"The patient is a source inspiration. It makes you wonder what you can do to try to cure him".

source Having patients in front of us every day with diseases that, unfortunately, in many cases, we are still unable to cure is a great professional challenge and, at the same time, an enormous source of inspiration," says challenge . "This forces you to improve yourself and drives you to do everything else: to pass it on to the students at , and to try to set up research projects that respond to these unmet clinical needs. This forces you to improve yourself and leads you to everything else: to pass it on to the students at School, and to try to set up research projects that respond to these unresolved clinical needs, which can improve the quality of life of those patients you have just seen at enquiry", acknowledges Dr. Gil-Bazo. "What is behind everything we do in teaching, research and attendance is a person who has a suffering associated with a disease, incurable in many cases.That is what gives meaning to everything else.

A specialist in Medical Oncology, Ignacio Gil-Bazo is, since 2015, co-director of the department de Oncología and director of the department de Oncología Médica de la Clínica Universidad de Navarra. He also directs the laboratory on Predictive Response Markers of the Solid Tumours Programme at CIMA, with special interest in lung cancer, mechanisms of drug resistance, mechanisms of metastasis and immunotherapy.

"The question journalists like to ask most is when are we going to be able to cure cancer," he admits, somewhat resigned. "But it is the one question we are not able to answer. Unfortunately, we will never be able to cure cancer because it is inherent in the ageing of cells. If we live longer, we are more likely to develop cancer," he explains. "In oncology, what we are concerned about and what we are working on is how we can treat cancer in the most appropriate way for each patient. And at the same time, of course, how to prevent it and how to diagnose it early.

In fact, the way cancer is diagnosed today has almost nothing to do with the way it was diagnosed twenty years ago. "There have been, above all, two major revolutions, which in turn have had a clear impact on treatment and on the survival and quality of life of patients," explains Ignacio. The first of the revolutions he refers to began in the late 1990s, when medicine was able to discover the first therapeutic targets. Until then, two things were taken into account: the tumour's subject , i.e. the organ of origin; and its histology, i.e. the composition, structure and characteristics of these tumour cells as seen under the microscope. Nowadays, the study of the tumour is approached at the molecular level, from the inside, making it possible to determine its differential characteristics, the specific alterations in the genome of the tumour. "To the extent that we know better the differential features of the patient's tumour, which are different from those of the tumour of other patients, a priori with apparently similar neoplasms, we can begin to think about treating that patient specifically. If we are able to diagnose more deeply, we are able to treat more effectively," he says. "A better knowledge of the biology is associated with a pharmacologicaldevelopment . The speed of development of new targets is starting to be exponential. For example, between 1990 and 2000, licence was granted for a single drug targeting a specific alteration. From 2000 to 2010, five or six drugs were approved, and in the last decade there have been more than two dozen," he says.

Different treatments, but also better, as they not only significantly change the life expectancy of patients, but also improve their quality of life. "In many cases, these are oral treatments, which are less toxic. Unlike, for example, chemotherapy, which is also a very unselective treatment: it attacks fast-growing cells without distinguishing whether they are cancerous or not, and therefore affects hair, mucous membranes, bone marrow, etc.," Gil-Bazo explains. And he resorts to a war metaphor to explain it better:"We used to go into battle armed with what we could, with what we had at the time, but without having any idea of what we were going to find. We didn't know whether we were over-armed or under-armed, whether the enemy was coming from one front or from three different fronts.... So the chances of winning a battle are low. But now, in this new era, we are able to start the battle with a very close knowledge of the opponent: we know who we are up against, what his strengths and weaknesses are, and therefore we can choose the optimal strategy that will allow us to disarm him.

The other major revolution that has changed the diagnosis and treatment of cancer has been immunotherapy, which is the use of the immune system itself to fight tumours. "We have been dealing with immunotherapy in oncology for more than five years. Today it is not yet a reality for all types of tumours, but in the near future it could be," explains Gil-Bazo. "Immunotherapy has shown that for selected groups of patients with specific oncological pathologies, it can even lead to a cure. And until now we have never seen this with other therapeutic approaches, not even with targeted treatments," he says. "There is enough data to be very hopeful, although not enough to think about a cure for cancer; nor, of course, to set a date," he insists.

Oncology research: transversal and embedded in the University's DNA

Oncology is one of the lines of research within the University's Strategy 2025. Dr Gil-Bazo is its coordinator. "If the University has set out to promote research with impact and focus, Oncology had to be one of the lines included in the strategy. Today, cancer is already the leading cause of death in the global population. Specifically, 25%, a quarter of the population of the first world, dies of cancer. So it is reasonable that the University considers it strategic to investigate such a relevant and worrying reality," concludes Ignacio. "Oncology research is so transversal and has been so firmly established in the DNA of the University of Navarra for so many years that it has an impact on almost any School and research centre, and on all campus. The great advantage of it being such a relevant line of research in the institution is that it is dispersed in many hands. Cancer research is carried out by nurses, doctors, researchers at Cima, biomedical engineers at campus in San Sebastian, pharmacologists, pharmacists, epidemiologists... My obsession as coordinator of this line is that everyone working on cancer at the University is represented in this strategic commitment, and that this wealth of research and resources is organised and oriented towards seeking synergies and collaborations", he confesses. "If we join forces and work together, we will surely go further," he concludes.