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tv   Dr. Francis Ali- Osman Delivers Remarks on Cancer Research  CSPAN  January 5, 2017 2:51am-3:56am EST

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about. >> thank you. >> thank you. [ applause ] more now from the science symposium at westminster college in fulton, missouri. up next, a conversation on cancer treatment and innovation. we'll hear from a cancer researcher from duke university. >> good afternoon. my name is kurt jefferson, and i am the assistant dean for global initiatives here at westminster college and director of churchill institute for global engagement. thank you for coming here today. i also coordinate the hancock symposium. i'm thrilled we're off to a wonderful start and is a wonderful day to be here. i would like to at this time invite you to the obligatory, please silence your devices, cell phones, and i would really like also to ask you to refrain
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from using your cell phones and also please do not go in and out of the room while dr. ali-osman is giving his talk. really would appreciate that. i want to introduce one of the world's foremost medical professionals and cancer researchers. we are really fortunate to have dr. francis ali-osman here. dr. ali-osman is the margaret harrison -- co-director of the experimental therapeutics program of the duke university cancer institute. a professor of surgery and pathology and an active member of duke's medical research team. dr. ali-osman is a world leader in the field of experimental oncology, cancer therapeutics and pharmacology and cancer drug resistance with a particular focus on tumors of the central nervous system.
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his research seeks to understand the cellular and molecular processes that underline malignancy and to determine the response of cancer patients to their treatment. this work is used to develop novel, highly targeted, smart anticancer drugs and to design more effective individualized treatment strategies. dr. ali-osman has held faculty positions at the university of washington in seattle, at the university of texas, m.d. anderson cancer center, and currently, as you know, serving at duke university in durham, north carolina. in the summer of 2016, he was appointed by president barack obama to the national cancer advisory board. dr. ali-osman earned an undergraduate degree from the university of science and technology in ghana and a doctorate with distinction from the free university of berlin. i give you our distinguished guest, dr. francis ali-osman.
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[ applause ] >> it's a special privilege and honor for me to be here today. the -- i would like first off to thank kurt jefferson for, and ester ellis, for, you know, being with me so many times with the e-mails trying to put this together and for putting what's just been an incredible symposium. this morning i'm sure reflects just a flavor. all your symposium. i come from duke university, which is a small university, as some of you well know. i hope when you graduate, some of you will come over and they will have some great courses
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that were there. duke has a very strong liberal arts tradition. actually, current it is hard to leave. we don't plan to steal your president here to replace him. but he came from yale university and he was a professor of classes. so he brought that flavor and the whole insight on leadership. and also as a counselor person, somebody by the name of mike bishop, michael bishop -- some of you may know him from the university of california san francisco. and he is probably about one of the biggest pillars in the field of cancer in that he and his protege discovered the unka
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gene. those revolutionized our thinking in everything we do today. and he was a liberal arts major, majored in english before he went to med school and got a ph.d and then went to the cancer research. and i had the privilege and honor of reviewing one of his grants. i do a lot of grants reviews for the nih. and just the impeccable english that he uses to write the stuff, it's just incredible. so liberal arts have a major place in medicine, in science. you had the talk earlier on today. so institutions like this have their place, and i hope they will forever be there. they open up the mind in ways that technicalities, some of the stuff we do, don't do. so keep up the wonderful job. the -- to talk on cancer, something that has since my early days in college has captured me, has captivated me which actually made me to skew my education and background less
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to hardcore clinical work, not that that's not important, people get sick and they need to be taken care of. but what fascinated me, from some of the courses that i took earlier, was just the challenge of the disease of cancer. it's extremely complex and needs all kinds of people from different disciplines to come to it. and it's always, you peel open one -- it's like there's another exciting question that's there. and long after we're gone, i'm sure you young ones coming will still be tackling with this and making great contributions. now, the other challenge with talking about cancer is that complexity. in 45 minutes, i couldn't even begin to do justice to a snippet of brain cancers, which is what i work on most of the time. so to try to give an overview of the whole field of cancer in 45 minutes, of course, a big challenge.
