Teresa Macarulla (Barcelona, 1974) is a world authority on pancreatic cancer, one of the most lethal tumors. Head of the medical program and principal researcher of the group of gastrointestinal and endocrine tumors of Vall d'Hebron.
Prevention, diagnosis, treatment. Where should the fight against cancer be focused?
It depends a lot on the type of tumor. Prevention is the dream, finding the tumors as soon as possible, because time works against curing them. It is necessary to invest in improving population screening to find the tumor in people who do not have any symptoms. In some cases, 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 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 made it possible to attack the tumor in a completely different way to chemotherapy; stimulating the patient's own defenses to fight.
The contribution of technology is seen in survival.
There are tumors such as breast cancer in which it has evolved a lot. Then there are tumors where we still have a lot of work to do. We are talking about new therapies such as immunotherapy, also nanotechnology, the fact that drugs can reach the tumor cell in a selective way avoiding circulation and therefore avoiding side effects... In some tumors all this it is much less developed for many reasons. It would be the case of glioblastoma (brain tumor), pancreatic cancer, bile duct cancer...
Detecting them 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 tissue from the tumor to see what type of cell we have. There is a lot of research underway to try to use a blood sample to detect a protein or remnants of DNA from the tumor so that we can make the diagnosis in a less invasive, easier, even earlier way. This requires a lot of investment and would be part of the diagnosis as well as the screening. The next few years will be a revolution.
And artificial intelligence applied to diagnosis?
It's a matter of teaching the algorithm to learn to diagnose through an image test from a scanner, or a biopsy, even. 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 chances that this tumor will have.
Is there inequality in access to advanced therapies?
In our country, all centers have research and it is thanks to research projects that new therapies arrive. In Vall d'Hebron one of the great advantages is that the patient has his standard treatment and has access to new treatments, most of which are in the research process. It also doesn't mean that all will end up proving effective, but some will. This country is competitive, and when we have a patient who can benefit from a research process, he can be referred to a center where it can be done. We must fight so that patients who we believe are good candidates can participate in this type of project. It is the way to move forward.
In his specialty, pancreatic cancer, it is difficult for him to advance.
It is one of the tumors in which we have made less progress in survival in the last decade, for several reasons. One of which is because most of us do not get to diagnose them in time. And also because the biology of the tumor makes it difficult to treat it with chemotherapy. Immunotherapy still hasn't worked. We have invested heavily in the field of clinical studies and have boosted laboratory research to understand the biology of the tumor, its abilities, in order to be able to attack it. We got the chemotherapy to get better. We also have the possibility to operate on more patients. We have improved a little in recent years, but we must continue to fight and improve this survival which nowadays, compared to other tumors, is low. What is the research path? In most patients, the driver of the disease is the KRAS gene, which is altered. Until today we didn't have a way to block this gene, but we are starting to have the first drugs that do.
Do you research better here or outside?
The great difficulty we have, if we compare ourselves to other countries, is resources. Persort, we have private aid. Any small question you want to ask in cancer requires resources, and this sets us apart from other countries. We are at a disadvantage, but the staff in this country is fantastic.
Does talent make up for this lack of resources?
There are things that cannot be replaced, because if you don't have resources, you can't research. We must continue to fight so that in this country we have resources for research and also so that these talented scientists do not leave. We must take care of them and 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 donated the money to research on the pancreas. We have a patient who was diagnosed years ago, she lives here, things have been going well and when she turned 50 she had a party and the gift she asked the guests for was donations for pancreatic cancer research. We must emphasize the generosity of people.
