Can We Cure Cancer ?

Can We Cure Cancer ?

Aladdin Maarraoui, MD, FACP.Clinical Professor, Gulf Medical University

Consultant and Chief of Hematology OncologyMafraq Hospital, Abu Dhabi, UAE

ينفعنا ما علمنا اللهمعلمتنا بما انفعنا و

الراحمين أرحم يا علما زدنا وMay Allah teach us what benefits us and benefit us of what he

taught us and increases our knowledge.

Who are you?

• Who are you cancer?• Are you the Emperor of terror?• Are you a ghost that enters without a notice?• Are you a prison that locks patients in?• Why are you so cruel?• Why are you so heartless?• How many sweet people you intend to harm?

The Truth is:

• You start and end with people.• You are being defeated more and more.• We started to know how you sneak into

bodies and we are detecting you very early.• Your risk factors are being recognized.• You are like a puzzle. But the puzzle pieces are

found every day.• You cannot disguise anymore.

Can we improve cancer mortality?

• In the western world and since year 2000, cancer mortality dropped by nearly 2% a year.

• This does not mean that cancer incidence is less, but this is the result of risk factors awareness, detection at an early stage and new treatment strategies.

Trends in lung cancer mortality rates by sex in select countries, 1950-2006.

Jemal A et al. Cancer Epidemiol Biomarkers Prev 2010;19:1893-1907

©2010 by American Association for Cancer Research

The First UAE Non-Communicable Disease Conference, January, 2014

Under Patronage of H.H. Sheikh Hamdan Bin Rashed Al Maktoum.

Our Goal is: to decrease cancer mortality

20% by year 2025

The First Cancer Survivors Day in UAE was in 2007

The Human Genome Project

• It mapped the human genome at the University of Utah. Started in 1990 and completed in 2003 at cost of 3 billion dollars.

• Human beings have 20,500 genes.

[TITLE]

Presented By Paul A. Bunn, MD at 2013 ASCO Annual Meeting

How Many Genes Give Cancer

• Not too many.• May be 300 genes out of the 20,500 genes.

Gene Array

The problem is not with the car. It is with the driver!

[TITLE]

Presented By Paul A. Bunn, MD at 2013 ASCO Annual Meeting

[TITLE]

Presented By Geoffrey R. Oxnard, MD at 2013 ASCO Annual Meeting

[TITLE]

Presented By Paul A. Bunn, MD at 2013 ASCO Annual Meeting

1: 84 year-old Female

• Never smoked cigarettes.• Diagnosed with locally advanced lung cancer in

10, 2010• Her symptoms were hoarseness and dyspnea on

exertion.• She previously received single agent

chemotherapy on and off with partial response. • She came to Mafraq Hospital in December, 2012.

Gene testing

• EGFR mutation (Leucine 858 Arginine) of exon 21.• Plans for chemotherapy and radiotherapy were put

off.• We started targeted therapy 1 tablet per day.

Result

11, 2015 Cancer started to grow again

CT Guided biopsy

[TITLE]

Presented By Geoffrey R. Oxnard, MD at 2013 ASCO Annual Meeting

On 13/11/2015 FDA Approved AZD 9291for EGFR resistant lung cancer

Company stocks immediately went up!

I contacted the company

• Patient will get the drug for free on their early access compassionate program.

• Ethics & Research Committee and Pharmacy & Therapeutics Committee are notified.

• The drug is on its way.

2: 53 year-old UAE Male

• Patient is a past smoker.• Developed abdominal discomfort and bloating.• He went to Munich, CT scans showed Lt. lower

lobe lung cancer and Liver metastasis.• Bronchial biopsy showed lung cancer on 23/3/13.• He underwent 1 cycle of cisplatin + Taxol

chemotherapy.

Gene testing

• Cancer cells showed EML4-Alk mutation in 65% of cells.

• Chemotherapy is stopped.• We started targeted therapy1 tablet PO BID.

Follow up PET CT showed complete anatomical and metabolic response

[TITLE]

Presented By Paul A. Bunn, MD at 2013 ASCO Annual Meeting

3- Trastuzumab blocks cell proliferation

4- Anti-angiogenesis

MRI at Baseline

Before Anti-angiogenic drug(on 22/3/2010)

Follow up MRI

Before and After

5-Case of relapsed brain tumor

27 Sept 2012 12 May 2013

6-

1.5 Year after

..

7- Carbon

The Carbon Atom

It gets accelerated to 2/3 of speed of light using a synchrotron.

Speed is generated by large magnets.

Charged carbon ions are directed to the treatment

rooms.

Work Station

Treatment Room with Robotic Couch

8-

• Survival rate of kidney cancer by stage in 2012.

Case of stage IV Kidney cancer. On targeted therapy pill 4 weeks on 2 weeks off

June 2011 July 2014

9- Colon cancer metastatic to the Liver

17 Feb, 2015

December, 2015

10- PD-1 and PDL-1 Inhibitors

ONCOLOGY

SURGERY

RADIATION

C H E MO THE R A P Y

IMMUNOTHERAPY

The PD-1 Pathway Inhibits Effector Phase ofT-Cell Activity

Quezada SA, Peggs KS. Br J Cancer. 2013;108:1560–1565.Pardoll DM. Nat Rev Cancer. 2012;12:252–264.Ribas A. N Engl J Med. 2012;366:2517–2519.Keir ME, et al. Annu Rev Immunol. 2008;26:677–704.Nishimura H, et al. Int Immunol. 1996;8:773–780.

PD-1, is a cell surface co-inhibitory receptor expressed on T cells that inactivates antigen specific T-cells in the tumor microenvironment. Its normal role is to down-regulate T-cell activity in peripheral tissues and limit collateral tissue damage during the immune response.

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Quezada SA, Peggs KS. Br J Cancer. 2013;108:1560–1565.Pardoll DM. Nat Rev Cancer. 2012;12:252–264.Ribas A. N Engl J Med. 2012;366:2517–2519.Keir ME, et al. Annu Rev Immunol. 2008;26:677–704.Nishimura H, et al. Int Immunol. 1996;8:773–780.

PD-1, is a cell surface co-inhibitory receptor expressed on T cells that inactivates antigen specific T-cells in the tumor microenvironment. Its normal role is to down-regulate T-cell activity in peripheral tissues and limit collateral tissue damage during the immune response.

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NSCLC Cells may Evade Immune Surveillance by Exploiting the PD-1 Checkpoint Pathway

• Tumor cells may block immune

responses via the PD-1 immune checkpoint pathway by expressing the dual PD-1 ligands, PD-L1 and PD-L2

• PD-L1 and PD-L2 engage the PD-1 receptor on T cells, inactivate T cell signaling, proliferation and effector function to allow tumor cells to evade the immune response

Freeman G, et al. PNAS.2008;105:10275–10276.Pardoll DM. Nat Rev Cancer. 2012;12:252–264.Zou W, Chen L. Nat Rev Immunol. 2008;8(6):467–477.Rozali EN, et al. Clin Dev Immunol. 2012;2012:656340. 78

Abu Dhabi Achievement (source HAAD)

Reduction in late stage breast cancer, from 64% in

2007 to 16% in 2012

Target 15-20%,

similar to other

countries such as UK

and US

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