New oncology. Part 1
How advanced science has re-equipped medicine against cancer
Marina Astvatsaturyan — Hello, dear listeners and viewers of Echo of Moscow! Marina Astvatsaturyan is with you. We continue our "Conversations for Life". The conversation today will be about the new oncology. "New oncology: how advanced science has re-equipped medicine against cancer." I welcome our guest Ilya Timofeev. Hello, Ilya!
Ilya Timofeev — Good afternoon!
M. Astvatsaturyan — Ilya Timofeev, oncologist. He's the director of the Cancer Research Bureau. As I found out, this is an autonomous non-profit Russian organization. Member of the International Committee of the American Society of Clinical Oncology, member of the Scientific Committee of the College of the European School of Oncology. We will talk about modern methods of cancer treatment, prevention, but not only of cancers ... in the broad sense of cancer. I would like to ask you to talk to us about prevention and cancer care in the world and in Russia. I hope that we will touch upon issues that concern, in general, a lot of people, regardless of their state of health. These are issues related to oncological diseases. But first about the life of our guest, because our conversation is "for life". Please tell us, Ilya, that you hold important positions in international professional societies. At the same time, you are quite young. Although, well, everything is relative. Regarding me, let's say. You are young relative to me. Where were you born? Where did you study? How did you study? Who did you study with? What was your path?
I. Timofeev — Thank you for the invitation. I am a Belarusian. I was born in the city of Mogilev, Republic of Belarus, graduated from school there and then entered the scientific faculty of Sechin University in Moscow. At that time it was a unique faculty where education was conducted individually. We had 5 people in groups with an eye to the future, science, and the development of science…
M. Astvatsaturyan — Did you get in right away? Arrived and…
I. Timofeev — Yes. Yes. Entered immediately. And, of course, I am very grateful to the 1st Honey for this way. It really was a unique project and, unfortunately, it is not there now. But I hope that in the future it will appear. Well, it has already gone further: postgraduate studies in oncology on the basis of the Blokhin cancer center and the creation of this ANO — Bureau for the Study of Kidney Cancer. At that time it was the 1st non-governmental non-profit research organization in Russia. Now it has already existed for 15 years. And on the basis of this Bureau, we are doing various scientific projects, ranging from fundamental, when we are looking for some kind of receptor on a cell, to clinical, when we study the effectiveness of immunotherapy in patients.
M. Astvatsaturyan — And joining these international organizations, already entering the international orbit — is it thanks to publications? Or were there any personal contacts, someone recommended you? How did it happen?
I. Timofeev — I think that…
M. Astvatsaturyan — Or both?
I. Timofeev — I think that entering the international... international society, involvement is connected only with scientific activity. ASCO is the largest company. Yes, I have had publications, and there are various studies. I was immediately noticed, if I may say so, by the Association for the Study of Kidney Cancer just for a 2007 study, when we described the role of fibroblast growth factor receptors in the development of this tumor. I was invited to make a report. And from that moment they noticed.
M. Astvatsaturyan — So this was a priority work? Absolute priority?
I. Timofeev — Yes. Which goes through my whole life, starting from the discovery of this receptor for kidney cancer and now the creation of drugs, which we are also doing.
M. Astvatsaturyan — We will talk about this later, too. Well, the topic of cancer, as I said at the very beginning, it certainly worries many. And even healthy people, I think, wonder where these diseases come from. Suddenly, as a rule, unexpectedly for the one who was diagnosed with it, and for his relatives. There are several theories: genetic, that is, hereditary, viral, and, you all know this, a theory related to adverse environmental factors — yes? — carcinogens, exhaust fumes and so on. This is popularly called "bad ecology". The evolutionary theory stands quite apart, but it is not about the origin of cancer itself. It's about what tumors are for. And there is Professor Andrey Petrovich Kozlov in St. Petersburg, he is developing this evolutionary theory. According to his theory, new genes that appear in neoplasms are being run-in, as it were… It's like this is a testing ground for new genes. New functions appear. Then they are launched into natural selection. That is, multicellular organisms, they evolved thanks to such a mechanism. There would be no evolution of them if these experiments on the selection of functional new genes did not take place in neoplasms. Well, such a purely theoretical thing. She probably doesn't give much as an oncologist. And here's my question: do treating, practicing oncologists ask about these theories, about the origin of cancer? Does it matter to them where this or that cancer came from? Or is it just their job to heal? By my own example. You can't be responsible for everyone, I understand.
