Josep Taberneroone of the greatest exponents of world oncology, has been ten years without taking antibiotics. It does so, he says, to preserve its microbiome, the set of foreign microorganisms that live inside us and are behind most of the diseases that plague us throughout life, including cancer. «Only 0.01 percent of the genes in our body are human.the rest are aliens, they are not ours”, explains Tabernero in an interview with ABC and estimates the different species of bacteria that inhabit us and that are behind the metabolic reactions that contribute to the appearance of many pathologies at up to 400.
From his office in the Medical Oncology Service of the Vall d’Hebron Hospital in Barcelona, which he has directed for years and whose position he combines with heading the Vall d’Hebron Institute of Oncology (VHIO), the transatlantic cancer research group he took the helm in 2010, this cancer ‘priest’ extends other “effective recipes” that are in our hands to protect the microbiome: “Eat well, do not engage in risky practices , and avoid air pollution to the extent that we can. «By behaving very well we could avoid up to 50 percent of tumors», maintains Tabernero, recognized as ‘Doctor of the Year’ at the ABC Salud awards.
Tailor-made treatments
An international benchmark in the design of customized treatments against colorectal cancer and digestive tumors, and president of the European Society for Medical Oncology (ESMO, for its acronym in English) during the years 2018 and 2019, Tabernero has been cooking in his laboratory for decades from VHIO cutting-edge molecular therapies capable of stopping cancer, a disease that is estimated to affect 30 million people worldwide by 2040.
The great engine that pushed him to immerse himself in oncology was, as he admits, helping patients, whose courage and resilience he has always admired. And it has done so: throwing body and soul into clinical research without losing sight of the social background that surrounds cancer: cutting-edge therapies reach all those affected as soon as possible and equally, regardless of the country in which they live. and their social and economic condition. On the eve of Christmas and in his particular letter to the Three Kings, this oncologist who loves mountaineering makes two wishes: “That better investment be made in healthcare and access to cancer medicines be democratized.” For politicians, he leaves the coal and gives them a “fair pass.”
-Immunotherapy gave science a good asset to gain positions against cancer. Now, the study of the microbiome as a reactive engine of the changes that occur in our body and that lead to disease, gives new ammunition to oncologists. In one of the investigations that you led, it was verified, for example, that by modifying the microbiome we can influence colon cancer not to appear or not be so aggressive. How can the study of the microbiome influence the fight against disease?
-There is a very interesting fact that relatively few people know about and that is that only 0.01 percent of the genes in our body are human. The remaining 99.9 percent are aliens, genes from microorganisms that we have. The nearly 400 different species of bacteria that we carry with us act like a great metabolic reactor. They help control sugar levels, brain functions… Bacteria don’t stop generating proteins and metabolites, which will do us good or bad. When the microbiome is not appropriate, that is, it does not work well and causes inappropriate metabolic reactions, these contribute to the appearance of diseases such as cancer, multiple sclerosis, brain and cardiovascular diseases…- From this it can be deduced, then, that we should take good care of it…-Indeed. We must protect it because it is not only the origin of some diseases but also influences their evolution or the effect that treatments aimed at combating them may have. We are currently trying to understand why the microbiome goes wrong, why it stops working well, and what we can do to prevent it from malfunctioning. We know, for example, that one way to care for it is to avoid bad habits such as tobacco or alcohol, prolong breastfeeding, and moderate the use of antibiotics. I haven’t taken it for ten years and I would only do so when absolutely necessary, not for a cold. Another way to preserve our microbiome is by eating well (eating fiber, limiting the consumption of red meat to once or twice a week, eating fish and legumes, dairy…) and avoiding contamination as much as possible, even if that sometimes it is very complicated.
-How does exposure to pollution worsen our microbiome?
-In polluted environments we inhale microplastics that enter our body and deteriorate our bacterial flora. They make small particles of zinc, silver… adhere to our immune system and induce allergic reactions to appear. The cases of celiac disease that arise in adulthood could be explained by this cause.
-How many tumors can be avoided if we behave well?
-Behaving very well we could avoid approximately 50 percent of tumors.
