The melanoma expert, recently appointed president of the Spanish Association for Cancer Research, is optimistic about the future of the fight against this disease, but calls for more funding.
Marisol Soengas (Agolada, Pontevedra, 55 years old) believes that most people do not know well what is being done in cancer research. “If they knew, they would demand much more so that, from politics, there would be greater support,” she says. She is an expert in melanoma research. In her laboratory at the National Cancer Research Center (CNIO) in Madrid, they have identified factors that help define the identity of melanoma and distinguish it from many other types of cancer.
Now she has just been appointed president of the Spanish Association for Cancer Research (ASEICA), an organization from which they want to improve knowledge about the work that researchers and clinicians do to combat one of the diseases that kill the most, promote reliable knowledge on cancer and lobby governments and big pharmaceutical companies to increase investment in research and make the most advanced treatments available to all patients.
Question. Science is extremely competitive and great advances are concentrated in a few places on the planet. What is the role of Spain in cancer research globally?
Reply. We have enormous potential and a great pool of researchers. I have colleagues from many countries who are calling us to recommend researchers. There are also highly trained professionals who are contributing to the development of very powerful technologies in other countries. But here, in Spain, we have a talent retention and attraction problem.
There are centers where very high-quality science is being carried out and Spain leads some important international consortia. The potential is there. The problem is that we have a budget limitation, bureaucracy and in terms of our ability to get infrastructure with which to be competitive. I think we play in the first division, we compete, but we don’t reach the finals because many of our best players are out and we can’t attract and finance them properly.
How do you assess the R&D policies of the Spanish Government?
There has been an effort and it must be recognized, but it is insufficient. We are at a 1.5% percentage of GDP investment in science and the average of the countries with which we want to compare is 2.5%. Much remains to be done and there is frustration in some areas because the advances that are being publicized do not reach the day-to-day of researchers. The calls arrive with a year or more of delay and that is something that we have to solve. One of the big problems we have, apart from financing, is this uncertainty of not knowing when the projects are going to come out and that, when they are called, it is done with very little response time.
In the pandemic, it has been seen that vaccine development times could be shortened thanks to the development of new technologies. Is this going to happen with cancer treatments?
The deadlines have been greatly shortened. Traditionally, a lot of effort was invested in trial and error, with hundreds or thousands of compounds. Now the research centers have already made part of this journey, with increasingly physiological experimental models. Not only has the number of compounds to be studied been reduced, but the group of patients to which I am going to direct these compounds has also been limited.
To speed up these processes, at ASEICA we also want to improve collaboration with the industry, with actions such as promoting the industrial doctorate [hacer un doctorado en un proyecto en una empresa, en lugar de una universidad o centro de investigación] and other types of interactions in those areas, because innovation is going to emerge from that cooperation. In other countries we observe that up to 70% of the investment in R+D+i comes from the industry and in Spain in this sense we have a significant deficiency.
Has collaboration between basic researchers and industry improved?
Now we pay more attention to the possible uses of intellectual property and collaborations with industry. I think it’s mutually beneficial in a way. We researchers have to get better training in this aspect of intellectual property and the protection of our rights, because sometimes we don’t negotiate well.
From personal experience, I can say that at the CNIO we had a compound that had a very novel form of action and, although at that time we did not know how to protect it with a patent and do it competitively, we learned, we did it and a startup [Bioncotech Therapeutics] which is now in clinical trials. I have been lucky enough to observe this path, which is not frequent, because as a researcher, normally, you stay in the publication phase.
How do you see the future of cancer treatment? Which approaches do you find most interesting?
The one that interests me the most has to do with the different strategies to activate and reactivate the immune system; that is going to be the future and it is already part of the present. And the clinical trials that are currently attracting the most attention are those that seek to treat the patient as soon as possible. It is about diagnosing tumors earlier and making a personalized diagnosis, to apply the treatments before the tumor cells have the capacity to spread throughout the body or have already done so. This has ethical problems, because you are treating patients at risk, but you do not know for sure that they will develop these tumors, and these treatments have side effects. We will have to assess the risk and the benefits and they will be very long-term treatments, but I think that the future lies there.
And then what I find fascinating is, from a diagnostic point of view, artificial intelligence, which will allow us to better distinguish benign from malignant lesions and identify patterns within these lesions to see which one should be treated and how. And we’re also seeing that each patient has multiple mutations. Tumor cells are all very different and we are also seeing the importance of the tumor microenvironment, that is, that malignancy is not only in the cell.