I. Timofeev — Yes, this is, of course, an excellent question, to which there is no one answer. Of course, all the theories, I am not familiar with Professor Kozlov's theory, but what you have listed, they have a place to be. The viral theory, it is absolutely already proven. We know for sure that cervical cancer develops due to the human papillomavirus.
M. Astvatsaturyan — ... human papillomas. Yes.
I. Timofeev — And a simple preventive measure is vaccination of girls and already boys even with one dose…
M. Astvatsaturyan — And vaccination separately…
I. Timofeev — Let's talk.
M. Astvatsaturyan — Yes.
I. Timofeev — Good.
M. Astvatsaturyan — This is a separate issue.
I. Timofeev — The virus theory is consistent. It also concerns, for example, liver cancer. When the hepatitis virus…
M. Astvatsaturyan — Hepatitis.
I. Timofeev — ... causes liver cancer, but it causes indirectly. It settles in liver cells — hepatocytes and causes an immune response against itself. That is, it does not mutate the cell, but the immune response strikes. Accordingly, there is also such an indirect viral theory.
M. Astvatsaturyan — Well, yes. Initially viral.
I. Timofeev — Of course, smoking is a scourge of the twentieth century in general. But then maybe we'll talk about the incidence of lung cancer and the smoking factor…
M. Astvatsaturyan — Well, I want to ask you more about prevention later. It is very important. So all these theories, do they have a right to exist?
I. Timofeev — Yes.
M. Astvatsaturyan — But at a specific moment…
I. Timofeev — If…
M. Astvatsaturyan — ... treatment of the patient, probably…
I. Timofeev — Too. They are also significant. But, of course, they are smaller…
M. Astvatsaturyan — Are they significant?
I. Timofeev — A tumor has already appeared.
M. Astvatsaturyan — It has already appeared.
I. Timofeev — Yes. Not so practically oncologists are already looking at the cause and are just focused on the consequence. But there are cases of smoking again, when a patient with lung cancer continues to smoke, the risk of an unfavorable course of this tumor increases. That is, of course, the oncologist should pay attention to this development factor…
M. Astvatsaturyan — And explain…
I. Timofeev — ... and explain. Yes.
M. Astvatsaturyan — And explain.
I. Timofeev — The same thing is believed to be related to alcohol. Alcohol consumption in esophageal cancer, for example, is associated with poor survival. Accordingly, in these cases, the oncologist can recommend to influence the factors that affect the development.
M. Astvatsaturyan — At the very beginning we started talking about your publications, which have resonance, at least in the professional community they pay attention to them. And here is one of your highly cited publications, it is from 2014 in the journal Lancet Oncology. This is an oncological supplement to the famous Lancet magazine. It is devoted to the problem of the increase in the incidence of cancer in China, India and Russia. At that time, it was 2 times higher than in the USA and the UK. Despite the improvement of socio-economic conditions, as there is even, in my opinion, in the introduction you have written so. What was the reason for these high rates? What could be done? And has the situation changed, most importantly, in these 7 years that have passed since the publication of that article?
I. Timofeev — Of course, at that time it was 2014, and the data in the article were used ... statistics that were even earlier, because we need to analyze, were very different in epidemiology in the USA and in Russia. Of course, the USA is a more favorable country in terms of various economic factors and factors affecting life expectancy. Russia is not. But now I can say that in the USA and Russia have become very similar, I must say, in all trends. The Bureau of Cancer Research conducted its own research to study the prognosis of morbidity and mortality from cancer in 2035. We brought in a statistician who did exactly the same predictive research in the USA. This is Lola Rahib. she's famous. And she did a similar study for the National Cancer Institute, the U.S. Cancer Institute. And what did we see? We saw that the trends are absolutely the same now. Russia has pulled up economically in terms of the impact on the same factors of smoking and so on. Smoking has declined. And we see that yes, even the top five, the top 5 most frequent tumors will be very similar in the USA and in Russia.
M. Astvatsaturyan — And in China? Or have you not been following…
I. Timofeev — We did not follow China. Their statistics are a little more complicated, let's say.
M. Astvatsaturyan — Is India the same?
I. Timofeev — India — yes.
M. Astvatsaturyan — The same thing.
I. Timofeev — But I think that in these developing countries the situation is similar, although there are differences. For example, the Asian region has always been famous for the terrible increase in tumors of the gastrointestinal tract.
