The director of the International Breast Cancer Center, president of Fundación Contigo and recognized as the number 1 researcher in the world in the HER2+ breast cancer subtype, explains the latest advances against a disease whose incidence continues to grow, although more and more are cured patients
Javier Cortes, director of the International Breast Cancer Center, president of Fundación Contigo and recognized as the number 1 researcher in the world in the HER2+ breast cancer subtype, explains the latest advances against a disease whose incidence continues to grow, although more and more are cured patients. Before the World Day of this disease, the expert denounces that Spain takes months or years to incorporate the most innovative drugs.
What have been the advances in the fight against breast cancer in recent years?Treatments have improved a lot and in the last decade there has been a spectacular advance. But I say it with fine print because many women continue to die, in Spain between 6,000 and 7,000 women each year and some men. When we talk about spectacular improvements and so many women continue to die, we have to be aware that we still have a lot to do. But it is true that we are curing more and more patients and those who are not cured live longer and better.How has it been achieved?We have won in three great aspects. The first, in early diagnosis. Women are quite aware of the importance of screening, mammograms and going to the doctor when they notice something. Thanks to this, we are increasingly diagnosing the smallest and most curable tumors. Second, diagnostic techniques such as mammograms or MRIs diagnose dwarf tumors and the prognosis is extraordinary. And thirdly, we have more and better treatments with mechanisms of action that were unknown a decade ago. Among them, immunotherapy stands out in the most aggressive breast cancer, triple negative, and immuno-conjugates or ‘Trojan horses’, those drugs that combine an antibody with chemotherapy that is released only within the tumor cell, it is very powerful and with fewer side effects.Are the new treatments intended for all patients?Immunotherapy is approved in the EU for triple negative breast cancer, which has the worst prognosis. And the ‘Trojan horses’ are approved in Europe for both triple negative and HER2+ and soon for hormonal tumors, so they seem to work for all types of breast tumors.But the patients complain that the EU approves the drugs but Spain takes a long time to incorporate them into public health.This is true. It is unfortunate to see how there are treatments approved since January 2021 and in Spain they are still not approved. In this situation, I think it is useful to differentiate between approval and financing. When a drug is approved by the European agency, it should be approved by all member countries. Another thing is who pays for it and for this we must all make an effort, of economic containment, because there are very expensive drugs. It is true that the pharmaceutical industry has invested a lot of money and has to have its benefits, but not everything can be paid for. That is why a titanic effort must be made by the Government, the laboratories and the medical community, which is the one that can assess whether the drug provides more or less important value. Because I think there have to be approved drugs that may not be financed by the public system because their benefit is small and they have exorbitant prices. But other drugs such as immunotherapy, which has shown very important benefits, must reach the portfolio of services as soon as possible.
“It is unfortunate to see how there are treatments approved since January 2021 and in Spain they are still not approved”
Is immunotherapy not funded?In metastatic breast cancer, yes, but in localized triple negative, no. And the latest ‘Trojan horses’, which have given such good results, are not financed. In addition, there are many private insurers that in the small print exclude these treatments and that cannot happen.To access them, do you have to be part of an essay?Yes, but there are many patients who die without having received the treatments because it is not so easy to enter the trials.The incidence of breast cancer, is it on the rise?Yes. 10 years ago there were around 23,000 cases a year in Spain and today there are around 34,000. Partly it’s because we diagnose it more and see more tumors in younger people. Instead, deaths are declining. Perhaps the global amount does not decrease, but the percentages do. Before, around 30% of patients died, now 20% or 22%.
“There are patients who die without having received the treatments because it is not so easy to enter the trials”
In recent times, he has received several awards, including the number 1 expert in the world in HER2+ cancer and fourth in the world in breast cancer. What has it meant for you?These recognitions mean three things. One, that the level of oncology in Spain is very good. Two, that what we are doing, we are doing well. And, three, that I have a team that I don’t deserve. It is not my merit but that of the people around me.Is Spain a leading country in cancer research?In clinical research [que se aplica en los pacientes]Without a doubt, Spain is among the top three countries in the world. But, in preclinical research, in the laboratory, we have extraordinary people but the resources are limited and sometimes very biased. And in care, Spain was a leading country but we are losing that leadership because we are not incorporating the new drugs into the health system, innovation does not arrive. We are part of the innovation, but we cannot be recipients of that research.
“The machines are very good, but we need time to treat patients as they deserve”
Do they receive sufficient funds?Preclinical research is financed with donations and public funds, but they are inefficient and scarce. Clinical research is paid for above all by the pharmaceutical industry, which is why there are resources.In care practice, patients complain above all about the lack of psychological support.They are right. And it’s not just the psychological part. How many times in consultations do we look them in the eye, shake their hands and we are really with the patients? We are getting better technicians but worse doctors. We have more and better treatments but less time to spend with patients and this is a reflection of society, where there is more and more internet and less talk. The machines are very good, but we need time to treat patients as they deserve.Are we closer to the end of cancer?We are closer but if the question is whether we are going to cure cancer, I am not going to see it. But we are closer to the chronification of some types of cancer.