Translated material
Cancer under the sight
The United States declared malignant tumors to destroy
* This is what the breast cancer cell looks like a microscope * The American word Moonshot literally translates as a “shot along the moon”. And it means not so much the actual “Apollo” flights to the Earth’s satellite (1969-1972), but the approach to “plan and do something unimaginable, not focusing on possible risks and not sparing funds”.
Barack Obama used precisely this word on January 12, speaking with his last message to the nation in the US Congress: “To cure cancer once and for all,” that is, the fight against tumors is now the national American megaproject. The vice-president Joe Biden, who has personal motives to do this, is responsible for the megaproject: he had a 46-year-old son a year ago from brain cancer.
Statistics from an old woman with a scythe
In the USA, cancer is the second most prevalence (after heart disease) the cause of death: every fourth dies from it. In Russia, the mortality from cancer is not so striking, but this is not the merit of oncologists. Simply diseases kill Russians three times more often than Americans, and as a result, only 15.3% of deaths account for a share of cancer: many of those who died from cancer in 80 do not live-they die from a heart attack of 60. And still, only from January to November 2015, 268,226 people died from cancer in Russia-exactly in the United States for the same period, while the population of Russia 2.3 times smaller than the US population.
Why should we be interested in news about American oncology? Because the “shot on the moon” does not involve the purchase of droppers and tablets for American patients, but primarily expenses on research, the results of which will be used in Russia.
“The science of cancer is mainly done in the United States. The vast majority of large companies that have arisen and began to bring to the market the drugs against cancer are also from the USA, ”says the molecular biologist Konstantin Severinov, professor of the American University of Rutgers University and Russian Scolt. “The US national health institutions spend $ 20 billion from their 30 million budgets on research grants and support about 50 thousand grants at once. In Russia, the number of scientists of the biomedical profile, which could, on a common basis in an open competition, claim such a grant is calculated by a few hundred. Maybe there are even less than a hundred of them now, ”explains the state of affairs Severinov. And further: “We study the unknown. And breakthroughs in the fight against cancer can come from the most unexpected studies, for example, from the study of ciliates, as happened when the enzyme of telomerase, which plays a large role in the cancer degeneration of the cell. It is necessary that there are a large number of good -level scientists involved in a variety of topics, not necessarily directly related to cancer. There are countries where these research is easier to do. More convenient. But the ideas that are necessary to get answers - they are indistinguishable in a sense, they fall into the heads without reference to geography. And if on the one hand tens of thousands of people, and on the other, a hundred and ideas come on average one of a thousand thousand, then it is clear that in the USA this will happen much faster. Just according to the law of large numbers. "
The history of the battles
What do cancer researchers do? We are used to thinking that cancer is a task for surgeons. And for chemotherapists - specialists in the selection of poisons who kill the tumor faster than the patient.
This is how things were about the first “War with Cancer” 45 years ago by American President Richard Nixon. During this war, the National Institute of Cancer from simply a research institute has turned into something like a separate ministry, and the US government spent more than $ 100 billion on cancer research. “Everything that has been happening since the late 1990s in the field of new drugs, the deciphering of cancer mutations is all in a sense the result of that initiative,” says the oncologist Mikhail Maschan, professor and head of the department of Dima Rogachev in the Moscow Center for Pediatric Hematology.
"The tumor is very actively trying to turn off the immune system"
At that time, a quick victory over cancer (which turned out to be more than one disease, but hundreds or even thousands of different ones) did not happen. But then the tongue has completely changed, in which cancer speak and think. “Studies of cancer as diseases are now carried out mainly by molecular and genomic methods,” says Professor Severinov. The initiative passed to molecular biologists-experts in mutation and DNA transcription, receptor proteins, cell death and cell division.
For old medicine, the tumor was a “black box”-this is how engineers call a mechanism whose internal structure is not known, but external behavior in strictly defined conditions is more or less predictable.
And molecular biology tried to figure out that the “box” has inside.
It all started with the assumption that the virus is behind cancer as a phenomenon - as it turned out later, in the general case, the wrong one. “The viral theory of Cancer was formulated by our compatriot Lev Zilber. And he created the concept of oncogen. The idea that cancer should be studied by the methods of genetic-molecular biology was along with the understanding that there are mutations that lead to cancer. And that there are genes responsible for cancer, ”says Severinov. The Nobel Prize for the opening of such genes in 1989 was divided by biologist Michael Bishop and medic Garold Varmus from the USA.
And then there was a wave of discoveries, which introduced the key to the modern science of cancer of the idea and concepts.
The P53 protein, which blocks the growth of tumors, was announced by the SCIENCE magazine “The Molecule of the Year” in 1993. Only in scientific articles for 2015 it is mentioned more than 50 thousand times.
BRCA1 and BRCA2 genes are also known, which, in the presence of mutations, significantly increase the risk of getting chest cancer. In 2013, BRCA1 was noted even in tabloids, when Angelina Jolie decided on the results of genetic tests, without waiting for the diagnosis of “cancer”, to a preventive mastectomy-the removal of both mammary glands. (Two years later, the ovaries and the phallopian pipes were removed from the same considerations).
