Andrey Kaprin’s interview to the weekly “Argumenty i Fakty”

Cancer ceases to be a fatal diagnosis. And the life expectancy of cancer patients is growing thanks to modern treatment technologies.

Says the chief oncologist of the Ministry of Health, Director of NMIC Radiology, Academician of the Russian Academy of Sciences Andrey Kaprin.

Lydia Yudina, “AIF”: Andrey Dmitrievich, on August 2 you will celebrate your 55th anniversary. As a person who has devoted his life to the fight against cancer, can you say that cancer will win?

Andrey Kaprin: Cancer is a systemic disease, and only a system (properly conducted diagnosis and prescribed organized treatment) and a team approach can cope with it. It is known that cancer is treated by a team of doctors (which includes morphologists, oncologists, surgeons of various specialties, micro- and neurosurgeons, radio and chemotherapists, anesthesiologists, radiologists, etc.). But the patient himself must become part of the team.

Oncology is a specialty where doctors meet with trouble every day. Therefore, on the one hand, it is important to be able to empathize, on the other – to prescribe treatment to the patient that will help him. Since most methods are quite aggressive, it is important that the patient is ready to fight and cooperate with doctors.

– According to your forecasts, the death rate of cancer patients in regional cancer clinics will fall, and in national medical centers – will increase. What is the reason for this paradox?

– The quality of oncological care in the regions is growing. We see this in the patients who come to us. Early and middle stages of cancer are successfully treated locally. We receive only severe, often “rejected” patients who were previously sent for palliative treatment. Today, our goal is to convert cancer of any stage into a chronic disease with prolonged remission, with which the patient can live for a long time. This has become possible thanks to new technologies.

Shut off the oxygen

– What are these methods?

– First of all, radiation therapy. This is one of the main methods of treating oncological diseases, which is used in one form or another in half of patients. Modern technology makes it possible to locally affect the tumor and deliver high doses to it in a short period of time.

Proton therapy is used today for the most aggressive and hard-to-reach tumors. In 2018, the first domestic proton accelerator started operating at the NMIC Radiology branch in Obninsk, and since then 600 patients with head and neck tumors have been successfully treated.

Irradiation does not cause any discomfort to the patient – the thinnest proton beam the size of a pencil lead allows protons to be delivered to a tumor of any shape and localization without affecting the surrounding tissues.

The session lasts 2-3 minutes, and the course of treatment takes 18-20 days. This time is usually enough for the tumor to shrink in size and regenerate into connective tissue. In the near future, we plan to start treating patients with retroperitoneal tumors – urological, pancreatic.

An advantage that is not obvious to patients, but significant for doctors, is the size of the domestic proton accelerator (5 m). If the construction of a new separate building is required for imported installations, then our accelerator can be assembled in any medical institution. And in terms of efficiency, it does not differ from foreign analogues.

– X-ray surgery is successfully used abroad for the treatment of certain types of tumors. Do we have this method?

– X-ray surgery, or radioembolization (blocking the blood flow of the tumor), is a unique development. It is known that the tumor needs an abundant blood supply (much larger than normal cells) and often creates its own circulatory network. By blocking the vessel that feeds the tumor, you can thereby “de-energize” it. To do this, microspheres with a radionuclide preparation are delivered to the tumor through arterial vessels using a catheter, which block the flow of blood and nutrition.

Today, the radiopharmaceutical yttrium-90 is used all over the world for these purposes. Its disadvantage is extremely expensive production. In order to charge yttrium, a powerful reactor is needed (in our country, this is carried out in Tomsk). If we take into account that the half–life of the drug is only 72 hours, it becomes clear that many circumstances that do not depend on either the doctor or the patient can lead to the cancellation of the operation, for example, non-flying weather.

A domestic pharmaceutical product, rhenium–188, was created at the NMIC of Radiology, which can be obtained using a domestic generator directly in the clinic. We hope that with this method we will be able to control even tumors with multiple spread in the body. After all, sometimes even a small tumor already at an early stage gives multiple metastases in the body.

Clinical trials of a radiopharmaceutical for the treatment of prostate cancer – lutetium-177 – are also beginning in Russia. The killer molecule is carried by PSMA (prostate protein), which searches for tumor cells throughout the body. The use of the drug is effective when the cancer develops resistance to hormone therapy and begins to progress rapidly.

– Sometimes patients do not have time to get adequate help, because the tests take too long.

– Of course, the main enemy of cancer is early diagnosis. All examinations of a patient with suspected cancer should be carried out as quickly as possible. In our branch in Obninsk, a new Cobas-6000 device has appeared, in which both routine studies and rare tests for tumor markers in the blood, in punctates, in various fluids are performed. The throughput of the device is up to 1 thousand tests per hour. The device works around the clock, and the test results are ready in 2-3 hours, which allows patients to return to a repeat appointment on the same day, at which the doctor will prescribe them treatment.

We do not yet understand the laws of tumor development, and it remains a mystery why patients respond differently to treatment.

Last year, we started forming the first domestic oncobiobank, which stores samples of blood and biological tissues of our patients. Today, 4.5 thousand samples have already been collected in it. We hope that this “collection” will help future generations of oncologists to find common biomarkers of the disease and prognoses of the course of the disease, as well as to develop new effective drugs.

With my bare hands

– So surgical interventions are gradually becoming a thing of the past?

– No modern method of treatment can yet replace the surgeon’s hands. But the operations that are carried out in our center are seriously different from those that we did just 10-15 years ago. These are, as a rule, extensive surgical interventions that require the work of various specialists: urologists, oncologists, vascular surgeons, X-ray endovascular surgeons. The branch in Obninsk has long had a department that deals with surgical and conservative treatment of radiation injuries. Unique surgical interventions aimed at eliminating the effects of radiation therapy are performed there. Sometimes, a complete reconstruction of internal organs (bladder, intestines, ureters, etc.) is required, which allows to preserve the quality of life of patients. Post–radiation changes are a separate story that requires a special skill of the surgeon. Scars after radiation therapy can be so powerful that a conventional scalpel is powerless against them and requires the use of modern electrosurgical instruments.