You already know that the best disease is the one that does not appear. What is better the prevention of a cancer than your treatment. And that an early detection of a premalignant lesion or a small tumor and its removal by surgery surpasses all the drugs that we can administer. But unfortunately, many times the oncological pathology is diagnosed when the removal by the scalpel is not enough or is physically impossible at that point in time. Therefore classical and targeted chemotherapy of the transformed cell continues to be an essential tool for curing the disease. There is a trend to move from multi-drug therapy regimens to kill any cells that proliferate, and that, for example, the prognosis of testicular cancer has changed for the better, to more targeted and generally less toxic treatments. But today I would like to talk specifically about some of the latest drug and cell therapies to treat cancermany of them novelties that are already here and are used in our hospitals.
An example of recently introduced drugs consists of those compounds that inhibit specific components of the molecular machinery needed by the tumor cell to divide excessively. It is the case of the calls cyclin inhibitors. Every cell lives in a cycle of growth, rest, division, and death. We can imagine it as the wheel of a car, spinning at full speed in a Ferrari and spinning more slowly in a horse-drawn carriage. The speed of these turns depends on proteins called cyclins and in recent times blockers of them have been obtained. Its main application is being in certain subtypes of breast cancer, where in addition to providing a clinical benefit, they are usually well tolerated by patients. In addition, for these patients in this group of breast tumors there was no drug associated with it and now these women are no longer ‘orphans’ in relation to their therapy. Another more recent example is the RAS oncogene. This was the first gene shown to be mutated in cancer. All this happened in the early 80s when the Naranjito thing, more or less. Well, it has taken about 40 years but we already have the first drugs directed against this genetic alteration of this transforming gene. Its first application will be in patients with lung cancera pathological entity that has also recently benefited from immunotherapy.
Speaking of using our defenses against cancer, in addition to drugs we can use “cells that eat other cells & rdquor;. The idea of these approaches is to extract cells from the immune system, activate them in the laboratory and show them a target of the tumor against which they want to fight. are the cells called CAR-T, TCR or ‘natural killers’. Those used clinically are currently the first, having meant a paradigm shift in unrecoverable cases of leukemias, lymphomas and other oncological pathologies of the blood. One of the problems is that they are currently very expensive therapies, but it is expected in the coming months, a couple of years, that their price will be lowered by automating their manufacture. There is another cell therapy called TIL: they are our T lymphocytes that are already attacking the tumor that we extract and concentrate them to give them back to the patient. Step by step, cell by cell for healing.
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Finally, point out the growing interest and hope for the development of cancer vaccines. Do not think that they are the same as the triple viral or covid-19 that are general for the population, but here they are personal, specific to each individual. One of the most promising early studies in this area has been done in the melanoma: using proteins expressed by this tumor in patients, the vaccine is made, so that when the melanoma shows its face again (relapse or recurrence), our body is prepared to receive it as it deserves. We are in this field at its dawn, but great advances are expected in it.
New drugs, new hopes. We are still in the game of cat and mouse. The tumor is hidden, changes its appearance to go unnoticed for one drug but shows weakness for another. And thanks to research we continue to gain time for many patients, also in quality of life. But the road is still long and it is sometimes difficult to discern where on the horizon the sea ends and the sky begins.