M. Astvatsaturyan — It's strange. Despite the abundance of all…
I. Timofeev — It is believed that this is due to the seafood that is there… And other etiologies again. But yes, stomach cancer is No. 1...
M. Astvatsaturyan — I meant vegetable food, fiber and everything…
I. Timofeev — Yes, yes, yes.
M. Astvatsaturyan — It is considered that it is very useful and preventive. But nevertheless.
I. Timofeev — But here… Yes, stomach cancer is prevalent in Asia. If we take India, these are tumors of the head and neck. That is, there is a difference here from Russia, with a European, let's say, cohort of patients. Here. If we look at the trends, the bad news in Russia is that the number of cases will increase. And it will increase by 13% in 15 years. There will be more patients compared to this year.
M. Astvatsaturyan — Is it connected with the aging of the population?
I. Timofeev — First of all.
M. Astvatsaturyan — First of all.
I. Timofeev — With the aging of the population and the increase in the population. The 2nd factor. That is, there are more people, and they are getting older. Accordingly, mutations in cells, which we have talked about a little, occur more often in the elderly, and accordingly the probability of developing cancer is greater. But the good news is that mortality will decrease by 20% in 15 years. Accordingly, the number of patients will be greater, but die from cancer…
M. Astvatsaturyan — There will be fewer deaths.
I. Timofeev — ... there will be less. This is, of course, a forecast. We…
M. Astvatsaturyan — It Is Clear.
I. Timofeev — Various factors can influence, but the trend is positive.
M. Astvatsaturyan — Well, I suspect that mortality should decrease as a result of the development of new methods of treatment, innovative. And we came close to the actual topic of our conversation, "new oncology, or how breakthrough scientific approaches are changing medicine, which is aimed at treating oncological diseases." Recent advances in oncology have been associated with the concept of immune therapy. And this is a method of treatment aimed at stimulating one's own strength, antitumor immunity of the body, one's own, innate. In this part, before we move on to other issues, I want to at least indicate what is included in the range of issues of immunotherapy. Targeted therapy by ear, therapy with checkpoint inhibitors. It's all by ear. It is sometimes difficult for the layman to understand, because all this seems to fall into one pile. Is this all immunotherapy? Or how? How are they here… How would you define this concept?
I. Timofeev — These are different types of drug treatment. In oncology, if we talk about drug treatment, there are several types: chemotherapy, which we know. This is a method that is directed... not aimed at the tumor. That is, we are hitting the tumor with a toxic agent.
M. Astvatsaturyan — Well, yes.
I. Timofeev — There is a targeted therapy that you mentioned. And this is a targeted approach of the drug to a specific receptor that is responsible for the development of the tumor. Here on cancer cells there is a receptor. A drug is being created that blocks this receptor. This is a targeted, directed blocking of the pathogenetic mechanism. There is immunotherapy. This method is not aimed at the tumor itself. It is aimed at the immune system, our healthy immune system, which reduces its activity in cancer patients, since there are suppressor mechanisms — factors that suppress the activity of the immune system. Checkpoint inhibitors are…
M. Astvatsaturyan — The Nobel Prize was given for them in 2018.
I. Timofeev — Yes, yes.
M. Astvatsaturyan — They are the most famous, maybe because. Yes.
I. Timofeev are new representatives of immune therapy. It's just so called checkpoint inhibitor drugs. That is, these are the control points…
M. Astvatsaturyan — ... dots.
I. Timofeev — ... controlled... which control lymphocytes are suppressed by these inhibitors. Lymphocytes become…
M. Astvatsaturyan — Because cancer cells, in turn, suppress these lymphocytes. Yes? Own.
I. Timofeev — Yes, yes.
M. Astvatsaturyan — And therefore it is necessary to suppress what suppresses…
I. Timofeev — Absolutely right.
M. Astvatsaturyan — ... in order to cure.
I. Timofeev — This is the way.
M. Astvatsaturyan — That is, the suppression of the overwhelming.
I. Timofeev — ... to slow down the immune system so that it detects some antigens on the tumor cell and kills it.
M. Astvatsaturyan — That is, it is actually... this is its function, because it is also antitumor of all our internal natural mechanisms that fight…
I. Timofeev — That is, everyone has tumor immunity.
M. Astvatsaturyan — Yes.
I. Timofeev — Not everyone gets sick, although a million tumor cells are formed in each person during the life cycle. But not all of us suffer from cancer, because our immune system is affected, but it cannot cope with cancer patients, and it needs to be helped by the use of immune therapy.