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i'll try. my talk will be somewhat eclectic, and i apologize for some if i may not go deep enough in some aspects of it, but my goal is to give you a flavor of what we're doing and what's going on. i'll spend a reasonable amount of time on the burden of cancer, because i think if that is understood, is well understood by young people, it's understood by policymakers, understood by the general public, that the fight against cancer would be even more vigorous, because this is an awful disease, but a beatable disease, you know. if you challenge the human mind, it can come up with solutions to make this not a problem that it is today. so, with that, well, i'm sure you young ones and even us older ones still have to thank our families, particularly our parents, for bearing with us and
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giving us opportunities to be who we are today. and i owe them every day there. the teachers who taught us and the students that we later on had who stimlateed us, questioned us, challenged us. and fellow students. in a place like westminster, you just have a unique place here. the smallness of the college, which i was told is by design. you will never make it too big. it brings such closeness and friendships and, you know, support that will carry you throughout the rest of your life, so cherish them. things you don't get in the 50,000 student body type institutions. so, and then trainees. some really brilliant fellows and doctor and medical residents go through my program to get
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trained. and incredible research staff. they are the soldiers, the foot soldiers who are making it happen. i have been blessed with a wonderful number of them. and collaborators, you know, colleagues that you've worked with. and then the agencies, both the government agencies like the nih and nci, private foundations industry and individuals. you know, sometimes a $10 gift, sometimes $10,000, sometimes $1 million. without them, we wouldn't be where we are with the fight against cancer. and ultimately, the patients who get this disease, suffer with it. sometimes, you know, lose their lives to it. without them, we wouldn't have the material we need and the encouragement that we need to do this work. so i just want to make sure that. now, cancer. cancer is not new at all, unlike hiv which didn't exist until -- cancer has been there in
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actually fossils and mummies, egyptian mummies. they've had evidence that they had cancer. they have lumps in some of the bones and that clearly today is cancer. so, it's been there for a long, long time. and yet the word, cancer, is still shrouded with mystery and fear and emotion. i mean, the worst thing you can be told that you have been diagnosed with cancer. your head just is spinning and all kinds of stuff going on. actually, some societies, they don't even discuss it. in japan until not too long ago, they wouldn't even tell the patient, unless under very special circumstances, that they have cancer. so there's still a lot of mystery and stigma tied to it. and, now, what exactly is cancer? i'll try to kind of shed some light on that. and then i'll discuss, like i said earlier, the burden of
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cancer on society, on us as individuals, tell you little bit about different types of cancer, touch here and there about treatment that we have for them today. and i don't think by that time i'll have too much time to touch on a very, very important thing, and that is prevention. a lot of cancers can be prevented. and i will say a few words about some of the things that we can do. and then as i go along here and there, i'll discuss some of the challenges and opportunities that we have. now, in the u.s., cancer's a real problem. that's why, 1961, president nixon had a national cancer act. it was such a big problem, when he saw the numbers, we have to do something about this. and you know the nih, it has all these institutes. and the nci, national cancer
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institute's one of them. but the nci is the only institute that has its own separate budget line and also can report directly to the president. it's why the president has the national cancer advisory board, which i was privileged to be appointed to a few months ago. it's a huge problem. and i have some of the numbers here. 40%, that's close to one in two americans will have a diagnosis of some form of cancer. that's huge. in 2016, there will be well over 1.5 new cases, not those that have it already, but brand new cases that will be diagnosed. and close to 500,000 people are going to -- excuse me, that breaks down to about 500,000. the mortality, that means those who are going to die from cancer, is staggering.
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about almost 600,000 deaths will occur this year from cancer. and that comes to about 171 per 100,000. it is the second most common cause of death, all deaths. so this is a big problem. i'll show you some numbers later on the impact side. children also get cancer, and there will be close to 16,000 new cases. this was 2014. it's a lot more than that today. and fortunately, just by the fact that so many people will get cancer, we have seen about 14 million americans living with cancer thanks to the advances we have, the treatments and so on. and it's estimated that in another almost ten years, we will have close to 20 million americans living with the disease, and they're living a
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quality life. they go to work every day. they hug their loved ones. so that's the good news. now, the economic burden of cancer is huge, about $125 billion that is spent on care, cancer care, alone. not to speak of the other impact loss of dollar, the dollar figure on loss of people working and so on. just the care. and this is projected to increase. hopefully with that increase, it's a good investment to keep increasing the number of people who are living with cancer. our hope in the cancer field is that cancer becomes, first of all, curable. that's our goal. and a number of them are curable today. testicular cancer, lance armstrong got cured, went on to win a number of tour de france, and many, many other people who are living with cancer.
