Martin Lazaro, oncologist: “With the help of immunotherapy, we achieve long survival for unimaginable tumors” | Health and wellness

A scientific revolution is at the heart of the fight against cancer: it is now known that no two tumors are alike, even if they are located in the same organ, and cancer research is delving into the fine print of tumors that molecular biology reveals. , is moving towards creating more and more personalized medicines, thought out and designed, even tailored to each patient. “Targeted drugs have been discovered that will allow us to choose which treatments will be most effective and suitable for patients based on their molecular changes,” explains oncologist Martin Lazaro (La Coruña, 59 years old), physician at the University Hospital Complex. Vigo and the architect together with his colleagues Sergio Vazquez and Joaquín Casal at the National Symposium on Precision Oncology, which took place a couple of weeks ago in Vigo.

Lazaro, president of the Oncological Society of Galicia and specialist in tumors of the lung and genitourinary system, analyzes the different areas of this new personalized precision medicine: it implies a therapeutic arsenal with increasingly targeted treatments, as well as a greater role for the patient in decision-making. . “Fortunately, we have moved past the stage of paternalistic medicine and now take into account the preferences of patients, and they also decide what is best for them.” And he gives an example: “If a patient has an advanced stage tumor with a poor prognosis where they can expect survival of one year, and we are going to offer them a treatment that can extend their survival by an average of two years. months, you may decide that it may not be worth going back and forth to the hospital with side effects that may limit you, and you would rather invest that time differently because you have to take into account that we are calling temporary toxicity (time spent receiving cancer care, including travel and waiting time),” explains the oncologist.

Ask. How much does this toxicity of time weigh?

Reply. There are patients who spend a lot of time between tests, trips to the hospital, treatments… With pancreatic cancer, this can take up almost 20% of the patient’s remaining survival time. And this is something that we also have to take into account.

TO. Does this mean that not the entire therapeutic arsenal is worth it?

R. I always tell patients that we have treatments that may be more or less effective. We know that a drug can prolong survival, that this increase in survival is significant at a statistical level, but perhaps it is more or less significant at a clinical level. That is, I see the statistics and the impact of this treatment on survival is real, but perhaps the time in which we increase survival is more or less important and the real significance of what it is needs to be assessed in consultation with each patient.

TO. A few days ago, an advertisement for a saliva test for early cancer detection went viral, prompting the Spanish Society of Medical Oncology to issue a warning that the experiment has no medical value. Are the results increasing?

R. This saliva detection study is something that is very early to say that it can help us find patients early. It is true that sometimes we exaggerate what is published. We want to see good news so much in the sense that we see the part that catches our attention, but we have a hard time seeing what meaning it makes afterwards and whether it actually implies something or not. We have to be very careful because sometimes it causes people to have false hopes.

TO. Has precision personalized oncology reached maturity?

R. In some parts we are at a maturity stage: knowledge in the field of molecular biology is increasing and more drugs are being used in some tumors. I use lung cancer as an example: when I was in my specialty, you could expect a median survival of 10 or 11 months. Fortunately, this cancer is divided into small parts that resemble slightly different tumors, and if a person comes to me with ALK-positive lung cancer (with a change in this gene, which accounts for 4% of lung tumors), I am going to begin therapy knowing that when a treatment stops working for this patient, new drugs will probably already be released that will allow me to choose the best treatment for that person when it doesn’t work. The problem is that this does not happen with all tumors, with some types of cancer we still have a way to go: there is a significant percentage of patients for whom we cannot choose the right treatment.

TO. You specialize in lung cancer, a type of tumor in which immunotherapy has worked and in some cases changed the course of the disease, but the overall prognosis remains poor. How is this interpreted?

R. There are still many subgroups of people who do not tolerate treatment well, but there are patients who respond to immunotherapy and the response is better and sometimes very long lasting. So much so that we are already starting to have patients who, after receiving two years of treatment and stopping it, live a normal life for two, three or even four years, without any progression of the disease and without the need for treatment. get more treatment. However, there are tumors that grow in a colder immunological environment with less enhanced immunity, and here we need to explore strategies that will allow us to turn this cold tumor into a hot tumor, as well as increase the effectiveness of immunotherapy. But there are many things we don’t know about immunity in cancer.

“Lung cancer screening needs to be implemented as it improves survival.”

TO. With lung cancer, a change in profile is observed: it decreases in men and increases in women. Will the tumor change?

R. It becomes obvious that women get sick more often because they later acquired the habit of smoking. But it’s true that in women it seems to be a slightly different tumor. In men, more than 90% of patients have the habit of smoking, and in women – in 50–80%. There are other factors that influence them: we are talking about the hormonal environment, which can be one of the favorable ones; It has also been observed that there are pro-carcinogens in tobacco that need to be activated for them to subsequently become carcinogens and this can be done through cytochromes (proteins) and some of these are more expressed in women. It is also true that women have a better prognosis compared to men.

TO. These are different tumors, but is the method of treating them different?

R. We have to take this into account because so far the treatments are very similar. Women tend to experience slightly more toxicity with chemotherapy and certain medications, and it is not known why. We know that the disease looks a little different, and we need to learn to stratify studies by gender as well.

TO. Lung cancer screening is controversial among scientists, but European authorities recommend it.

R. In my opinion, screening will be necessary because studies have shown that it improves survival or reduces mortality from lung cancer. What’s happening? This has many meanings because of what it entails. This is a population in which we are going to find a small number of tumors, and we are also going to trigger investigations as a result of the results that we will see on the CT scan, and who do not know what they are, which will require a diagnosis. and which will often be benign lesions that can sometimes lead to serious complications. And we also have to see how this significant volume of diagnostic testing is implemented.

TO. The survival rate of some tumors has ceased to be calculated in months and has begun to be calculated in years, but oncologists always find it difficult to talk about cure or transformation of the tumor into a chronic form. Is saving time the ultimate goal?

R. There are situations when we help to recover, and when the disease is advanced, we try to prolong it as long as possible. With immunotherapy, we are already achieving that in some tumors that were previously unthinkable, long-living people appear that were not there before. And this is an irrefutable fact. But let’s start with the fact that for most tumors with advanced disease, the approach will be to delay tumor development.

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