What technologies will defeat cancer?
The best oncologists of the country told about promising methods of cancer treatment
Ksenia Kolesnikova, Rossiyskaya GazetaWill the oncogenome bank be the key to defeating cancer? How are oncology, immunology and bioinformatics related? How are 3D models of organs created? The correspondent of "RG" visited the meeting of the National Society of Pediatric Hematologists and Oncologists (NODGO) in Moscow and learned about the most promising methods of cancer treatment.
Fix the geneThe biology of cancer is well studied.
It has many forms, but the property is common: at some point the "program" of cell division and death is disrupted. Why?
– Oncology does not have its own "periodic table" yet. And since the human genome was decoded in 2000, doctors and scientists have been collecting data. Geneticists "read" the DNA of sick people and enter them into an information database. Such a project is being implemented in the USA, and we are cooperating with American scientists," says Alexander Rumyantsev, Director of the Dmitry Rogachev Federal Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Chief Pediatric Hematologist of the Ministry of Health of the Russian Federation. – The goal is to accumulate bio–data on the entire variety of tumors.
And then it's up to mathematical analysis. With the help of computer systems and bioinformatics, it will be possible to understand whether there is a connection between specific genetic "breakdowns" and cancer. And if there is, then what. This is the number 1 task for doctors and scientists. Some oncogenomes are already known, others are not. If scientists can decipher them all, it will be possible to pick up a "key" for each tumor – a special molecular medicine that will cope with the disease with minimal consequences for the body, will strike at the target.
Another promising area is DNA diagnostics. During pregnancy, mother and child exchange cells. By taking her blood, you can analyze the child's DNA and identify many genetic diseases in advance. If the work with the oncogenome bank gives results, it will be possible to determine the child's predisposition to certain types of cancer.
The forecast has changed- 40 years ago, when I started working, 80 percent of children with cancer died.
Now 80 percent are recovering, – says the chief pediatric oncologist of the Ministry of Health of the Russian Federation, Academician Vladimir Polyakov. – Statistics differ in different nosologies. For example, with thyroid cancer – almost 100 percent recovery. With kidney tumors, soft tissue sarcomas – 70 percent, we have very good results in other diseases, including malignant blood diseases.
In the whole country, from 3.5 to 5 thousand children get sick every year. Over 20 years, this statistic has grown by 15 percent. Approximately half of the cases are malignant diseases of the blood and lymphatic system, the second half are solid tumors: brain, liver, kidney, bones, soft tissues, eyes and orbits, etc. Along with the true increase in morbidity, this is influenced by the introduction of more advanced diagnostic methods.
– There are many methods: molecular, radioisotope, radiation diagnostics. Plus – cytogenetics, immunohistochemistry, immunophenotyping, computer, magnetic resonance, positron emission tomography and others. Without this, modern oncology can no longer, – says Vladimir Polyakov. – Unfortunately, not all of these funds are available in the regions, but in large federal centers, where the most "difficult" patients get, they are.
After an accurate diagnosis is established, treatment begins. And here the most important thing is an interdisciplinary approach. Ideally, a team of 8-10 specialists should work with one patient. For example, a child has a brain tumor. All stages of his treatment should be supervised by a clinical oncologist, who becomes a kind of "manager" of the patient. In addition to him, a specialist in radiation diagnostics, a radiologist, a neurosurgeon, an anesthesiologist-resuscitator, a rehabilitologist, an infection control specialist, etc. deals with patients. And each stage of treatment must comply with clinical protocols. Not only medical procedures should be under control, but also quite everyday ones: what the patient eats, what toys he plays with, how the ward is ventilated, etc.
Cells against cancerIncreasingly, doctors are saying that immunotherapy will replace chemotherapy.
So far, most of the drugs in this class are experimental, and cost a lot of money. For example, 12 weeks of treatment with them is equal to 160 thousand dollars. Why do doctors think that this direction is the future?
– Chemotherapy is a cellular poison that affects rapidly dividing tumor cells. At the same time, "chemistry" also damages healthy tissues – skin, mucous. Some patients after a course of chemotherapy cannot speak or eat, and experience severe pain. At the same time, there are forms of cancer cells that are resistant to any chemotherapy drugs," says Kirill Kirgizov, a doctor at the bone marrow transplantation department of the Russian Children's Clinical Hospital. – And immunotherapy drugs act pointwise at the intracellular level. In fact, these are special active cells that bind to malignant formations and destroy them, but do not touch healthy tissues.
Immunotherapy is already being implemented in large federal centers of Russia. It is used both at the Dima Rogachev Center and at the Research Institute of Pediatric Oncology of the N.N. Blokhin Russian Research Center along with other innovative methods.
– There are 2.5 thousand medicinal molecules with a point effect under consideration by regulatory authorities in the world. They are already interfering with the genetic breakdowns inherent in some tumors. 10-15 similar drugs are registered annually," says Academician Alexander Rumyantsev. – We are facing an era of complete drug treatment of cancer.
Some drugs are prepared for each patient individually, based on human, donor cells, for example, antibodies for children with neuroblastoma. But immunotherapy is not the only point method. 3D modeling has already entered the "clinic".
– In order to protect the patient as much as possible during radiotherapy, a 3D model of the irradiation area is made using a tomograph. It shows where exactly it is necessary to direct the rays," Kirill Kirgizov says. – This model is embedded in the radiation therapy device, and it "hits" precisely so that healthy organs do not suffer.
By the wayOn the basis of the Federal Scientific and Clinical Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, a center for postgraduate training of doctors and scientists in 17 areas is being created.
– We cannot hire young people who have just graduated from university. Their training is too general. They spend only a year on a narrow specialization, and this is not enough to treat children with hematological and oncological diseases. They should know the basics of laboratory hematology, molecular biology, genetics, blood service systems, control of cellular homeostasis, pathology, morphology, etc. We are already teaching this to people, broadcasting our experience to the regions," says Alexander Rumyantsev. – Education is a complicated and expensive thing, it depends on the technical capabilities of the institution. We have them in the center, and we want to broadcast our experience.
The development of pediatric oncology is impossible without special education and modern knowledge, says Academician Vladimir Polyakov. Therefore, on the basis of the Research Institute of Pediatric Oncology and Hematology of the N. N. Blokhin Russian Research Center, which has unique scientific and clinical capabilities, the department of the Russian Medical Academy of Postgraduate Education has been working since 1993, where doctors receive primary education in the specialty "Pediatric Oncology", and also once every 5 years they necessarily take courses doctors from all regions of Russia and CIS countries. In addition, training cycles are conducted, lectures are given for all children's specialists and health care organizers, which contributes to increased oncological alertness and earlier diagnosis of tumors in children.
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18.06.2015