Breast cancer research speaks Spanish.

Dr. Javier Cortés,

director of the

International Breast Cancer Center

in Madrid and Barcelona

, ​​was considered the first expert in the world in research on breast cancer of the HER2+ subtype last October.

The data comes from the international Expertscape ranking, which evaluates the work of 69,311 researchers.

In addition, this classification has considered him the fourth world expert in breast cancer, among more than 300,000 scientists.

"The situation in metastatic breast cancer is bittersweet," he says.

Advances have been evident in recent years, "but patients continue to die. We are investigating and improving in different fields

-he points out-, such as immunoconjugates, which are medicines made up of three components: a monoclonal antibody, chemotherapy drugs and a link that unites the first two".

These novel drugs are, as he specifies, "a form of optimization of chemotherapy administration.

They act like Trojan horses because they go through the blood, through the tissues, they join the tumor cell and cross its membrane, which is like a wall, and they release all the chemotherapy inside the tumor

," he explains.

He also adds that "the two available are sacituzumab govitecan -with very good results in the triple negative subtype- and trastuzumab deruxtecan, in HER2+ breast cancer. These two great drugs are already part of our usual clinical practice".

Therefore, the strategy of using drugs as Trojan horses is already a reality, although currently they are only used in the second and subsequent lines of treatment.

"There are numerous studies that are testing them in the first line and, even, in early stages in which the tumors are localized and curable, with the aim of curing more patients. And this path continues to be explored, optimizing the drugs, modifying its structure or adding more chemotherapy drugs to it," he says.

On the other hand, he continues,

"they are choosing to administer them with other immunotherapy drugs

, that is, they stimulate the immune system so that it is the one that fights tumors. The results are very promising. In addition, new potential receptors are being sought tumors to which to direct these new drugs", announces Cortés, who also chairs the Foundation With You against Cancer for Women.

In the specific case of HER2+ subtype breast cancer, as a world reference, he summarizes that

the treatment is based on different drugs such as monoclonal antibodies, Trojan horses and targeted drugs

"but always focused on blocking the HER2 protein".

Another line of research is triple-negative breast cancer, a subtype with a poor prognosis that has been treated,

until about five years ago, solely with chemotherapy

.

"Now we have seen that immunotherapy is fundamental both in localized tumors and in metastatic ones when they have a biomarker. And, as a second line, we began to use Trojan horses. But chemotherapy continues to be key in this area," he stresses.

KNOW WHICH PATIENTS BENEFIT MOST

The aforementioned immunotherapy drugs are also providing very good results in certain cases.

"In this field,

we are investigating biomarkers

that allow us to know which patients are going to benefit the most and which are not. Another interesting line in which we are working is in combinations of different immunotherapy drugs. Thus, we not only enhance lymphocytes to that attack the tumor cells, rather we stimulate or block other cells that may play a regulatory role in the immune system", he explains, adding

"a third line of research is to better understand the microbiota

, that is, the field of bacteria in our gut," he details.

And what role will chemotherapy continue to play, which has been the standard of treatment until a few years ago?

For this expert, "it will continue to be useful in some scenarios, but less and less: for example,

around 50% of the patients to whom we used to give chemotherapy now do not receive it and we can treat them only with hormonal treatment.

This year, in the congress of the American Society of Medical Oncology that will be held next June -advance-, I am going to present absolutely fascinating results on how we can not have to give chemotherapy to localized tumors of the HER2+ subtype Until today, chemotherapy was the the only treatment in these cases, but we are beginning to see that it may not need to be given, even in patients with large aggressive tumors."

But if there has been a significant advance in cancer in recent years, it has been that of

personalized medicine, although Cortés prefers to call it "precision

medicine" , because all medicine must always be personalized. What we do is, with exhaustive knowledge of the biology of the tumor and its microenvironment (the cells that make it up and surround it),

we design treatments that block or activate specific proteins in this context

.

In this way, today we can block tumors because we block essential proteins for these tumors.

Or, on the contrary, we activate the body's defenses because we know molecular biology better.

Currently, research in this field is managing to find more and better markers and, in addition, we are learning to combine them with other therapeutic strategies, such as chemotherapy, hormone therapy, immunotherapy or the Trojan horses that I have mentioned above" .

Another approach that is being investigated and that is beginning to provide

very promising results is that of liquid biopsy

.

It consists of taking a sample of blood, urine, or any other fluid from the body to look for cancer cells.

As Dr. Cortés points out, this process allows us to better understand both minimal residual disease (the few cells that remain in the body after treatment) and metastasis.

And even predict when a tumor will appear before it is diagnosed.

Another advantage of this procedure is that it can be repeated, which makes it possible to check the evolution of the patient.

IMPROVE PREVENTION

Breast cancer screening, based on

mammograms, is a fundamental tool for prevention.

From his point of view, in Spain "it is done very well: women are well informed, doctors do their part and the health system responds to these needs," says Cortés.

However, he believes that, even so, "it must continue to improve, for example, with buses that perform mammograms or Papanicolaou tests (for cervical tumors),

we must reach those population centers that have less access to screened

."

In her opinion, it could also be improved by personalizing the screening: "I think that it should not be the same for all women, since some require a more exhaustive screening, while others require a more lax one. It is now that we begin to understand the importance to personalize it, but it continues to be a pending issue in Spain".

As in so many other areas of health, the Covid pandemic caused a huge impact in terms of cancer diagnosis.

Cortés estimates suggest that

the delays were around 20%.

"These diagnoses did not disappear; the patients came to the consultation later

and the diagnoses were more advanced. We have been able to recover the figures, but along the way we have left patients who could have been cured and who, unfortunately, will not be able to do so for these delays," he laments.

HOW TO PREVENT THE APPEARANCE OF CANCER

We all know that you should not smoke or drink, that you should avoid a sedentary lifestyle, eat healthily...

To this highly publicized and well-known list, Cortés adds that it is essential that the media publicize advances in early diagnosis.

"And I insist, we have to ensure that the possibilities of screening reach all population centers, the most remote rural areas. And let's not let our guard down, because

sometimes there are negative and unscientific campaigns, with an important echo in networks that do not do any good

. That is why -he continues- we should work so that these comments are adjusted to reality or are careful, because when they come to light, the number of patients who undergo screening decreases, which can be translate into a clear increase in mortality", criticizes, but at the same time acknowledges that "of course

Breast cancer screening has its drawbacks, but it has been shown to improve survival from the disease

". She insists again that "not all patients should do everything the same, we need more and better breast nuclear magnetic resonance machines because some patients need".

One last aspect that Cortés highlights is the work carried out by patient associations.

"For example, Pilar Fernández, president of the Spanish Association of Metastatic Breast Cancer, or Màrius Soler, of the Association of Male Breast Cancer, are magnificent people, very prepared and who leave their skin to publicize the disease. They play a fundamental role so that drugs are approved earlier," he concludes.

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