Teresa Macarulla (Barcelona, 1974) is a world authority on pancreatic cancer, one of the most lethal tumors. She is head of the medical program and principal investigator of the Vall d'Hebron gastrointestinal and endocrine tumors group.
Prevention, diagnosis, treatment. Where should we focus the fight against cancer?
It depends a lot on the type of tumor. Prevention is sleep, finding tumors in time, because time plays against curing them. We must invest in improving population screening to find the tumor in people who do not have any symptoms. In some things, such as those of the breast, colon or prostate, a lot has evolved. In others it is much more complex and screening programs are not applied because they are less frequent tumors or not so easy to diagnose.
What can we expect from advanced therapies?
We see great improvements in terms of treatment. On the one hand, in terms of personalization, the study of the tumor genes, understanding that not all breast tumors are the same. It is technology that has allowed us to find these genes and then personalize treatments. We have also improved a lot with the introduction of immunotherapy, which is what has allowed us to attack the tumor in a totally different way from chemotherapy, stimulating the patient's own defenses to fight.
The contribution of technology is seen in survival.
There are tumors like breast cancer where a lot has evolved. Then there are tumors in which we still have a lot of work to do. We talk about new therapies such as immunotherapy, we also talk about nanotechnology, the fact that drugs can selectively reach the tumor cell, avoiding circulation and, therefore, avoiding side effects... In some tumors it is much less developed by many reasons. This would be the case of glioblastoma (brain tumor), pancreatic cancer, bile duct cancer...
Detect with a blood test, to what extent will the liquid biopsy change the paradigm?
We continue to depend on the traditional biopsy. A piece of tumor tissue to see what type of cell we have. There is a lot of research underway to try to detect a protein or DNA remains from the tumor through a blood sample and so that we can make the diagnosis in a less invasive, easier, and even earlier way. This requires a lot of investment and would be part of the diagnosis and also screening. In the coming years it will be a revolution.
And artificial intelligence applied to diagnosis?
It is a matter of teaching the algorithm to learn to diagnose through an image test from a scanner, or even through a biopsy. That you can digitize the images and that the algorithm learns. This will probably be our future. We will have an algorithm that will tell us, with this x-ray, this gentleman, the possibilities that this tumor has.
Is there inequality in access to advanced therapies?
In our country all centers have research and it is through research projects that new therapies arrive. In the Vall d'Hebron one of the great advantages is that the patient has their standard treatment and has access to new treatments, most of them in the research process. It also does not mean that all will end up demonstrating effectiveness but some will. This country is competitive, and when we have a patient who can benefit from a research process, they can be referred to a center where it can be done. We have to fight so that patients who we believe are good candidates can participate in these types of projects. It's the way to move forward.
His specialty, pancreatic cancer, is finding it difficult to advance.
It is one of the tumors in which we have achieved the least progress in survival in the last decade, for different reasons. One of them is because we did not diagnose the majority in time. And also because the biology of the tumor makes it difficult to treat it with chemotherapy. Immunotherapy hasn't worked yet. We have invested heavily in clinical studies and enhanced laboratory research to understand the biology of the tumor, its abilities, to be able to attack it. We have managed to improve the chemotherapy. We also have the possibility of operating on more patients. We have improved a little in recent years, but we have to continue fighting and improving this survival that today, compared to other tumors, is low. What is the research route? In most patients, the driver of the disease is the KRAS gene that is altered. Until today we had no way to block this gene but we are beginning to have the first drugs that do it.
Do you do better research here or outside?
The great difficulty we have, if we compare ourselves with other countries, is resources. Luckily we have private aid. Any small question you want to ask in cancer requires resources, and that differentiates us from other countries. We are at a disadvantage, but the people in this country are fantastic.
Is this lack of resources made up for with talent?
There are things that cannot be replaced, because if you do not have resources you cannot investigate. We have to continue fighting so that in this country we have resources for research and also so that these talented scientists do not leave. We have to take care of them and we have to give them the tools to be able to carry out projects.
Talk about private aid.
The Vall Viva foundation organizes a festival every year in the Vall d'en Bas. This year he gave the money to pancreas research. We have a patient who was diagnosed years ago, she came here, things have gone well and when she turned 50 she held a party and the gift she asked for from the guests were donations to research pancreatic cancer. We have to highlight the generosity of the people.
