Mariano Barbacid: "educational campaigns can have more influence than research."
When we talk about cancer, should we talk about a single disease or a group of diseases?
Today we can say, without a doubt, that cancer is not the only disease, but the set of diseases that have the same characteristic: especially the accumulation of defects in the genes that must fulfill the control of reproduction and cell death. In cancer we find very curious cases, in which some tumors have a clinically very similar behavior and very similar anatomopathological characteristics, they can have a completely different pathogenic character. This shows that the clinical development of tumors and their response to treatment can be very varied.
He has been researching cancer for many years. What has changed throughout this time in research?Has anything been advanced?
Since 1974 I have been working on basic oncological research and from this perspective I can tell you that in the last quarter of a century we have had a real revolution in the knowledge of cancer, we already know what it is and how it occurs, which must be thanked for the discovery of the molecular mechanism that ends with the neoplastic processes. The current revolution in genomics and proteomics affects basic research in a very positive way, although little has changed in the way of doing daily work.
In addition, there is a great interest in the development of translational research, that is, in the immediate transfer of all these findings to the world of cancer patients, in order to improve the diagnosis of the disease and improve the existing treatments.
You have launched and are director of the Oncological Research Center of Spain, what will you investigate there? And in the world, what lines of research are open?
I will only be able to answer the first question because if we focused on the second question, it would easily overcome the limits of time and place of this conversation. However, if necessary, I can answer that it is about attacking cancer everywhere possible and that all these aggressions are valid if they meet the minimum scientific rigor.
In the Oncological Research Center of Spain, a basic and applied research will be carried out, but always before clinical research, since our center will not offer help to patients. In basic research, topics of molecular oncology will be addressed, especially the research of the molecular mechanisms of cancer and the identification of modifier genes that affect our ability to suffer this disease. According to our Molecular Pathology Program, applied research will focus on the molecular diagnosis of cancer; we will soon begin using biochips to perform molecular studies of large scale tumors. We expect to have 5,000 oncoated genes for spring. The second line of applied research will focus on the search for new drugs, following the operational schemes of leading biotech companies in the United States. This program will be launched this year and we expect the pharmaceutical industry to be an ally.
What strategy, path… is left to investigate? What, in addition to curing cancer, is the biggest challenge?
The pathways or strategies selected in research depend on technological development. 15 years ago the sequence of a gene of 5,000 bases was a great challenge. Today, only one person can do so in a few hours, otherwise it would not be possible to perform a human genome sequence of 9.000 million bases. If necessary, the main challenge would be to know the functioning of the 50,000 genes that are part of the human being and to better understand the mechanism of this cancerous malfunction.
Recently there is a lot of talk about genetic therapies. The origin of cancer is properly genetic, but there are other factors that can trigger cancer. What is more important, the position of our genes in the development of cancer or the influence of external factors?
First of all, I must say that genetic therapies have become very popular in society, that they like people, but that more than 500 clinical trials have already been conducted, and none have given positive results. This does not mean that it is not worth continuing to strive because, as I said before, all efforts are valid from the moment they have the minimum scientific rigour; and, of course, the case of genetic therapy is this. Of all the reasonable information we have today, there is no doubt that the origin of the cancer is genetic, that is, the cancer is due to mutations, both for errors in our cells and for external factors such as tobacco, the sun or some diets. Obviously, there are epigenetic factors that have a great influence on neoplastic processes, so we want to find modifier genes. Anyone who burns tobacco causes mutations in their DNA that, without a doubt, will activate some of the cancer-related genealogies. However, we all know that smoking tobacco increases 1,000 times the chances of developing lung cancer, but not all smokers have lung cancer. This is another of the great challenges we have to discover and solve.
Advances in technology, information campaigns… seem to contribute. But do they really serve for something?
If you want to reduce the incidence of cancer, information campaigns are critical. When the cancer is detected before the metastasis, before it laughs in our body, the chances of healing, especially with surgery, are usually very high. For this reason, especially in the case of tumors that can easily reach the outside of the body, such as skin cancers, breast head, testicles or prostate, education can be of great importance. In this way, early detection will reduce the likelihood of metastasis and will allow the affected organs to be removed before effects are still unhealthy.
From another point of view, educational campaigns can save thousands of lives, much more than research itself and treatments can save. If the population, especially the young population, who still have time to quit smoking or not to start smoking, will really realize the danger posed by this custom, the incidence of lung cancer, one of the most lethal, would be almost anecdotal. Unfortunately, cancer takes more than 30 years to appear and there are still many people who do not recognize that they kill tobacco.
The media report on more than one occasion the miraculous remedies and cocktails of medicines, but alone in animals, that stop or stop the disease. What do you think about all this?
Here you have to make a very clear separation. One thing is what you call miraculous or anecdotal remedies, and another is the research done with animals, among other things because it is an inescapable obligation to treat human beings. As you well say, experience has shown us that healing of animal tumors is much easier than healing of human beings. In fact, of the ten new products that are currently included in the clinical trials of cancer, only one is allowed for its subsequent donation to humans, without taking into account the clinical trials that are performed in the field of genetic therapy mentioned above. But this process is essential and we must continue fighting to improve it.
In fact, this is one of the lines of research that is currently being carried out in the Oncological Research Center of Spain, through genetic manipulation, the new and better development of animal modelling systems, which will allow to better predict clinical trials with animals and thus increase the possibility of antitumor drugs of human utility.
I know that the researchers do not like to answer these kinds of questions, but do it as journalists. Therefore, there it goes: How long and why will the solution to cancer come?
Scientists should not fall into the adventure question of advancing deadlines, and less on a topic as important as cancer healing. However, I will dare say that in the future, as has happened so far, advances will occur step by step and with certain types of tumors. In answering your first question, I have told you that cancer can be similar to infectious diseases with high content in etiology, so it would be bad to think that only one drug will be cured. We will also win the battle against cancer, or at least turn cancer into a chronic disease with low mortality rates, with the help of everyone. The society itself must contribute to the reduction of the risks to which it is exposed, to the reduction of the combustion of tobacco and to the exposure to ultraviolet rays. For their part, doctors will also put it, offering comprehensive care to patients to facilitate and speed up tumor detection. And finally, the researchers, better understood of the disease, to design better and more effective drugs.
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