The future will make better use of technology to better define genetic alterations and all the risk factors that we are not aware of and that could be detected earlier as a herald of tumor disorder risk. And then, in the field of skin cancer, where I work, I find it very interesting that you can have pendants, bracelets, detectors on your clothes that warn you that you are exposing yourself to the sun too much and that you should protect yourself. Or the liquid biopsy, the diagnosis through blood and urine samples, which give us early warning.
Can’t this interest in detecting cancer as soon as possible make us sick before our time?
Well, there is a lot of talk about these ethical and social implications, but in principle we are going to do this preventive monitoring in patients who have a family history or someone who has smoked all their lives, that is, people who are at high risk. The doctor must guide to see what type of patients has to have this type of follow-up in order not to be slaves to technology.
The study of aging and the creation of treatments that combat this process globally, are they an alternative to the search for specific treatments for each different type of cancer?
They are complementary paths. Researchers are motivated by responding to current problems, but we also want to know, to break boundaries, and these works of tissue regeneration, recovery of damaged cells, reactivation of processes that deteriorate over time are on that path. It is clear to me that in the future we could try to reverse or compensate these alterations that accumulate and increase the probability of developing cancer. And also, in addition to controlling your diet, smoking or exercising, look for treatments that recover neurons that you have altered or muscle function or vision. We’re going to end up being a little bionic.
Cancer research sometimes seems like a path through a mountain range in which you climb a peak and when you get to the top you see that there is another valley and more peaks after. When a question about the disease is resolved, new questions appear, greater complexities.
If we could have explained all cancer with a few mutations, that would have been great for patients, but it doesn’t. This is not the case because we know that tumor cells evolve, change, adapt, acquire mutations, epigenetic alterations. That complexity for me is a challenge that we have to embrace to solve it.
It is true that sometimes discoveries are made and you think that you will be able to influence the trajectory of the disease of the patients, as when the first mutations in melanoma or in the lung were identified, which were highly recurrent. And then the frustration comes because you see that this is not enough. But I am optimistic. I don’t know if we are going to make the disease chronic, but we are going to see progress that will allow patients to live longer and improve their quality of life.
Do you think that with greater access to information through the Internet or social networks, the authority of doctors and researchers has been called into question?
There are therapies that are dangerous and pose a risk, such as when we hear patients say that they have seen a therapy on a blog, for example, with active ozone. There is a big problem of misinformation and that creates more problems, because there are patients who decide not to be treated or to be treated with alternative therapies that have been shown not to work, instead of going to a clinical specialist.
But empowering the patient is also important and I think they also have the right to know, to know their pathology and the alternatives, and they have the right to participate in the decision with an oncology specialist. The specialist should be the one to guide and give options. An informed person has a different capacity to face the disease and to decide, for example, if he wants to participate in a clinical trial. It is important that the patient have more information and we at ASEICA are promoting interaction with patient associations so that they have better information and strengthen a relationship of trust. Sometimes there is a problem of mistrust because you hear things about many alternatives and you don’t know what to decide.
Sometimes it is even heard that pharmaceutical companies do not cure cancer because they do not want to…
To think that a pharmaceutical company is blocking the development of compounds against cancer does not make sense. What they will want is for their compounds to be used and to make their investment profitable.
Is it possible that in some cases investment in safe bets, which will achieve small extensions of life expectancy or a reduction in toxicities, is encouraged more, but bets on more innovative therapies are avoided, which may involve a higher risk investment? , but could they also lead to more revolutionary advances?
What worries me is that there are very powerful advances that are excessively expensive. Perhaps unnecessarily expensive. We are talking about therapies such as CAR-To very efficient drugs for very specific pathologies, as we saw with hepatitis C. I am concerned that the advances do not reach the patient because the health systems cannot afford it. There has to be a renegotiation and pressure with the leaders of the pharmaceutical companies. And I am also concerned that, depending on the autonomous community or the city where you are, there are treatments that reach the patient or not. That is where I see that we have to go hand in hand with researchers and patient associations to achieve more equitable access and exert social pressure so that pharmaceutical companies recover their investments, but once they have recovered, the treatments are more affordable. Daniel Mediavilla