M. Astvatsaturyan — When in 2018 these two professors, the Japanese Tasuku Honjo and James Ellison were awarded the Nobel Prize, then it was about 3-4, in my opinion, drugs. For these almost, well, more than 3 years, the number of these checkpoint inhibitor drugs has increased?
I. Timofeev — First of all, I want to say that I remember the moment when Ellison presented his data at the Oncological Congress of the American Association for Cancer Research.
M. Astvatsaturyan — What year was it?
I. Timofeev Is… I don't even remember. It's 2007 or 8th. He was showing these receptors. It was a huge hall there for 5 thousand people. The whole audience stood up and applauded. That is, it was clear…
M. Astvatsaturyan — It was immediately clear.
I. Timofeev — It was immediately clear that this was something…
M. Astvatsaturyan — Amazing.
I. Timofeev — ... revolutionary. A revolutionary discovery. Well, several years have passed, 7 years since the appearance of the 1st inhibitor. 7 years now we are fixing. And, of course, over these 7 years, a large number of new checkpoint inhibitors have appeared. They inhibit different control points or are more specific to the same control point. If we look at all monoclonal antibodies in medicine, not only in oncology, but all monoclonal antibodies in medicine that are used for autoimmune diseases, antibodies are now used for the treatment of migraines, then oncological antibodies, namely checkpoint inhibitors, occupy the 2nd and 3rd line for the greatest distribution…
M. Astvatsaturyan — Distribution…
I. Timofeev — ... in medicine. That is, the progress is huge only in the last year of 2021. For the first 2 inhibitors, 13 new indications appeared. What is 13 readings? This is conditional 13...
M. Astvatsaturyan — 13 diseases. Yes, yes.
I. Timofeev — ... new tumors, yes, that we can treat. And let's take stomach cancer, for example, which has not been treated at all for 20 years. There was only chemotherapy. A checkpoint inhibitor has just been registered.
M. Astvatsaturyan — Amazing.
I. Timofeev — Accordingly, the future is rosy.
M. Astvatsaturyan — Let's get back to him. Let me remind you that the guest of today's program in the cycle of "Conversations for Life" is Ilya Timofeev. We will return to this studio soon.
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M. Astvatsaturyan — Marina Astvatsaturyan at the microphone. We continue our conversation with oncologist Ilya Timofeev, Director of the Bureau for Cancer Research. In the 1st part we touched… Before the break, we touched on innovative drugs, in particular checkpoint inhibitors. I'll take it more broadly: what oncological diseases are already being treated with immunotherapy? Which organs are susceptible to it? What really has already entered the clinic? Have these drugs already made up an arsenal of modern remedies? Can we talk about arsenal?
I. Timofeev — Checkpoint inhibitors are already the 3rd coming of immunotherapy, because there are other drugs.
M. Astvatsaturyan — That's it. Yes.
I. Timofeev — These are cytokines. This…
M. Astvatsaturyan — I would like to take it wider. Yes.
I. Timofeev — ... there are vaccines, methods of cell therapy, it's all left 10 years ago. Now the checkpoint inhibitors have arrived. Those drugs were active only in 2 tumors, which were considered immunogenic for some reason. That is, it is these tumors that cause an immune response to themselves. It was kidney cancer, which I was dealing with, and melanoma. My dissertation is devoted to these tumors. And they, in fact, were treated with immunotherapy in the form of cytokines. But checkpoint inhibitors have opened up a new direction. That is, in principle, they are studied for all tumors that now exist with one or another degree of success. The successful use of immunotherapy now, with these checkpoint inhibitors, is considered to be for lung cancer, melanoma, kidney cancer. Tumors of the gastrointestinal tract, gastrointestinal tract, were not surrendered, but now they have found new forms of use. And now they are no longer incurable, but are treated with immunotherapy.
M. Astvatsaturyan — We are being treated. Yes.
I. Timofeev is a cancer of the stomach, esophagus, colon cancer, breast cancer. Hormonal tumors have always been poorly susceptible to immunotherapy. Breast cancer and prostate cancer. But now certain forms have already been discovered, for example, triple negative breast cancer, which is sensitive to immune therapy. Accordingly, now almost all tumors in a certain indication are sensitive to immunotherapy.
