Dr. Cesar Núñez Interview – Lima Peru – “Immunotherapy as a Cancer Treatment”
It is finally here.. The entire translation of my video interview with Dr Cesar Nunez!
This was an amazing experience and unplanned event but I think it turned out great. I firmly believe in his work and the potential it offers to help cancer patients. I really hope you enjoy it, as he provides a lot of good information and further explains what immunotherapy is and how his personalized treatment works. He kept me and the camera crew on our toes for the entire session. It is my deepest desire that the information contained herein provides much education, support and hope to all cancer patients across the world.
The entire interview is in Spanish but right below, I provide the English subtitles placed on the actual video.
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Subtitles: (My voice in bold)
-Dr. Núñez, good morning.
-Blessings. Good to see you.
-Please take a seat.
- Hello my friends. I am Karen Berríos from Lima, Perú. Once again, I’m visiting my native country for my immunotherapy treatment follow-up with my doctor, Cesar Núñez.
I wanted to take this opportunity to share with you more details about my treatment; what immunotherapy means, and also ask Dr. Núñez some questions, which I would also like to share with my readers.
Dr. Núñez, good morning. Thank you for being here, for having accepted my visit today.
Dr. Núñez, what causes cancer?
To say exactly what causes cancer would not be a correct approach, since cancer is multifactorial.
It is important to clearly understand that there are multiple factors converging for cancer to express itself. And the basic cause of cancer is unknown since it is due to multiple factors.
Based on current studies, we know very little about the real causes of cancer. Approximately 35% of causes are known, at least in scientific terms. But it is important to understand that multifactorial diseases are chronic and thus cancer is a chronic condition. Therefore, we need to eradicate the generalized idea that cancer is fatal, or a disease which places you between life and death. Actually, we should basically see cancer as another chronic disease, like diabetes or hypertension. As a chronic disease that might not be cured, but can be controlled.
From this perspective, the therapeutical approach can also change in structure and nature.
-Doctor, and when you say cancer is a multifactorial disease, could you please expand a little bit on what you mean by multifactorial?
-It is hard to give a concrete answer because there is a lot of speculation into cancer- causing factors, as there are also defined factors. I can only refer to already defined factors, which include: smoking (among well-defined causes of cancer) or also excessive fat, as another risk factor. We need to clearly understand that it is not fat per se that is harmful, but rather its excessive consumption is. In studies considering fat as a risk factor, it was not a patient who ate a lot of fat who was at risk but rather someone who ate excessive fat for years–we need to understand this very clearly. There are lots of factors involved, which are mostly speculative.
Something that might help in giving this explanation is a study published in Science, which basically states that cancer is due to “bad luck”. Unfortunately, I did not like the way they put it, but there is a genetic study conducted to find out what percentage of genes could predict cancer behavior, which states that approximately 35% of genes could be predictive of cancer. And this is why this study refers to cancer being a result of bad luck mutations. What might really be extrapolated from this study is that 65% of cancer is not predictable –also meaning that 65% of risk factors are unknown, which is also a fairly good answer, I think.
-Dr. Núñez, would you say that lifestyle, emotions, nutrition and physical activity are factors which can impact or contribute to cancer?
-When dealing with multifactorial diseases, their management is always multidisciplinary. Hence, there are two fundamental aspects to consider in the multidisciplinary approach: the therapeutical arsenal on the one hand, and lifestyle on the other. Both are very important and are interdependent. When we are faced with evidence-based medicine, it is very easy to understand that if I have a therapeutical arsenal available to a diabetes patient, his/her lifestyle also plays a very significant role in his/her evolution. Also, life expectancy not only depends on the therapeutic arsenal but also on lifestyle. However, when dealing with cancer, unfortunately life expectancy is seen as being only dependent upon the therapeutical arsenal, and lifestyle is not well regarded, as far as evidence-based medicine is concerned.
Then, it is important to establish that nutrition, emotions and motor aspects, or physical activity, are essential in the evolution of a patient with cancer. This has not been established in evidence-based studies, however Science is now studying nutrition, emotions and physical activity as interdependent factors. They depend upon each other and hence cannot be considered separately. Often times, they have to be taken as a whole.
-Doctor, can you share with us what immunotherapy is?
-Explaining immunotherapy requires me to go back in time to a very old concept of the 50’s. Immunotherapy as a concept means specifically stimulating the immune system. A vaccine does the same thing: it specifically stimulates the immune system. So, what is the difference between them? Time. If I have a specific stimulus of the immune system before I get sick, it is called a vaccine. If I have a specific stimulus of the immune system after getting sick, that is called immunotherapy.
So why, this being an old concept, -as I just mentioned-, why was immunotherapy not used as the therapeutical approach of choice at that time? Because unfortunately there was no evidence-based medicine back then and this concept couldn’t thrive, or spread, or be implemented, without the necessary technology to prove these concepts, and now there is. So, to explain what immunotherapy is about, I would have to explain a little bit about what the immune system does. And the immune system, as a general concept, of a cancer patient is not a compromised immune system. It is an immune system with an acquired specific deficiency. That is to say that a cancer patient is not immunosuppressed, but has an acquired specific defect.