-But some have a hereditary basis…
-Yes, but it is a very small percentage, they only represent between 5 and 7 percent of the total. Let’s not forget that other tumors are linked to aging.
unlock resistance
-Immunotherapy, empowering our immune system to fight cancer, has opened up a world of possibilities for years… What handicap do you have at the moment?
-Well, it is only effective in those tumors in which the immune system recognizes the tumor as something abnormal, and that represents only 25 percent of tumors. In the remaining 75 percent, the immune system is unable to recognize any abnormality in the tumor.
-What do you do in such cases?
-We are studying strategies aimed at unlocking this resistance, that is, educating the immune system to attack cancer cells. For this we use vaccines, autolytic viruses or biospecific antibodies. In this last strategy, in particular, it is about taking the T cells to the tumor and once there making them understand that they have to attack it.
-A few days ago, scientists from the Barcelona Biomedical Research Institute found the cells responsible for colon cancer metastases. They also saw that treating them prior to surgery with immunotherapy prevents relapses. How do you rate the find?
-It is an important finding that confirms that the cells that end up developing metastases are predetermined from the beginning. It is true that animal models, on which these discoveries are based, are increasingly sophisticated, but let us not forget that the human system is much more complex.
-Immunotherapy, targeted therapies and the study of the microbiome. Oncologists have increased their ammunition to stop the spread of cancer, but there is an effective way to fight against it, which is to get ahead of it. Is early detection still a recipe for success to avoid serious cases of the disease?
-Effectively. The best cancer is the one you don’t have. Between 15 and 20 percent of tumors can be avoided with early detection.
-In this sense, what role does liquid biopsy play?
-It allows the detection of genetic mutations with great sensitivity through a simple blood test, it is not an alternative to traditional tissue biopsy. The latter gives information about the architecture of the tumor, the expression of genes, but to look for specific mutations, blood is more sensitive and more specific. The potential of liquid biopsy at this time is enormous. Other techniques are also being studied that will allow us to detect with a simple analysis, in the case of colon cancer, which isolated genes are associated with a polyp phase and which with a carcinoma. We have more and more instruments to take advantage of the disease.
more agile regulation
-70 percent of cancer therapies are not yet financed in Spain. In the case of drugs for metastatic breast cancer, there are still eight drugs validated in Europe to be financed. Is our country up to the task of drug approval?
-In clinical research we are leaders and in drug approval we are ahead of some countries and behind others that have a higher GDP than us. What is certain is that the approval system for drugs from the moment they are authorized by the regulatory agency until they reach patients can be improved. We need faster and more transparent regulation. The current regulation, which is relatively old, establishes that the approval is not published until an agreement is reached with all parties. The debate and deliberations phase before final validation is not transparent as in England, where all discussions with pharmaceutical companies are also exposed. If these discussions were known, it would also be a way for the delay in the validation of certain drugs not to fall exclusively on the Administration. Here we are not yet in that line.
-Shortly before taking the reins of ESMO, you said in an interview with this newspaper that one of your objectives at the head of the organization would be to “democratize” access to cancer treatment. Has progress been made in this direction?
-It has improved but we have to keep moving forward. It is clear that a medicine should have a certain price in a country with a low GDP and another cost in one with a higher GDP. It is the way to guarantee access to cancer medicines to the entire population regardless of the country in which they live and their economic and social condition. Isn’t it true that a pizza doesn’t cost the same in Uganda as it does in Norway? Well that.
Covid delayed diagnoses
-How did Covid-19 affect the diagnosis of cancer?
-Between March and April 2020, the peak months of the pandemic, cancer diagnosis fell by 40 percent overall, and a year later, in 2021, we saw patients with much more advanced cancer due to not being he had detected them in time. We saw a lot of colon and breast cancer with delayed diagnosis.
– What survival is there currently in cancer?
-30 years ago survival in cancer was 35 percent. It now stands at 58 percent for men and 62 percent for women. Future prospects point to 70 percent survival by 2030.
-Christmas is coming up. What will you ask the Kings this year?
-One of the things that I would ask of you is that the health budget be better invested, in short, that it be better invested in health. There also needs to be a shift in our healthcare system. The current one is not flexible, it is clear that it does not adapt well to changes. It is also necessary to improve political leadership.
-In your previous interview, you gave politicians a resounding fail… have they improved their grade?
– Not much, really. Now I give them a fair thumbs up. No more.