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i personally know of many women who were diagnosed more than ten years ago, breast cancer, living wonderful, happy life. but we're still very cautious using the "c" word, cured, in cancer. we talk about survival. you live so long. it's such a disease, it can sneak its way, a long period of time and you have to deal with it again. so just some numbers. let's see, maybe i could -- okay. the -- so here are some hard numbers. again, like i mentioned, i want the burden of cancer really to come out because from there i think then the vigor with which we attack it is going to be -- prostate cancer in men accounts for about 26% of all cancers.
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you can see the list goes on. with women, breast cancer, that's the number one cancer. lung cancer, you'll see another figure later on, is increasing in women. likely due to the fact that smoking is, for some reason hasn't been controlled in women. smoking, tobacco, is the single most important and one would say easiest thing to deal with in cancer. it causes cancer, in addition to all kinds of other conditions. but, you know, there's addiction to it and lots of other problems. anyway, this is the estimated new cases that are going to be diagnosed. now, the probability of developing cancer, like i said, is about 1-2, 1-3.
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these are the most common cancers. if you add all of them together, that's when it's 1-2 in men. in women it's a little bit less, 1-3. and i think the big difference is prostate cancer, that obviously doesn't apply to women. the -- it's interesting, when you look at the rates of incidents, the incidence rates of cancer, it peaked about 1993 and it started going down and this coincides with around the time that psa came out as a prognosis for prostate cancer. notice for women it's just a straight line. it's coming down a little slowly because you can diagnose prostate cancer early, and if you do, like most cancers, most diseases, you have a better chance of dealing with it. if a man, for example, is diagnosed early and the disease is within the prostate, hasn't
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moved out, there are so many options for treating it, that can almost not affect your life span. so men, see a doctor, make sure the prostate, you know what's going on in there. unfortunately once it breaks out of the prostate, big, big problem. gets into the bones, it spreads out and it's really a challenge to deal with it. another cancer that could be prevented. and, again, with the women, i think it's the lung cancer, that's what's keeping it going slightly up. as you can see, black men, and it's not -- part of it is access to care and not seeing your doctor early enough. there is a genetic component. why blacks -- african-americans, africans in general, tend to have a higher rate of cancer. and interestingly, in the cancer that i work on, brain cancers,
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there's a risk. african-americans get less risk for brain cancer. particular particularly gleoblastoma, worst kind of brain cancer. that has a genetic component. we're interested in trying to understand what's there. suppress in gene in that, in the africans? if there is, maybe that can give us ways to prevent it in whites. or is it something else that could contribute to this? now, this is the incident rate by -- some of the data that i showed but broken down into all the different races, therefore, men and women. and you can see, again, blacks have higher rates than almost across the board, both for women and for men.
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the -- now, despite the differences in incidents, there are also differences in survival. as shown here. for some cancers, it's dramatic. like oral cavity. i think that's, again, has to do with the smoking. up to a 20% difference. in the uterine, the womb, it's about 20%. so this is, i think, a national challenge and it's being addressed by the nci. disparities in cancer incidents and survival rates. just giving more data on that. this puts the picture more vivid fashion. you see the curve. this is in women. the lung cancer just shooting up.
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it's beginning to tip a little bit down. again, this is because of the rate of smoking amongst women, when most other cancers are coming down, even breast cancer is coming down. so that's -- the tobacco problem is still a national problem that should be dealt with. we've been talking about heart disease, emphysema, other problems associated with smoking. just cancer, alone, the death rates, part of the incidence and all the others that i showed you. now, children. children also get cancer. and this is the incidence rate in children for the different age groups. you notice leukemias and brain tumors are the number one cancers when you combine them together. brain tumors are next to leukemias in children. and it's shown again in this figure.
