“Every cancer that appears in a patient is a different disease.”

“Every cancer that appears in a patient is a different disease.”

Every time the media echoes a scientific development in his laboratory, Edward Battle's mobile phone buzzes with activity. Your email inbox is also filled with messages. They are patients or relatives of patients who want to know what impact this discovery will have on their lives.

His field of research is sensitive and has significant social impact. Patel is an ICREA researcher at the Barcelona Biomedical Research Institute (IRB) and coordinator of the oncology research program at the centre. The laboratory he runs specializes in colorectal cancer.

A football player of sorts, he understands scientific research as a “formula of life.” “You travel a lot, and even when you go hiking in Collserola, you always think about experiences.” He agrees with other researchers: “In this country there is a lack of resources and this takes up an important part of our time,” but he is clear that science is a “stimulating” activity. “It's difficult and demanding, but it's a really great challenge, both intellectually and goal-wise, to find a cure for these patients.”

The research work carried out by Edward Battle was honored with the 34th National Research Prize, awarded by the state government and the Catalan Foundation for Research and Innovation.

Data suggests that cancer is no longer the scary word that was a death sentence a few years ago.

— Survival has improved and is improving every day thanks to the research and development of new treatments. Unfortunately, too many people still die from cancer, but we save more every day. People who had tumors that were previously incurable are now cured. And a lot of people who have advanced tumors we may not be able to cure, but we can synchronize the disease and patients live with a very reasonable quality of life for many years.

I was recently talking with someone who has had three cancer surgeries in the family and is therefore particularly sensitive to the perception of illness. He said that often, in movies or series, when a character disappears, the writers make him die of cancer. Such cases indicate that in the popular imagination the disease is still strongly associated with a negative prognosis.

Unfortunately, there are some types of cancer that we are still unable to treat. Pancreatic cancer, for example, has a very high mortality rate, as do brain tumors. In most types of cancer, when there is a malignant tumor, the prognosis is poor. So it is true that many people still die from cancer. These conditions – not the people we treat – are often the conditions that have the greatest impact and carry the greatest weight in our view of what illness is.

Cancer is often talked about as a single disease, but in reality each case can be very different.

— Each tumor behaves differently, has a different physiology and development. Even within the same type of cancer, there are many types, and each cancer that appears in a patient is a different disease. This is part of the complexity of cancer treatment.

There are researchers who say that cancers should not be classified according to the organ in which they arise, because there are completely different types of the same organ, and instead, they can originate in different organs with many similarities.

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– Yes, this is correct. We know that metastases from different cancers that arise in the liver have a number of common characteristics because they originate in this organ, even though they arise from different cancers. This is an interesting angle, because it is not so much about the origin of the tumors but rather the location of the tumors. It is an idea that has not been systematically explored much, although there is evidence to support it.

Would it be worth exploring it further?

— Yes, especially in the context of metastases. This means that it is possible to believe that there are treatments that may be successful in treating metastases of different types of cancer in the liver or lung. Especially when treatments do not focus so much on treating the tumor, but, for example, on treating the tumor microenvironment, the immune system or the cells surrounding the tumor, because they have common characteristics in different types of cancer.

There are many studies that indicate that there is an increase in cancer in young people.

– There is a global trend, which has become an epidemic in the United States at the moment, and which is also starting to be very evident in Europe. Certain types of cancer, like colon cancer for example, begin to appear very early. 20 years ago, this cancer was a disease of people in their 50s, peaking at 70, and now young people aged 25, 30 or 35 are starting to be diagnosed. All this with the complication that is difficult to treat, because if you are young and suffer from stomach pain or indigestion for a long time, or you have blood in your stool, do not think that you have colon. cancer. In addition, starting at age 50, there are programs to detect blood in stool. Here in Catalonia it is done. You have already received the message.

Why this increase in cases in young people?

-We don't understand why. In the case of colon cancer, we know that tumors in young people are very similar. They are very similar molecularly, but somehow, the process of tumorigenesis in young people has been accelerated. It is suspected to be food related, perhaps with some type of additive or some type of food processing that produces carcinogens or some other type of substance that speeds up the process.

Colon cancer has a lot to do with diet?

– Until now, the main risk factor has been age. Now we are beginning to see that this is no longer the case and that diet plays an important role. We know that diets high in fat or processed meat, these types of less healthy diets, actually increase the risk of colon cancer.

