Delvys Rodríguez-Abreu decided what she wanted to do when her mother and a cousin fell ill with cancer. “I’ll become a doctor and become an oncologist,” he told himself. He studied in Havana, the city where he was born in 1974. After finishing his training period as a resident, he crossed the pond and landed in Switzerland with a research grant. After a stopover in Barcelona to practice in two hospitals in the Catalan capital, he flew to Gran Canaria, his home since 2008. From a municipality in the north of this island, Santa María de Guía, his grandparents left for Cuba decades ago, like others so many canaries, in search of a better future.
Twelve years after arriving in the land of his ancestors for family reasons, to “go back to his origins”, Rodríguez-Abreu leads a team that has placed the Islands on the world map of research against lung cancer. His signature appears in almost a dozen articles published in The Lancet and The New England Journal of Medicine, two of the scientific journals with the greatest impact in the medical community. A milestone that, apart from giving visibility to the work carried out at the Hospital Insular de Gran Canaria in this area, allows increasing resources to continue researching through scholarships and projects.
The oncologist explains that lung cancer is not the cancer with the highest incidence, but it is the most lethal. “It kills more people than the colon, breast, prostate and pancreas combined. Every twenty minutes a person dies in Spain from lung cancer”. In 2019 around 21,000 people died from this disease throughout the country, about 1,000 in the Canary Islands. During that period, 29,000 cases were diagnosed in the national territory. The Canary Group of Lung Cancer, an association founded by Rodríguez more than two years ago, figures at 17% the increase in the incidence of this type of tumor in the last decade.
Despite these indicators, it is the sixth type of cancer in research resources, points out the specialist doctor. “There is a lot to improve, our dream is to grow and have a whole research unit. We have advanced a lot in the disease, but the mortality rate is still very high.” Until ten or fifteen years ago, only chemotherapy was used, a treatment “that has saved many lives, but that attacks those cells that move a lot and is unable to discriminate between good and bad cells.” Rodríguez-Abreu explains that in recent decades two therapies have begun to be implemented, targeted and immunotherapy, which have managed to increase the survival rate of patients with metastatic lung cancer.
It is these two fields of research that have made the Hospital Insular de Gran Canaria a leading international center in the last decade thanks to its participation in numerous clinical trials. In many of them, as the complex with the most patients treated in the world. “The best thing for a patient with lung cancer is to be in a clinical trial, because it is the only way to have access to the newest drugs. This is what we have done in the Canary Islands and we have done it well,” says the oncologist.
In the case of targeted therapies, the process begins with the sequencing of genes. Rodríguez reports that until a few years ago, the only categorizations of lung cancer made reference to the size of the cells and, within the small ones, it was differentiated between squamous and non-squamous cells. Now, thanks to this technique, it has been possible to “subdivide tumors into small groups”, to detect mutations in their genes (EFGR, ALK, ROS1, KRAS …) in order to individualize therapies, to administer drugs to patients that they block those specific mutations. The other great advance has been immunotherapy. “We started in 2011 with melanoma (the most serious type of skin cancer) here at Hospital Insular and we quickly moved on to lung cancer. It is a new drug that boosts immunity to attack the tumor. In recent years we have learned a lot of biology and we have been pioneers in these studies “, he remarks.
The results are encouraging. The oncologist points out that until five years ago the survival rate of lung cancer with metastases at five years did not reach 1%. Currently, it can reach 15% in the general population and up to a third in certain groups. “Six years ago a patient came from the island of La Palma and asked me if he was going to be cured. I told him that he would get better, but that we probably couldn’t cure him. At that time we started the studies with a new immunotherapy, with a Marker. Today he is cured, he is free of the disease and the drug we use is already standard, it is used throughout the world. At that time it was unimaginable, “he emphasizes.
80% of cancer patients smoke
Eight out of ten lung cancer patients are smokers. In the Canary Islands there is also a differential factor that is worrying. Almost a quarter of the youth population smokes, a very high percentage. “We must insist on prevention campaigns, make more efforts, continue fighting for smoke-free spaces, for more consultations in Primary Care to avoid smoking. It continues to be the first cause of the disease. We can investigate a lot, but what What we want the most is for them to stop smoking, “explains the oncologist, who states that fewer activating gene mutations are produced in this group of patients than in the remaining 20%. Radon gas is the second risk factor, which is why Rodríguez-Abreu’s group is conducting a study to detect the “hot spots” of this element in Gran Canaria, the places where it is most present.
“We must continue researching. It is an exciting time for those of us who dedicate ourselves to this,” says the oncologist, “the visible face” of a multidisciplinary team in which there are also professionals from nursing and other medical specialties, such as Radiology, Medicine Nuclear, Thoracic Surgery, Pneumology or Palliative Care. Its field of action is wide. Research lines include the search for gene mutations, patient resistance to these mutations or new drug combinations that allow better treatment results.
They are also transferring these targeted therapies to the initial stages of the disease in cases of early diagnosis. “If we already know that these drugs are the best in metastatic disease, if we use them from the beginning we can still cure more people.” The oncologist alludes to a study by the Spanish Lung Cancer Group, recently published in the journal The Lancet, which demonstrated the benefits of combining chemotherapy with immunotherapy before subjecting patients to surgery. “We saw that three quarters of the cancer cells had disappeared when we removed the tumor. It is revolutionary,” he says.
Although statistical data are not yet available, Rodriguez-Abreu perceives a strong negative impact on cancer patients as a result of the health crisis caused by the COVID-19 pandemic. “There is fear of going to hospitals, surgeries, diagnostic tests have been delayed … Unfortunately, in my office, 80% of patients with lung cancer arrive with metastatic disease, very late, and that is catastrophic.” The specialist doctor explains that there are studies that show that low-intensity CT screening reduces mortality from this type of tumor, although he acknowledges that it is a thorny issue, because it is an expensive procedure and in which around 60% of discovered nodules are benign. “We have to do it, but also improve how to do it. We have not yet been able to see what is the best mechanism to implement it, but it already exists.”
Canary Lung Cancer Group
Delvys Rodríguez-Abreu is also the promoter of the so-called Canary Lung Cancer Group, established at the end of 2018 and now in the process of becoming a foundation. According to Wendy López-Trejo, spokesperson for this association, the objective is “the comprehensive improvement of patients.” On the one hand, through research activity, trying to bring together the professionals involved in the treatment of the disease to achieve funding (public and private) and advance their knowledge and therapies. On the other, through work to assist patients and their families from the initial diagnosis, which includes psychological support and the fight against “stigmas” associated with a pathology that, according to the spokesperson for the group, generates a strong feeling “of guilt. and loneliness. ” The third leg is communication, dissemination, focused so far on the events organized during the International Lung Cancer Day, which is celebrated every November 17.
Among the priority projects of the future foundation are the carrying out of genetic sequencing studies in the Canary Islands, psychological and social assistance to patients and their families, the promotion of the training of health personnel, the improvement of assistance protocols or the creation of a registry in the islands of lung cancer. It also aims to achieve accreditation to be able to test drugs for the first time in humans (studies First in human). In all of Spain there are only 37 units of this type, none in the Archipelago, so in order to carry out the tests, patients have to be referred to the Peninsula. “We are more than two million inhabitants. It would be profitable,” says Rodríguez-Abreu.
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