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but the good news is, despite that, you notice before 1977, how many kids survived with leukemia today, close to 90% of children will survive leukemia because of the treatments, the advancements we've made. they'll go on to have children and grandchildren. i personally know some kids who were treated successfully as kids, went on to college, graduated, married, living their lives. so there is hope. if we do the research and put the effort, that we can make a difference. the brain tumors are still a challenge. but even there we're making small inroads. now, another way to look at the burden of cancer is in the
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person years that are lost to the disease. and this shows you that this is tremendous. okay. this was the u.s. what about the world? it's even worse. when you look at the whole world. there will be 14 million new cases and about over 8 million deaths. in 2016, i was looking at the figures, i wasn't able to update this, i was expecting it to go up and up. more than 50% of the new cases and two-thirds of these deaths will be in the developing world. and good reasons for that, infrastructure for health, for treating cancer, diagnosing cancer, cancer science, cancer medicine is so underdeveloped in these countries, you know, when you have it, it's almost a death sentence. and there's a lot of effort in these countries, africa, south america, on malaria, aids, hiv, tuberculosis. and billions of dollars are being put into those. but guess what, if you combine all of those diseases, more people die from cancer than all them combined.
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so it's a huge, huge problem. and the burden this is going to put on these societies and these countries in terms of their resources, you know, for health care and ultimately if that is an economic problem then it goes into security of the government, stability, and things that can eventually can come back and affect the rest of the world. so it is a problem. and just another figure that in these places, in these countries, you're likely to die from cancer -- your chances of dying from cancer six times higher than from a traffic accident or from war, 40 times from war. so it is a problem. so i hope i've impressed upon you that cancer is a major societal problem. and society needs to come to grips.
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we as individuals, chances are very high, one in two, one in three, that we're going to deal with this disease, if we're not even already dealing with it. so we, the government, communities, should all get on board. so what is cancer? that's another mystery. let me start with the word, "tumor." people use it, you have a tumor, you have a cancer. a tumor is simply a mass, a mass of cells. you can feel it as a lump. it can be anywhere. but, so cancer is a tumor. now, the difference is that a tumor can either be benign. all of them are characterized by abnormal growth of cells. that's how you get that lump. because in the normal cells, there is the genetics of the
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normal cell are like clockwork. and this is just awesome, if you believe in god, there's got do be a god to make it work so well in the normal cell. it knows when to divide, how long to divide, when to die, when to be replaced, it happens correctly. but when something goes wrong with that process, it keeps growing, doesn't know when to stop until it forms the lump. fortunately a good number of these lumps, these tumors, are benign. the surgeon can go in there and cut it out. if he does it well, it's gone. if it comes back, goes back and can do the same thing. in terms of cancer, that growth is very, very, very abnormal. you just keep growing. the critical thing about cancer is they can invade, they don't just stay where they are, they move out from the local site to different places. you can have a breast cancer or melanoma on the skin, moves to the brain, to the liver, to the lungs.
