A ticket to the genetic identity of cancer
What cancer treatments will there be in the future? The epidemiology of cancer, personalised treatment, immuno-therapy and the outlook on breast cancer treatment, for example, are some of the topics discussed at the symposium on Oncology at Leaping Forward/Hospital da Luz, organised by professor José Luis Passos Coelho. However, there is one research line in particular in the spotlight: that which uses the ID of each type of cancer to treat this disease.
Imagine each of our cells are a factory, composed of several assembly lines. The cell is healthy when these assembly lines function smoothly. But if they become dysfunctional, that is a signal of a sick cell. Such are cancer cells, the ones with some damaged assembly lines. This description of one of the most feared diseases in the World is so recent that researchers and doctors address it as if facing the immense universe.
«Cancer medical, drug therapy is very recent. The first chemotherapy drug was discovered after the Second World War, when medical oncology did not exist yet and we knew very little about cancer. The first therapeutic associations developed in the 1960s and 70s. We have progressed a lot ever since, as is known. And today we know much more. We have actually come to a stage where our knowledge of cancer delivers to us every day treatment choices», says José Luis Passos Coelho, coordinator of the Oncology Centre at Hospital da Luz and professor in Medical Oncology at the Faculty of Medical Sciences of Lisbon Nova University.
«Now, this approach to cancer, which speaks about cell ‘assembly lines’, is one of the newest research lines into the treatment of this disease. It tells us that it is not exactly organ A or B that is sick – therefore, the treatment should not address breast or lung cancer individually -, but rather that treatment must target the ‘assembly lines’ of the cancer cells of individual A or B which are blocked, broken or functioning poorly, in order to make them operational again», the doctor clarifies.
According to Passos Coelho, this was one of the most significant advances of research into this pathology: «To choose the appropriate treatment type per person, we must first try to identify the ‘assembly lines’ which are damaged in the cells of the specific cancer. It is as if we tried to establish the cancer's ID, its finger print. And this is something that today, with molecular and genetic laboratory techniques, we manage to obtain more quickly and easily. And at an increasingly lower cost», he highlights and adds: «Which is why we're already anticipating something new in the way we address this disease: the fact is that if we have the ID of each cancer, we will no longer treat breast or ovarian cancer; we will actually be treating a cancer with several damaged pathways».
This new approach to cancer treatment opens up an almost endless world in the choices and combinations of therapy. «What this actually tells us is that there can be pathways or assembly lines which are damaged in the cells of a specific tumour in one organ and which are similar to that of other types of tumours of other organs. We also realise that there may be two people with breast cancer who, while to date were treated in the same way, will now be treated with different drugs, since the one has changes in pathways A, B and C and the other in pathways E, F and G», the doctor argues. «In the end we will have 50, 60, 100 different drug cocktails. And this is another of the greatest challenges of this age».
A priority for Hospital da Luz
Yet Passos Coelho does not hide that this is also one of the greatest difficulties of this approach to cancer treatment. «Because it will make it more difficult to conduct clinical studies», he explains. «Will it still be possible to gather large groups of patients with the same tumour cell ID to conduct clinical trials with drugs which may produce reliable results? Perhaps not», he admits, and adds: «These studies will have ten, 15, 20 patients at a time. Precisely since variability will be so great and therapeutic associations so specific that, in the end, we will have to accept that the number of patients treated in exactly same way will always be very small».
When approaching these patients for treatment, oncological patients will be inevitably submitted, on a routine basis, to genetic studies. «This is where we are heading», the oncologist from Hospital da Luz confirms. But this study will only be conducted when the disease manifests itself, i.e. «the cancer's ID is traced only when it appears. And technology has evolved in such a way that, very soon, it will only take a couple of days to obtain the exact sequencing of the genetic code of each tumour, and for a reasonable price».
For certain types of cancer the only exception will have to be the cases where there is a family history. «In such cases, it is possible to find out if they are risk patients or not by studying the normal cells of relatives. This is because cancer cells share some change which the other cells have and which facilitate the emergence of the tumour», Passos Coelho explains. He underscores that «In most cancer cases this is not what happens. The cells are normal until cancer develops. And what happens with the cancer cells is that they accumulate a series of errors, which means that there comes a point when they become different from the rest. In other words, in most cases, to study normal cells will not take you anywhere», he concludes.
The oncologist does not hide his enthusiasm with regards to this approach to cancer treatment and «the wealth of information» it can convey to research into the disease and the choices of therapy. Therefore, this is one of the highlights of Leaping Forward – International Clinic Congress which has gathered in Lisbon, at Hospital da Luz, a group of experts in the different areas of Oncology.
«As I have explained, the fact is that the knowledge we have today about the disease has led us to study different ways of treating cancer. There are several strategies which must be studied and tested. And there are already drugs for all of them. There is an immense variety of choices of therapy. We're going to discuss all of this at Leaping Forward», states Passos Coelho and explains further: «Usually, Oncology meetings focus mostly on the findings of recent studies, information about what is being done today, although they also discuss the future. At Leaping Forward we're looking for something different: we want to look into the future, we want to anticipate what will happen, both in epidemiological terms, and in terms of strategies and treatment weapons. This is to say, we want to understand what are the treatments of the future based on what we are learning today about the disease».
«This is a commitment of the organisation of this international congress– Espirito Santo Saúde itself», José Luis Passos Coelho concludes. Furthermore, «Oncology is thus a priority area for us, here at Hospital da Luz. An area which is part of our present and, clearly, of our future». G.R.
Special Report, Leaping Forward - Lisbon International Clinical Congress, Hospital da Luz, Lisbon, february, 13-19.