M. Astvatsaturyan — That is, they have their own immunotherapy.
I. Timofeev — They have their own targets of immunotherapy, let's say. And that's what I'd like to say too. Melanoma, for example. We can use any immunotherapy regardless of the predictors, receptors on the melanoma cell. And there are tumors for which any one is not suitable. That is, we can't just… A patient came and was immediately prescribed immunotherapy. We have to determine some factors of sensitivity to this immune therapy in this patient. For example, this is microsatellite instability, so-called when a tumor cell is genetically unstable. There are many different mutations and breakdowns in it. This is bad…
M. Astvatsaturyan — In general, tumors are heterogeneous. They…
I. Timofeev — Heterogeneous…
M. Astvatsaturyan — They are very heterogeneous there.
I. Timofeev — Such an unstable tumor cell divides very often. And, of course, without immunotherapy, this is bad for the patient. But now there is immunotherapy. And that's just how the immune system recognizes such unstable cells better than stable tumor cells. Accordingly, what are we doing? We take tumor material from the patient, study it genetically, find this microsatellite instability and prescribe immunotherapy. That is, immunotherapy has also become targeted. In addition, other factors have appeared. For example, PDL-1 expression. This is the control point. For kidney cancer, for example, it is not necessary to evaluate this expression of PDL-1, to look for a control point ... expression, because it is a priori there. But there are such tumors as lung cancer, where it is necessary to look for expression. It will significantly increase the effectiveness of immunotherapy. Accordingly, we can choose patients: a candidate for immune therapy or a candidate for another type of treatment. Accordingly, modern approaches to immunotherapy are the selection of patients whose effect will be even better.
M. Astvatsaturyan — Even better. Some time ago, well, in fact, many years ago, great hopes were pinned on such approaches as angiogenesis inhibitors, hormone therapy. Angiogenesis inhibitors are means of suppressing the germination of blood vessels in tumors. That is, simply put, a way to make the tumor starve, and then it will shrink. If she doesn't have blood vessels, the blood won't deliver nutrients. And if you suppress the formation of blood vessels in the tumor, it will die by itself. Well, hormone therapy also seemed to be such a promising direction. Have you forgotten about it now? Or was it not as promising as first thought?
I. Timofeev — Indeed, the 1st revolution of the last decades was connected just… This is targeted therapy, when we influence the vascular growth factor, or some receptors or proteins in the tumor cell. It really was a revolution, because if we take the same kidney cancer, with the help of targeted therapy, these are angiogenesis inhibitors, we were able to increase survival. That's when I started this, the patient was living with metastatic cancer, when there are already metastases, 4-6 months. 4-6 months! Now the patient lives for years. That is, we are already counting a 5-year indicator of the effectiveness of these drugs. So, of course, this is a revolution. But now there are all the same drugs, targeted therapy, but new generations, even more selective. They bind to a specific site on the receptor — exactly the one that responds. That is, new classes appear. And what do we see now? We see combinations of targeted therapy and immune therapy. It is logical to combine this good drug with an immunotherapy checkpoint inhibitor. What did it lead to? Again, an example, I'll take kidney cancer. The effectiveness of therapy has increased to 70%. That is, globally 70% of patients can… Their tumor will shrink. Previously, we could not achieve 10%. And now 70. That is, almost all patients. That's what the combination of targeted therapy and immunotherapy gives.
M. Astvatsaturyan — Well, targeted therapy, in fact, it is already in some sense the previous generation. They have been around for 30 years. And now I remember, I just talked to some people, not doctors, but research biologists, who are not very ... not that optimistic, but with a certain degree of criticism about targeted therapy, because tumors mutate. This is known. They also acquire resistance to chemotherapy. And they can, for example, confuse in such a way that the target will simply disappear. And what to do here? You nod your head. Do you agree?
I. Timofeev — Yes, yes.
M. Astvatsaturyan — Is there such a problem?
I. Timofeev — Yes, yes.
M. Astvatsaturyan — Yes?
I. Timofeev — I am amazed again how well informed you are.
M. Astvatsaturyan — Yes, it's not me. It's my guests who are good.
I. Timofeev — Of course, there is such a problem. As we have already said, the tumor cell changes endlessly. New mutations appear. As for the coronavirus, only with a tumor cell…
M. Astvatsaturyan — Well, yes.
I. Timofeev — ... which makes her insensitive to the targeted therapy drug. But progress does not stand still. Immediately, the development of targeted therapy drugs of new classes begins, which will work already with this mutation. Lung cancer is a good example. Initially, we knew about mutations in the EGFR gene in lung cancer cells. There were two main mutations there, let's say. And there were drugs of the 1st generation, EGFR inhibitors. But then the tumor cell began to produce a T790M resistance mutation, and a Class 3 drug blocking this mutation immediately appeared. Accordingly, we now have lines of so-called therapy. 1st line, 2nd line, 3rd line, when we can consistently prescribe, or immediately choose, if this mutation is initially present, the drug in the 1st line is the most effective. That is, there is an evolution of targeted therapy.