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when they do that, they subvert the normal physiology of the cell and also produce, overproduce or underproduce factors that are necessary for normal growth, and ultimately this is what then takes over and it's a loss of life. the -- so really the big difference between a malignant tumor and a benign tumor is that uncontrolled growth and invas e invasiveness of the tumor -- of course there are many other differences but grossly this is how we look at it. the -- now, i'm sure you're familiar with so many terminologies that are used to describe cancer. the carcinomas, adenocarcinomas,
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sarcomas. unfortunately, cancer is not a single disease. just like the different tissues in the body and the organs are not the same. they have different functions, do different things. when they become cancerous, it translates into that. so it's really -- some of the features are the same. but when you look at the disease, they're very, very different. and it's estimated 100, sometimes you'll hear people say 200 different diseases. so it adds to the complexity. the other level of complexity is even in a single -- if you have three women with the same type of breast cancer, it dehaf s digitally in them because they bring their own innate genetics to bear on the disease. you have your basic carcinoma of the breast, ten women treated with the same treatment, three, four would respond, the others wouldn't respond. because we all bring to bear,
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you know, whatever god has given us to bear on the disease. so it's quite a challenge. this gives you an idea how they look like, different cancers. prostate cancer, lung cancer, what we call kidney cancer, clear cell kidney cancer and so on. so not only do they look different, a good pathologist takes one glance at it and often can tell you what type of cancer it is. so how does a cancer develop? all cancers come from normal cells. if there is no cell, there is not going to be a cancer. so there is a process we call anything. i'll say a little bit about that. that happens in the normal cell. now today we know it's at a genetic level. that normal cell gets transformed into what we call a transformed cell. it's still not a cancer. at least with the technologies we have today, you can detect the evolution of a normal cell to a transformed cell. although in some cases like a
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pap smear, we can take a look at the cells, see it has some changes. even in prostate cancer, there's beginning to be some changes. what we hope is to be able to get molecular markers, that secrete into the bloodstream that you can imagine. there's fantastic work at m.i.t. where they're working on a small little nanochip that you can inject and get readouts about what's going on in there. remotely, with computer science, you can track it, the patient comes to see you, gives signals on what's going on there and you can begin to pick up some of these differences. for now, except in a few cases, we can detect this very early stage. but from the transformed cell, a process called promotion has to
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occur before the transformed cell becomes an actual tumor cell and starts the actual aggressive process. and there are actually chemicals that fuel this promotion. so if you have the transformation but you don't have the promotion, you're not exposed to it. things like that. it can actually move to transform the cell into the tumor cell. and then from the tumor cell to a big cancer that is clinically diagnose bl can take anywhere from a few months to several years to happen. there are some very slow-growing tumors, cancers, but unfortunately there are others that are very fast. brain tumors, pancreatic tumors. and then, of course, once they become -- they progress into that aggressive cancer, they start to invade and spread and so on.
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and the earlier you can get it, the better the chance that you have to deal with it. but what causes this change? that from normal cell to the transformed cell to the tumor cell? it's funny, i thought i would put this slide on, but just to give you what over time how people thought about, of course, the knowledge of biology and everything at the time was, you know, microscopes in some cases didn't even exist, so they had to go by their hunch. that was the so-called humeral theory that body fluids, then the limp theory, the blastema theory, the irritation theory, trauma theory. when i look at this, though, and when you look deep, it wasn't actually wrong. it was just too simplistic. today, with everything you know, you could actually explain any of these theories. you can put substance to it. so there have been thinkers all
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along, not just today, who have been changing the world. but no one would talk about these today as the cause of cancer. rather -- oh, okay, i thought i would step back. like i said, cancer, we know today, is the problem of the genes. a disease that occurs at the genetic level. i think i'll spare you, i was just going through to explain. but the key thing is the term oncogene to suppressive gene. every cell has an oncogene, a precursor of the oncogene. we have tumor suppressor genes. these genes work in balance, like offense and defense and keep everything steady. when a mutation occurs in the oncogene or the tumor suppressor gene, the normal balance is
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tipped. the proto oncogene keeps things going. if there is a mutation, what ke we call an activated mutation in the proto oncogene, becomes an oncogene, it will become a tumor suppresser, or if there is a mutation in the tumor suppresser gene that prevent ts from suppressing the growth of the cancer, then you can get cancer. there are other genes that add to the whole process. these are the two that -- and we know that initial stage of what we call carcinogenesis, the process of developing cancer, physical, radiation, uv light, and the chemicals. you heard this morning, upstanding, eloquent talk about
