Sergio Vazquez President of the Oncological Society of Galicia and Chief Investigator of the Lucus Augusti University Hospital Service
"In the case of cancer, these new protein biomarkers play an important role in the diagnosis and prognosis of patients and, in addition, open an alternative as possible new therapeutic targets"
Q_ As a researcher, can you tell us what the study of tumor markers is currently focused on? Have they been expanded for cancers that are usually not detected, such as skin?
A_Tumor markers are substances that cancer cells or normal cells make in response to cancer in the body. Some tumor markers are specific to a type of cancer.
At present, the study of tumor biomarkers (which must be differentiated from the more nonspecific tumor markers, previously commented) focuses on carrying out different types of genomic and molecular analyzes to identify them and, thus, be able to establish therapeutic decisions of custom shape. Although most of these studies are carried out on tissue samples, liquid biopsy samples (serum, plasma, urine) are also used.
At present, in clinical practice the study of these tumor biomarkers is only applied in those cases in which there is an approved therapeutic target, such as lung, breast or colon cancer, among others. The same occurs with melanoma, where biomarkers such as BRAF and PD-L1 are analyzed, which help us make decisions about the most appropriate treatment for each patient.
Q_What happens in those or benign diseases that test positive for these markers?
A_Tumor markers, not tumor biomarkers, which is something completely different, can be elevated in the blood in situations where there are no malignant tumors, such as inflammation of different organs, among other situations. For this reason, we must be very cautious about using them as a diagnostic method without clinical support, physical examination and imaging techniques. Nor should they be solicited routinely. Only in those clinical situations that require it, usually by a specialist doctor.
Q_Could you explain the pillars of proteomics for those who are new to this topic?
A_Proteomics is important to study and characterize the entire set of proteins (proteome) expressed by a genome, in order to obtain an integrated global vision of cellular processes. Taking into account that the proteome of a patient with a certain pathology is different from that of a healthy individual, the location of these differences can find different molecular biomarkers (proteins, in this case). In the case of cancer, these new protein biomarkers play an important role in the diagnosis and prognosis of patients and, in addition, open an alternative as possible new therapeutic targets.
Q_Can immunomarkers and work with immunotherapy be carried out in all cancer pathologies?
A_Where it is currently most developed is in melanoma, lung cancer and genitourinary tumors, but its use is spreading to all tumor types. In some cases we have useful biomarkers such as PD-L1, but not in other tumor types. What we do know is that there are patients who benefit greatly from immunotherapy. The problem is selecting them from the start. We are working on it. It is also being combined with chemotherapy and other immunomodulatory molecules for better results.
Q_Vaccines control women and men differently? If you were like this, what impact would it have with the covid?
A_I do not have enough information to answer this question, but I do not think there are differences by sex and, in fact, we are not noticing those differences in COVID-19, as far as I know.
Q_What consequences is the pandemic having on possible patients with other pathologies, whatever they may be?
A_In the first wave, in Galicia, if we notice diagnostic delays in oncological pathologies, fundamentally due to the fear of the patient to go to Primary Care or Emergency and a Primary care collapsed by COVID, with the consequent repercussion on the fast pathways of cancer, such as around the world. This was less noticeable in Galicia than elsewhere, due to the lower intensity and later arrival of the pandemic, which allowed us to be clearly better organized. In the rest of the waves, with the health system clearly better prepared, there have been no problems. We will notice the global effect on cancer survival in the longer term.
Q_ How the head of the hospital service could tell us how he sees that patients with other pathologies carry the covid, what consequences or sequelae it can lead to older people?
A_Oncology patients and their caregivers have always been more aware than others of the pandemic, due to their immunosuppression situation and, from the first moment, they have taken measures to reduce the risk of contagion. In fact, in the Health Area of Lugo, A Mariña and Monforte de Lemos we have only registered 30 patients infected by SARS-CoV-2 in 1 year, with 3 deaths. This is also due to the fact that our Service and the Management of our Health Area took very early measures and agreed with the different specialists, apart from the fact that the HULA is a very modern Hospital with many available spaces, which facilitates any action in this regard. .
Ania Casal, Vigo, 2021