that allows us to do the same genetic analyzes we would have made of tumor tissue butps with three benefits – explains Ramón Palmero, a Medical Oncologist of the Lung Function Unit of & # 39; The Institut Català d 'Oncologia (ICO) – The first, which is less intrusive. The second, which allows us to perform molecular analysis in patients who can not have a bape or not have enough tops . A third, which can be repeated as many times as necessary ".
A fluid biopsy allows a more complete molecular diagnosis of the disease to continue to be early, to monitor the tumor's response to treatment and even if the tumor appears. However, not all cancer can be found with this test. This is the cause of brain tumors, for example. In the case of these cases, Joan Seoane, Icrea's research researcher and translation research director at VHIO, has successfully developed a similar test that uses cerebrospinal fluid rather than blood, which combines the brain and # 39 ; r mêr bones, and is obtained through a lumbar fragment. I'm patient
Historically there were three types of treatment: chemotherapy, radiotherapy and surgery, the three pillars in the fight against cancer. However, developments in recent years have added two new pillars: targeted therapies a immunotherapies.
Targeted therapies are drugs that have been designed to specifically attack a specific molecular change of the tumor that is not present in the rest of the body.
And the fifth pillar in cancer treatment is immunotherapy. In this case, the treatment is not directed against the tumor cells but to the patient's immune system. These are drugs that try to implement the patient's own defenses, especially the T lymphocytes, to fight the tumor.
In addition to the preventative drugs of the immune control point, antiDP1 and anti CTLA4, what they do is turn the body protection system into action to act against the tumor, two of them most important developments in immunotherapy are
Advanced cell therapies with Cart cells a melting tumor or TIL lymphoste therapies, according to its acronym in English, which modifies or manipulates the immune system itself. This last therapy was able to eliminate all the tumors of a woman with metastatic breast cancer, an unprecedented milestone.
In order to create CAR cells, oncologists take patient Lymphocytes, and insert an artificial gene that has planned to supply these antigenic supplies to these immune cells. These receptors connect to a molecule in the tumor cells and then send a signal to implement the destruction machines and the lymphocytes T. Unlike other therapies, only once the patient this applies, because the cells of the cart remain in the patient's body multiplying. This therapy was shown to be very effective in acute lymphoblastic leukemia and some types of lymphoma. The Ari project is underway in the Clínic, precisely in terms of Cart therapy
Another important priority is the antibodies and in particular the bipartic antibodies, can "bind to tumor cells and the immune system, and it is trying to attract lymphocytes to the tumor, as well as other types of antibodies that carry chemical inside and when they reach the cancer cell, they join and release it, they are less toxic than other treatments, "said Prat, from Clinic.
The problem is, at the moment, that immunotherapies are only effective in 25% of patients and in certain types of tumor. "The challenge of the future is to go from effectiveness in 25% of patients to a higher number and that each season is recognized by the immune system," recognizes Tabernero.
"The challenge of the future is to go from effectiveness in 25% of patients to a higher number and that each term is recognized by the immune system"
Another challenge, adding Palmero, in terms of some imitations such as CART and TIL is "great-scale delivery. To achieve TIL, for example, how much tumor you need to remove T lymphocytes is very big , is complicated to be achieved in every patient. Technology is also a constraint, because it is still very complicated and slow: to make TIL a single patient who can take two or three weeks. Probably, the structure needed to do large-scale TIL or CARs with the number of patients we currently have is not acceptable. It's a matter of time before the technology improve and become cheaper. "
Y vaccinations they are another immunotherapy strategy. One type of vaccine has been based on taking the patient's dendritic cells, which play a key role in the body's immune response, prepares them with specific antigens for the tumor that are taught I hunt and destroy tumor cells and spray it back into my body to promote the immune system.
Other vaccines use viruses like Trojan horses to spread the tumors and attract the immune system. These viruses cross the hemantoencephalic obstruction and handle very aggressive cancers, such as glioblastoma.
"Ultimately, surely, it will be a question of combining different equipment: antibodies, with viruses and chemo, for example," said Prat.
5.-The microbiota, star theme
One of the topics discussed in 2018 is the relationship between bowel and cancer microbiot. A number of studies have already brought light on the relationship between this community formed by millions of mostly living colonies in the colon and diseases such as Alzheimer's, multiple sclerosis, Parkinson's and also cancer. It has been shown that the composition of wet microbiota can influence the response to chemotherapy and, in some cases, is even behind a tumor.
"As a beginner, we are studying whether extending breastfeeding by one or two years is a protective factor for children and mothers against some tumors. There are signs that extend breastfeeding [que influye en la composición de la microbiota intestinal] it would be immunoprotective, "said Tabernero.
"It's being studied whether extending breastfeeding one or two years is a protective factor for children and mothers against some tumors."