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some carcinogens, estrogens, that can contribute to the development of cancer, breast cancer, prostate cancer and so on. but there are many other chemical carcinogens, cigarette smoking, hydrocarbons that come out of it, that are very carcinogenic. you know, high temperature grilled meat. i'm sure we all know that and so on. and then there are viruses associated with cancer. hpv, the human papilloma virus. the hepatitis "b" and "c" and of course hiv and so on. interestingly, within the body, there are processes that go on, the metabolism, that actually contribute to carcinogenesis. oxygen is a great thing, of course, we need it to get energy and so on, but oxygen can also be very toxic because it
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produces what we call reactive oxygen species. and these things, small molecules that can damage the dna, one of the basis of the dna, and this if not repaired can become carcinogenic lesion and lead to cancer. in addition to these, there are individual factors, factors related to the individual that can contribute. like i mentioned, genetics, you inherit your genetics from your parents and you live with it. about at least 5% of cancers, breast cancer, ovarian cancer, a number of other cancers, have a familial component to them. but, again, the fact that you have it doesn't mean you have to get the cancer. there are things you can do to minimize your risk of getting cancer. there's something called genetic polymorphism which some
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of you are familiar with. you can have the same gene but different forms of it. and two individuals can be dna repair genes, they can be metabolizing genes. genes that metabolize a carcinogen once it gets into your body. those differences can also contribute. then there are mutations that you inherit, some of the tumor suppressor genes, for example. and, of course, there's lifestyle and environment in which you live in. you diet properly, you know, exercise and so on. of course, smoking. and habits that expose you to hpv or hiv and so on, that can then contribute to having cancer. all of that can contribute to it. the -- now, i'm going to touch a little bit on the treatment of cancer. the -- of course, surgery, it's
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one of the tools that have been available but surgery is very, very effective in benign tumors or tumors that are developed early and are localized, haven't spread. surgery is often the only treatment you need. you take it out and go back home, let the wound heal and go about your life. but unfirefight, i said it's not the case, sometimes people come when the disease has sort of just started to expand. it's not always their fault because some of the symptoms are not very obvious. pancreatic cancer, for example, a dreadful cancer. generally you have bloatedness in the stomach and things like that. it's not a lump you can feel. you go to the doctor, i had a bad meal, whatever i ate didn't -- it's really something else. so then instead of surgery you have radiation. radiation has been the hallmark of cancer therapy for a long time, i'll say a little bit
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about that, and then chemotherapy that you know. these are the mainstay of cancer therapy. there are lots of other treatments, some of them are investigational, but they're representing advances that are going to make a difference in the future, and i'll talk about a couple of those. now, chemotherapy, most patients who are diagnosed with cancer are going to get some form of chemotherapy today. it's still the number one treatment. it's used either alone or combined with surgery. and chemotherapy is simply the use of chemicals to destroy the cancer cells. the history of chemotherapy is actually interesting. it started during the second world war when mustard gas which is a chemical used in chemical warfare, started noticing that people exposed to it were having changes in their blood cells.
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so they started doing some research, developed other forms of mustard until they came out with nitrogen mustard and nitrogen mustard actually was first chemotherapy agent. so those were the two chemotherapeutic agents that came out. today we have a whole slew of them and better ones are coming up all the time. this is just a list of some of the things. the problem with chemotherapy, however, is that at a time most of them were discovered, we knew so little about cell biology that the main tool to discover them was whether or not it killed cells and when i was
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still in college, the two cell lines which are tumor models that i used to test these drugs were from a mouse, a mouse leukemia. no wonder that a lot of the drugs that were discovered were good for leukemia, not that good for so many other things. today, we discover them in slightly different ways, but the -- like i mentioned, che chemotherapy is used in two different ways. we continue to improve upon how we do that. adjuvant, given post-surgery. or neo-adjuvant, you get it before your surgery. today we don't use them individually. we combine them, hopefully use cleverer and cleverer strategies, what we know about how they work, how they will have overlapping effects, but
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rather more than additive effects. then the other big thing is how you combine chemotherapy with some of the other therapies that you have. and i'll talk a little bit about that. and then there's a new -- there's another type of therapy that works with leukemias which is you hit it very big. often you push the patient to almost at the brink, but if you do it well, you can salvage and it seems to be working well. but interestingly, i don't have it on this slide, there's a new type of therapy that's coming, chemotherapy, called metronomic therapy where you actually give small doses of the therapy. little toxicity, but if you do it right, fractionate it right, you actually end up having better results than if you went with the higher dose. so we're learning a lot about how to use chemotherapy alone and in combination. and i think interestingly,