M. Astvatsaturyan — Can we say that the means of biotherapy, they revolutionized oncology, turned the situation around?
I. Timofeev — For most tumors — yes, we can say so. But there are tumors that we can't beat yet. For example, pancreatic cancer. According to our forecast, morbidity will increase, and mortality, unlike, for example, from the same lung cancer, will increase.
M. Astvatsaturyan — It will increase.
I. Timofeev — Unfortunately, this is sad for this tumor. 5-year life expectancy, all stages, even the early ones, is 10%. That is, 10% of patients can survive 5 years.
M. Astvatsaturyan — They can survive 5 years.
I. Timofeev — Let's take kidney cancer — 74%. There is a difference.
M. Astvatsaturyan — The difference. Yes.
I. Timofeev — But also for pancreatic cancer, new options are being sought. And there was also targeted therapy of a new generation. Some patients have a mutation in the BRCA gene called. They, these mutations are, for example, for patients... patients with ovarian cancer…
M. Astvatsaturyan — Well, it's breast cancer.
I. Timofeev — Yes.
M. Astvatsaturyan — Yes. Aha.
I. Timofeev — Well, it turned out that there are also such mutations in pancreatic cancer cells and in prostate cancer cells, too. And now these drugs blocking this mechanism are being studied and have already been registered for the pancreas.
M. Astvatsaturyan — Well, this is encouraging.
I. Timofeev — I would also like to note, if we are talking about the pancreas, that a big, big role in development belongs to various organizations. For example, PanCAN, there is such an organization. This fund is, in fact, a patient's fund…
M. Astvatsaturyan — Patient. Aha.
I. Timofeev is a patient foundation that encourages research in this area. For pancreatic cancer, until the formation of PanCAN, there was only one study for the whole world. About 100 studies are currently underway. Here patients can influence…
M. Astvatsaturyan — That is, they are like the engines of this progress.
I. Timofeev — They are engines.
M. Astvatsaturyan — Amazing.
I. Timofeev — Accordingly, perhaps something will change in this area.
M. Astvatsaturyan — Are there any contraindications for using advanced methods? For surgery, if the area is achievable for a surgeon's scalpel, then there are probably no contraindications. Yes? If the surgeon gets there. But if there are contraindications? Who should not use these methods?
I. Timofeev — Of course there are contraindications. But the number of these patients who are not allowed is very small in fact.
M. Astvatsaturyan — What is the reason?
I. Timofeev — If we take…
M. Astvatsaturyan — The immune system, right?
I. Timofeev — Yes, immunotherapy, then the 1st contraindication is an autoimmune disease. If the patient's own immunity is strongly activated.
M. Astvatsaturyan — Strongly.
I. Timofeev — For example, we will conditionally call it allergies. Autoimmune diseases.
M. Astvatsaturyan — Well, yes.
I. Timofeev — Crohn's Disease.
M. Astvatsaturyan — Multiple sclerosis of some kind.
I. Timofeev — Multiple sclerosis. If we use immunotherapy, we can do harm and cure the tumor sooner than later.
M. Astvatsaturyan — Because she stimulates her own immunity, and he already…
I. Timofeev — And so hyper.
M. Astvatsaturyan — ... hyperactive.
I. Timofeev — Yes. If we take targeted therapy, which affects angiogenesis, respectively, the undesirable effects of targeted therapy are exactly the same — it is hypertension, an increase in blood pressure, because it affects blood vessels.
M. Astvatsaturyan — Vessels.
I. Timofeev — Accordingly, we cannot hypertensive patients who have high…
M. Astvatsaturyan — Without that. Yes.
I. Timofeev — ... figures, — yes, — apply these methods. Well, it's a small pool. We can play with doses, with regimens and apply even in such patients. For example, it is already possible to use immunotherapy in patients with psoriasis. This is also an autoimmune disease.
M. Astvatsaturyan — Yes. It was considered incurable.
I. Timofeev — Now it is possible, controlling psoriasis, to use immunotherapy.
M. Astvatsaturyan — Today we talked about modern oncology with oncologist Ilya Timofeev, Director of the Cancer Research Bureau. And our conversation will continue. See you!
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