"Awakened" T-lymphocytes (cells of the immune system) attack a cancer cell
But the real reason for politicians to talk about Moonshot is still new loud results among researchers. “From my own experience, I learned that science and therapy on the threshold of incredible breakthroughs,” the vice president Biden, who was forced to follow the news of oncology, indicates in his statement, indicates in his statement. - Only over the past four years we have witnessed amazing progress. This is a turning point. "
It is easy for oncologists to name the reason why Biden speaks exactly about the “last four years”: exactly so much time has passed since the appearance of a medicine that mobilizes our own immunity to the war with cancer.
Immunity lowered from a leash
If you have a nose and a temperature has risen, this is a typical response of the immune system to something alien in the body. Immunity recognizes and attacks bacteria, viruses, and even completely harmless pollen (if you are an allergic). But for some reason he does not react to the cells of a malignant tumor that can kill.
“When I studied at the institute, everyone said that the immune system does not see tumors,” recalls Professor Maschan. - But it turned out that in fact the immune system sees everything, just the tumor is very actively trying to turn off the immune system. And he does this using special switches. ”
The main combat unit of immunity, designed to attack new threats, is T-lymphocytes. In the 1980s
French researchers accidentally discovered from some of them on the surface of the “black mark”-CTLA-4 molecules that prevent tumors from attacking. Another such “black label”, later found, the PD-1 molecule, which triggers in T-lymphocytes, the cell suicide mechanism.
In 1996, it was first shown: if “turn off the switches”, then the liberated T-lymphocytes in mice begin to attack cancer tumors and they are reduced in size.
“Four years ago, a commercial drug appeared on the market, which removes this blocking signal in people,” continues Maschan. - His role is not to attack the tumor on his own. He, as it were, lowers the dog from a leash. ”
A medicine called Ipilimumab is a monoclonal antibodies, a special protein that produces a special cell culture in a tube with microscopic portions. Two years ago, two more drugs began to be sold, which act on the same principle. In 2013, the results of many years of clinical testing of such drugs for patients with melanoma and some other types of cancer were published: in 53% of patients, a tumor under the blows of an awakened immune system decreased by 80% or more. A woman who, as a result of melanoma in the lungs, formed a tumor the size of a grapefruit, 13 years after the diagnosis was alive and well. In a man with metastatic tumor kidney cancer, they continued to decrease even after he stopped taking the drug. It is not surprising that in the same 2013, Science Scientific Journal declared cancer immunotherapy.
The drug Ipilimumab is about four thousand times more expensive than gold: 1 mg costs $ 157, and the annual rate of combined therapy with the drug Nivolumab costs $ 295 thousand
Another example of “amazing progress over the past four years” is CRISPR, a method of point editing the genome. It was invented in 2012, and CRISPR can shoot in therapy of cancer in the near future. In theory, he opens the opportunity to correct the cancer cells so that they stop being cancer. Professor Severinov explains: “Since the nature of cancer is genetic, if mutations that are responsible for the occurrence of this or that form of cancer are certainly known, probably with the proper development of CRISPR technologies, they can make it possible to correct these mutations and, consequently, treat cancer.”
Where to get the pills
Now the bad news: even if tomorrow cancer researchers come up with a panacea, it will not be possible to buy it the day after tomorrow at the pharmacy. “Now from the appearance of the molecule to the appearance of the medicine in the market, five to six years through an optimistic scenario,” Maschan says. - And this is in the global market, in the USA and in Europe in the first place. As for Russia, we, as a rule, lag behind for two to three years for various reasons, not only economic. ”
And economic reasons have to be taken into account. For example, the drug Ipilimumab is about four thousand times more expensive than gold: 1 mg costs $ 157, and the annual rate of combined therapy with the drug Nivolumab costs $ 295 thousand, or about 24 million rubles.
Even if you personally are able to collect that kind of money, it is not a fact that treatment will be available to you. Commercial companies evaluate market capacity. If they see that there are no insurance companies or a state in the country that is ready to pay such amounts for these new drugs, they are simply in no hurry. Moreover, in Russia, the withdrawal of medicines to the market is associated with certain bureaucratic barriers.
You can imagine another development of events-as with penicillin, which until the beginning of the 1940s was an invaluable substance like radium (it had to be re-isolated from urine patients so as not to lose a milligram), and in the 1950s it was already sold for a penny in any pharmacy.
It is impossible to predict in advance and even more so the results of the new “War with Cancer” - especially now, while Moonshot exists in the form of a declaration of intent, and not a step -by -step program. US Vice-President Biden promised scientists that things would follow the words: in the next year, research areas will discuss with oncologists, and the budget with financiers. If we compare this Moonshot with the lunar program, now on the September 1962 calendar, when President Kennedy only uttered his “lunar speech” in the stadium in front of the 35,000th crowd. The astronauts have not yet been selected, the Saturn-5 missile exists only in the form of sketches, ahead-7 years of search, failures and work ...
But it is already clear: it is worth flying at all costs.