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almost all the new therapies that have been discovered, i'll talk about immunotherapy, which is the latest buzz out there, even those work best when you combine them cleverly with chemotherapy. so it's ongoing work. but like i said, part of the problem of -- one of the major problems of chemotherapy is the low therapeutic index. its inability to differentiate between the normal show and a cancer cell. so i'm sure you've all seen kids with bald heads, people getting chemotherapy, they lose all their hair because the chemotherapy gets at the hair follicles and kills all the cells there. you know, the bone marrow is suppressed and lots of other things happen. skin problems and so on. the hope is that it's a price you pay for hopefully that you get at the cancer cell. interestingly, some of these
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drugs actually get at the cancer cell with a bigger bang than they get to the normal cells, so that's the differential. our goal in research on these therapies is to continue to get -- continue to get -- improve upon this differential. the other big problem is resistance. that is, tumors have the ability to develop mechanisms that block the effect of the drugs. so you have the patient respond very well for months or even years, and then they fail to respond to the therapy, and you have to kind of find ways to overcome that. so these are some of the things that the future work that's ongoing to improve chemotherapy, to understand the mechanisms and develop new agents, new approaches of combining them alone, together or with other
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modalities. okay. i think i'm getting close to the end. the immunotherapy, i'm sure you've all heard about immunotherapy, is the latest and biggest thing out there. it's funny because way back when i was early in my training in the field, immunotherapy was kind of pooh-pooh'd upon. it was more of a mystical, witch's brew type of thing. that was in part because we didn't know enough about the biology and about the immunologic processes. now it's doing wonders. now all kinds of people are responding. president carter had a melanoma, failed everything, then it moved on to his brain. normally that's the end of the story.
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so he was put on a type of immunotherapy. and, well, we know the rest of the story. tumor disappeared, can't find it in the brain anymore. we keep our fingers crossed that it's going to continue. exactly how it's working, we're not 100% sure. what he's getting, or what he got is what we call an immune checkpoint inhibiter. these are proteins that block the immune system, like checkpoints. so when that happens, then the tumor is able to grow. so if you're able to intercept that process, then you are allowing the immune system to attack the tumor and take care of of it. so basically what the immuno therapy is -- we're all healthy,
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i hope, that we don't get infections and so on and don't get infections in our bodies because that immune system kicks in. we have this robust immune system. so when it doesn't work well, and cancer, unfortunately because it comes from normal cell is not quite a foreign body inside you. but there are sufficient changes that make the cells foreign cells. so the goal of research is to find out the differences between the normal cell and the tumor cell and be able to allow the immune system to recognize the tumor as a foreign body and attack it. and the other thing is a tumor cell is quite clever. they have things they do that suppresses the immune system. once you realize you can remove that shield that they have, so basically it is letting your
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body's immune system attack the cancer. so you get injected and it goes after it and attacks it and kills it. then came adoptive cell therapy which some of you are aware. you take the cells from the patient. you isolate what we call the t cells and some times you can reengineer those cells or activate them and grow them in large quantities and get them back to the patient. i may have a slide on it. no. i will skip on that. we have an immune modulator that will activate the t cell but you
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also engineer it so it will have a molecule that can recognize the cell. when you do that and then you grow those cells in large numbers -- and we do that in our program for brain tumors. you grow it and you give it back to the patient. we have two things. all of this is still experimental. you have all of the necessary scientific teams to be able to do it. that's a great future. then there's molecules that stimulate the immune cells. you can give a patient that. it makes itself very active and it's able to attack the cell.
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that's a real exciting thing. immuno therapy, you have vaccines where you can immunize the patient against the tumor. then bcg probably and that also, if you do it so it doesn't cause tb first but it can activate the immune system to once you give it to the patient. it is used a lot in bladder cancer. it's slowly being extended into other cancers.
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again, it has limitations, benign tumors. that's the treatment. it is used for many other aspects of cancer care for diagnosis. it is some times to really get to most of the time actually to know what kind of cancer it is and to know what molecular changes are taking place. you need a sample of that tumor so it's a safe procedure. to know the extent of the tumor you need to have some -- it's a curative surgery. and some times it's important when the tumor is so desimilemid and it's causing pain and compromising quality of life
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some times it can help. so say you have lots of to try to kill the tumor. very quickly other cancer treatment modalities out there are being research heavily. hypothermia raised the temperature to the tumor to around 106 degrees and if you can do it focally -- and today we have high frequency so you can put it on right there and just heat that it can kill the tumor that way.
