The Spanish Association Against Cancer announced this Wednesday the largest Spanish philanthropic project to finance cancer research independent of the pharmaceutical industry or state aid. These are two projects that will receive 18 million euros in total and on which more than 350 researchers will work. The aid is part of the contribution that the AECC wants to make to achieve an overall cancer survival of 70%. Now, that rate is 55.3% in men and 61.7% in women. To increase these percentages, two projects have been chosen to investigate tumors in which survival is very low and there is great room for improvement.
The first of them, endowed with ten million euros, will be dedicated to the study of small cell lung cancer (SCLC), a tumor that is associated with tobacco and is one of the most lethal. It grows very quickly and spreads quickly, something that means that in around 70% of cases it is diagnosed when it has already traveled to other organs. In these cases, survival is minimal, around 3%, but it is not very long in those that are detected earlier. “It is very sensitive to chemotherapy and radiotherapy, but the response is usually short-lived and relapses early; The long-term cure rate is less than 10%,” explains Luis Paz-Ares, from the Hospital 12 de Octubre in Madrid, leader of the project together with Marcos Malumbres, from the Vall d’Hebron Oncology Institute (VHIO) in Barcelona. .
Another reason for the low survival is that it has not been possible to develop inhibitors of genes that cause cancer, so there are no molecular therapies available to combat it, and immunotherapy, treatments that have changed the perspectives of many patients in recent years. years, it only works in some patients and with less benefit than in other lung cancers. “Another problem is that it is difficult to access the tumor, because they do not operate and the amount obtained in biopsies, which are also complicated, is very small and is exhausted in the diagnosis. Therefore, there is little material for research,” he points out.
The financing from the AECC has allowed the creation of a consortium (SOSCLC) that will continue beyond the five years of the project. There are 40 groups from 16 cities throughout Spain that will try to understand and attack SCLC from many points of view, with researchers who will study the biology of the tumor from a basic point of view to more clinical ones who will test molecular therapies that do not work until now. with this type of cancer. According to Paz-Ares, the application of liquid biopsy will also be very relevant, which can collect information about the tumor with a blood test, to overcome the difficulty of making solid biopsies. In addition, the aim is to raise awareness about a disease closely associated with smoking, but which is also influenced by other risk factors, such as exposure to radon.
The second aid, of eight million euros, will be allocated to research into the most common liver cancer in a project led by Josep Llovet, from the Hospital Clínic of Barcelona, and Xoxé Bustelo, from the Salamanca Cancer Research Center. Hepatocellular carcinoma is detected every year in 6,500 people in Spain and now has survival rates of less than 30%. Transplantation, which is one of the possible treatments, is only applied to 25% of patients, due to lack of organs, and relapses after surgery affect a high percentage of those who undergo surgery, up to 60% after five years.
“There are circulating cells that nest again and cause recurrence,” explains Llovet. Furthermore, these types of tumors affect people with cirrhosis, caused by the hepatitis C virus, alcohol consumption, obesity or diabetes, something that complicates treatment. “Hepatocellular carcinoma usually appears in this disease, because an inflammatory environment is created with DNA mutations,” the doctor continues. Cirrhosis makes chemotherapy too toxic to be an alternative and surveillance programs for the at-risk population are applied to less than 50%. Too many tumors are detected when they are very advanced.
To overcome these obstacles and improve survival figures, they will carry out a proof of concept with 80 patients in 15 hospitals, to whom they will apply a plan that has shown its effectiveness in improving survival in people with other tumors such as melanoma. It involves providing immunotherapy before surgery to reduce the size of the tumor and increase the chance that relapses will not occur. This treatment, which will also incorporate immunotherapy after surgery, will be applied to half of the patients and will be compared with the usual treatment until now, which only applies immunotherapy after surgery.
Furthermore, in a part of the project that involves 10 research centers, samples from participants will be used to search for markers with which to predict each person’s response to treatment and personalize therapies or look for ways to combat resistance. This combination of testing treatments and research on the basic mechanisms of a type of cancer is, for Llovet, one of the great advantages of this project, which does not depend on the specific interests of a pharmaceutical company that does not pay the same interest to research facet.
The general director of the AECC, Isabel Orbe, explains the selection of the projects as part of its strategy to achieve the greatest impact and also to promote equity in the treatment of the disease. That is why they have emphasized that the projects include researchers distributed throughout Spain, who work in a network, sharing information, and that they give the option for patients to be treated in their environment. And that is why they chose tumors with lower survival. “If it’s bad enough to know you have cancer, imagine being told it’s small cell lung cancer,” she says. “Look at how breast cancer was 50 years ago, and how it has improved, we want to put the focus on these tumors that affect an important part of the population,” she summarizes.
Orbe believes that another of the values and originality of its approach is that, although the projects are designed for five years, “they are not projects written in stone from the first to the fifth year.” “It is a project that is going to be built between many groups that are going to share knowledge and we are going to accompany the researchers to continue adjusting the objectives to reality, which may change with the progress of the project,” he points out. “Our research system is very rigid and does not allow that flexibility, which I think is something that is being very well received,” he emphasizes. Finally, he criticizes that the State does not do enough in cancer research. “People believe that cancer is a disease and there are 200, absolutely different, and you can fund cancer research, but breast cancer is not the same as lung cancer,” he continues. “We do not confuse the flu with HIV, and both are viruses, and we cannot confuse breast cancer, which already has a 90% survival rate, with small cell lung cancer, which has 3 or 10,” concludes.
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