It was in July 2016 that 60-year-old lawyer Suzane de Castro discovered that she had cancer.
Following a persistent cough, he went to see a pulmonologist and, on the first examination, a seven-centimeter tumor appeared in the right lung.
The next step was to perform a more specific test known as PET (positron emission tomography) that revealed that I had metastasis, that is, that the disease had begun to spread to other parts of the body.
“At this point, surgery was no longer an option for me. That's why Dr. Andrea Kazumi Shimada, an oncologist at the Syrian Lebanese Hospital, said chemotherapy. I did it for five months, from July to December, but the effect was not what we expected, “recalls De Castro.
“In January 2017, I decided to change treatment and do immunotherapy“.
After a year and a half of doing this treatment every 21 days, exams showed that small metastatic tumors had disappeared and that the main tumor had reduced to almost a third of its size
In July 2018, half of his lung was removed and he continues to be treated today.
“Cancer is like a chronic disease, it needs control and surveillance. But after immunotherapy, I can take a absolutely normal life. Work, walk, travel … Having this diagnosis is not a death sentence, “he reflects.
Immunotherapy
Cancer treatment has reached important milestones since the arrival of chemotherapy in the 1940s.
But, in recent years, there has been a great technological advance and many new developments have emerged, such as the immunotherapy treatment that De Castro has followed.
After chemotherapy did not work, Suzane de Castro began an immunotherapy treatment.
Angélica Dimantas, medical director of Bristol-Myers Squibb (BMS), the biopharmaceutical company that does research and immuno-oncological drugs, explains that this procedure uses the Human immune system itself to fight disease.
“These are drugs that, instead of focusing on cancer, focus on the patient and the body's defense, so that it can detect tumor cells and fight them,” he says.
“We believe that by 2025, 2030, 70% of cases of the disease, at some point, will be treated with immunotherapy,” he adds.
The mechanism of action of this treatment is based on the premise that, when a cancer appears, it promotes a reduction in the activity of the immune system, and when the immune system stops recognizing the tumor cells, they begin to grow out of control. .
To overcome this, researchers have found ways to reverse the process that help the immune system to Recognize tumor cells and fight them.
The director of the biopharmaceutical BMS believes that in the future, 70% of cancer cases will be treated with immunotherapy.
Gelcio Mendes, an oncologist and care coordinator at the José Alencar Gomes da Silva National Cancer Institute (INCA), comments that the strategy, recognized with the Nobel Prize in Medicine in 2018 (awarded to immunologists James P. Allison of the United States, and Tasuku Honjo from Japan) has been especially successful in skin cancer with melanoma, but also in lung, kidney, bladder, head and neck cancer and some lymphomas.
“It is a procedure that is most often applied in patients with metastases,” says the doctor.
“We are not talking yet about curing the disease, but with this therapy we have been able to improve the quality of life and increase survival“.
In the area of immunotherapy, one of the main novelties is the combination of two medications to further stimulate the defense system; when only recently one was used at a time.
In Brazil, for example, even the National Agency for Health Surveillance (Anvisa) approved a few months ago the combined use of the drugs nivolumab and ipilimumab, expanding the possibilities of treatment for all types and stages of melanoma.
“Other combinations for other types of cancer are being researched and tested, and will soon be launched,” says Bima Dimantas.
Antibodies
Other positive news in the fight against cancer, in principle for leukemia, are treatments with bispecific monoclonal antibodies.
“They allow a link between a specific target in the tumor cells and the defense cell (T lymphocyte), which destroys the tumor. They are extremely effective,” explains Nelson Hamerschlak, Hematology Coordinator at the Albert Einstein Israelite Hospital.
Along the same lines, biopharmaceutical Amgen develops T BiTE technology that, like immunotherapy, helps the immune system attack cancer cells.
“This technique allows the antibody to be linked to two different types of cells at the same time. On the one hand, a cell of the patient's immune system (T lymphocyte) and, on the other, a tumor cell that needs to be fought,” says Tatiana Castello Branco, medical director of the company in Brazil.
“This link activates and stimulates the production of more T lymphocytes and, with that, the medication causes the same immune system to attack and eliminate the tumor cells,” he adds.
A study presented by Amgen this year at the 24th Congress of the European Hematology Association (EHA) in the Netherlands found that the survival of adults with acute lymphoblastic leukemia (ALL) with minimal residual disease (DRM) – patients who still have the disease but in mild degree, even after chemotherapy – it was 36.5 months when they underwent the new therapy.
For Hamerschlak, this result represents a breakthrough in the fight against the disease.
“ALL is the most common hematological cancer in children and for this patient profile it has a high cure rate. But in adults the prognosis was very poor a few years ago, since with chemotherapy a complete recovery was not achieved in most the patients, “he explains.
“It left a residue of diseased cells that caused even more aggressive relapses, even in patients with bone marrow transplantation,” he says.
Cellular therapy
Another recent chapter in the fight against hematological cancers is cell therapy, particularly the modality of CAR T cells (acronym for chimeric T-cell antigen receptor), which uses modified cells of the immune system itself of the patient.
In cell therapy, the patient's T lymphocytes are reprogrammed to recognize cancer cells.
According to Dimantas, from BMS, the therapy works like this: T lymphocyte cells are extracted from the patient's blood and genetically reprogrammed in the laboratory to recognize cancer cells. Then they are reintroduced into the person to fight the pathology.
“This is a totally treatment individualized and promising That has had impressive results. We believe it will be the future of the fight against cancer, “says the specialist.
Radiotherapy
Even radiotherapy, one of the most traditional cancer treatments, has news.
In radiotherapy, more effective and safer techniques are now being used.
Rodrigo Munhoz, clinical oncologist specializing in melanoma, skin tumors and sarcomas at the Hospital Sirio Libanés and the Cancer Institute of the State of São Paulo (ICESP), highlights the hypofractionated radiotherapy.
It consists of “the application of high doses of radiation with greater precision About the tumor This technique, in addition to being effective, is safer because reduces the risk of killing healthy cells and allows reducing the number of sessions, “says the doctor.
This technique is used to combat certain types of cancer, especially lung cancer, but it has also begun to be used in cases of prostate cancer.