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you with spare the tumor and what we now know is when you combine it with other treatment modalities you can have a very positive effect. you can also use cooling to kill the tumor. you can direct it and use liquid nitrogen. you can freeze it that way, we r e eraticate it. where you put a photo sensitive molecule you administer to the tumor and you bring light. that light would activate it.
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they are not killed because the light doesn't get to them. there is a radio biologist doing really fascinating work and generating new photo synthesize molecules that also the way he delivers the light and now he is even using radiation to activate them and so this is all very promising things in the future. another exciting thing that is going on, chemomobilization. that way you don't have the systemic effects and localizing
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in the tumor and deal with a tumor that way. you have probably heard of the gamma knife and so forth. it is actually radiation that is used very focally, computer controlled to bring radiation right to the site of the tumor. and the radiation therapy you can radiate it too. in the last few minutes i will spend talking about targeted therapy. that's a big part of the work i do. the targeted therapy is simply
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identifying an abnormality and then it attacks that, hoping it's only in the cancer cell then that therapy has been very selective for the cancer cell. that's the basic concept. this is actually a face to metaboli metabolism gene. it transfers onto toxic compounds, binds to them and these treat it.
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i saw that tumors and several reasons i can't go into right now, they help regulate this protein tremendously. it is an example of brain tumors. all of brown colors you see heher here, it's all of the tumor cells. and when a tumor has high amounts of this gene especially if one in the nucleus of the cell it has about four fold higher chrhig higher risk of death. this had been crystallized we
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knew the structure it was over the molecule. once you have that then what you can do is through drug design you can direct different chemicals or fragments into the active site of the protein using the crystal structure. you can come out with compounds that bind with the highest affinity to the sight. you validate the molecules and make it clinical.
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i just want to repeat -- you know, i tried to find -- if anybody knows it i appreciate it. i have been able to we cannot direct the win so i know it's hard. there's lots of help to stop smoking. if we cut out smoking we can reduce 30 to 50% of the cancer. not to speak of heart disease and all of the things that's attributed to smoking. smoking is the one thing that, you know, i think is low hanging fruit. it's a tough one but we can do it. it builds a habit exercise.
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it's not fully understood but it has a very powerful effect. again, heart disease, we know that, answer cancer. several studies have shown us that. sun exposure, especially very fair skin, let's minimize it, sunscreens and things like that. there's uv light and when it gets there it will damage your dna. some of it will start to it is wonderful but the things we can do to minimize it. again, early detection is the key. you know, go to your doctor.
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have it checked out. if you're a man get your psa done. it doesn't matter what gene you have inherited i know you have heard about this. especially if a lot of women have ovarian cancer. there are so many things you can do. it's never too late to start. i'll stop and take any questions you might have. [ applause ]
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the director of national intelligence james clapper and michael rogers who heads up the national security agency will testify about cyber threats including russian hacking. we'll have live coverage from the senate armed services committee 9:30 here on cspan 3. this weekend on american history tv on cspan3, on the civil war author william marble. >> the secretary was very timid. it was impossible for him interfering with the armys. he could not see that the enemy was in danger. the enemy would not have been in danger if he had been in the field. tracy loot describes the
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careers and social pressure on women writers. >> i try to assign her stories about the stuff that would have made her really happy except she just kept busting out. she wrote stories about divorced laws, called for divorced laws largely because of her mother's experience. she wrote about conditions for women who worked in factories. she wrote about the medical treatment of the poor. >> sunday afternoon at 4:00 on real america the nasa film friendship 7 documenting john glenn's orbit around the earth. >> capsule is turning around. oh, the view is tremendous. >> and at 8:00 constitutional law professor talks about the passage of the 22nd amendment limiting the number of terms a president can serve. >> no person shall be elected to the office of president more
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than twice. no person who has held the officer president for more than two years of a term to which othe others. next a conversation of artificial intelligence. we'll hear from jennifer nevel, a computer science and statistics professor who focuses on data mini

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