Why are there types of cancer that are difficult to treat, such as pancreatic cancer?

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—There are several aspects that make cancer incurable. The first is location. Today, surgery remains the most effective treatment. If the tumor can be operated on and removed, you have a good chance of survival. The pancreas is very difficult to operate, like the brain, because many arteries pass through the pancreas. In addition, it does not give symptoms and when it is discovered it is very late. There has also traditionally been more research into more common cancers, because they affect more people, and there is greater interest among the population and pharmaceutical companies.

Great strides have been made in treating these most common cancers.

Breast cancer is an example of this. There are many patients with advanced breast cancer for whom we have very good treatments as a result of research conducted over the past 20 years. There are four or five types of breast cancer, and in the past some were incurable. Today, patients live 5, 10, 15 years or more with the drug and with the metastasis with a reasonable quality of life. Regarding colon cancer, there has also been a lot of research but we have not made much progress.

because?

-We don't understand him well. We have a knowledge gap and need to refocus research in a different way moving forward.

By what logic?

-We have been a bit ignorant for many years and now it is starting to change. In colon cancer, we know very well the primary disease, which is the disease that appears in the colon, and we treat it with surgery, but on the other hand, we know very little about metastases. What we know now is that metastases in different organs behave differently from the primary tumor, even in the same patient. This greatly complicates the therapeutic approach. For some time now we have been focusing more on metastases.

Can metastases be prevented?

— There are patients who already have a metastasis at the time of diagnosis, but there are many patients who do not, who have localized disease and undergo surgery. In some cases, it relapses into a malignant tumor with a poor prognosis. This means that the tumor, months or years ago, has spread seed-like cells that remain hidden in the organs and are reactivated. Treating these patients at the time of diagnosis with immunotherapy, which involves activating the immune system to detect and attack cancer cells, helps eliminate these seeds.

There is also the so-called Targeted therapies Very promising

— There is a gene against KRAS, a gene that is activated in 90% of pancreatic cancer cases and 50% of colon cancer cases. Until now we thought we couldn't find drugs to turn it off, but there have been a lot of advances in chemistry that have made it possible to generate molecules that do this. The data that is starting to accumulate, both with preclinical models and in patients, is quite impressive. I think this will have a very big impact in the next two or three years.

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Treatment with CAR T cells, a patient's immune cells genetically modified to detect and eliminate tumor proteins, is also promising, but because it is a personalized treatment, it is very expensive. What are your future prospects?

– A lot of money is being invested in it and there will be amazing progress. There are already approved treatments, especially for leukemia and lymphoma. Hospital Clinic has a very active program.And now there's a lot of development going on to make CAR T cells that would be suitable for everyone or a large portion of the population, so you wouldn't have to make them for every person. There are also developments in biotechnology to take a person's lymphocytes and modify them using a much simpler technique.

However, there are still tumors that escape the immune system.

– In fact, there are tumors that respond and many that do not, but we know that we will be able to identify those that do not respond when we understand exactly how they work. It's about getting to know them better.

Cancer cells are very different from healthy cells and more diverse. That's why understanding it costs so much.

-They are rapidly evolving machines. Normal cells cannot develop because they have to do their job. They cannot change. But cancer cells have acquired this ability to constantly change and adapt to new environments. For example, when they travel and settle in different organs, many of them die, but there is a selection process and some survive. When we put treatment on them, there are those who change, adapt to the treatment, and resist it. This makes their removal very difficult.

It is a book on the Darwinian process of natural selection.

– exactly. This happens at different levels. First, at the genetic level, when the genome of cells changes and acquires mutations that make them resistant to the drug. On the other hand, there is a phenomenon that we are very focused on, which is the phenomenon of cellular plasticity, which has to do with this ability to transform and adapt to different environments or treatments. It's like in the movie Matrix: Now I want to fly in a helicopter and take pills. We know little about the mechanism, but we think that if we have drugs that interfere with it, we can make cancer cells less adaptable and, therefore, treatments will be more effective.

Will cancer be cured or is it a utopia to think about?

-I think we will eventually end up treating or treating many types of cancer. Every day there is progress and it is very clear that there is an increase in the survival rate. Now, we won't be able to cure all of them because there are tumors that will be very difficult to treat, but there will be increases in survival in cancers that are incurable today. Metastatic melanoma was a death sentence fifteen or twenty years ago, and today immunotherapy has brutally improved prognosis.

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