Immunotherapy as a concept stimulates a specific defect, so I can correct a defect with immunotherapy by its definition. It may sound beautiful: I have an acquired defect and I have a tool that specifically stimulates this defect, hence, immunotherapy is curative by concept and definition. And this is true; however, it is also true that a patient is not only an immune system, it is a group of systems and organs which function concertedly. Turning this concept into vision takes a more comprehensive approach which is what you said a while ago. It is not only about applying a tool, but rather managing the whole context to make this tool work.
- So, doctor, in immune terms, how is cancer generated?
- It is important to understand that we are all subject to cell divisions every day, millions of them. And within those million cell divisions per day some tens of cells do not divide correctly. Normally, failed cell divisions degenerate, but it isn’t abnormal for a failed cell division to survive in all human beings, every day. This surviving failed cell division is called a transformed cell or tumor or cancer cell. In other words, although it took me a while to explain, what I mean to say is that we all develop tumor cells in our bodies. And when a tumor cell develops in my body, an alarm goes off in my immune system, which is a process called immune surveillance.
My immune surveillance system simply detects the antigens expressed by this cell and sends immune cells to destroy it, like cytotoxic T lymphocytes, natural killer cells, natural killer T cells, macrophages, and many other cells that we surely don’t know and we are barely starting to discover.
And this natural process of our body is called elimination, meaning that we eliminate tumor cells. If our immune system fails in eliminating tumor cells, we then have tumor cells, but that does not yet mean that we have cancer, since cancer or a tumor is not only about tumor cells: a tumor has cells and tumor blood vessels. The only way in which cells can divide and form tumors is by creating their own blood vessels since the latter provide oxygen and nutrients.
Then, there comes a second moment where the immune system acts within our body, called state of equilibrium, representing the antiangiogenic function of the immune system. Tumor cells send signals to form blood vessels and the immune system blocks these signals to form blood vessels. While there is equilibrium, cells won't be able to get organized and the tumor cannot thrive. But if this equilibrium is somehow broken, and of course in a cancer patient this state of equilibrium is indeed broken, the tumor forms blood vessels, gets organized and expresses itself. And this gives rise to the phase called cancer.
And in cancer terms, we then speak about tumor evasion. The tumor has grown, developed and found a series of mechanisms through which it evades the immune system completely. In this way, something that the immune system considered alien to itself and avoided its formation and expression, is no longer alien and thrives. And therefore, if it’s no longer something alien in a patient’s body, it becomes his/her own. And if it is their own, what does the immune system do against the tumor? Not only does it not do anything, but it helps it thrive.
And this explanation I have just given explains why statistically a young cancer patient has a worse prognosis than an older patient with cancer. This is the statistical behavior.
- Having said this doctor, what is your treatment about and how does it work?
- I have already referred to immunotherapy, but what I do is called passive specific immunotherapy. And what I will do with this passive specific immunotherapy is revert this process I have just explained. I will induce the patient’s immune system to recover not only its anti-tumor function but also its antiangiogenic function, that is destroying tumor blood vessels.
I will explain how we do this:
First, I draw blood from the patient. And the patient’s blood contains tumor antigens expressed by the tumor. A tumor not only expresses one, two or ten antigens, but hundreds of tumor antigens. And all of those tumor antigens should build an anti-tumor response, but, as I have just explained, this response is blocked by the same tumor. So then I inoculate your blood (which contains tumor antigens) into a host or several hosts actually, which are hens (animals) who will recognize those antigens present in your blood and will then generate an immune response against them which is called late immune response. And in the peak of the late immune response I will recover this immunized blood and will freeze-dry it. Freeze-drying means I will remove water from it without altering its biological activity, and put it into capsules. And those capsules will be administered to you. So the process from the blood draw, until the capsules are ready, takes 15 days more or less.
- Doctor, and how long can a patient take your treatment?
- Actually I don’t consider a defined time, since the immunotherapy protocol is not defined beforehand. The search for immune induction in a patient is defined based on the recovery of his/her functions. Therefore, if I start the immune induction process with a patient, its purpose is to induce recovery of the antitumor and antiangiogenic function. This means that the patient won’t show evidence of disease based on the clinical exam, images or laboratory results. So, if I am able to achieve these three elements, which can be considered as a complete disease involution, I then finish the induction phase and start maintenance. Maintenance means I will space the patient’s treatment, see him/her from time to time, but controls will be defined on a case by case basis with time. If everything goes well, maintenance therapy will be spaced until eventually the patient receives nothing.
- Dr. Núñez, what are your treatment’s side effects?
- When I explained the immunotherapy process, I mentioned it is personalized and is based on biological elements. Also, the blood drawn from the patients is not much, and the sample taken works for 5 months at the most. We don’t need to use excipients or preservatives; meaning that this treatment is biologic. Without preservatives or excipients with no side effects whatsoever.
- Doctor, can the treatment phases suggested to your patients vary?
- During the induction phase, even if the disease is not too aggressive, I always try to do the same thing. Induction means the patient will receive treatment for 10 days and take 5 days off, 10 days on, 5 days off, and so on and so forth. Therefore, whether the disease is aggressive or not, I try to start induction as I would with any given patient until the phenomenon is generated or the patient reaches the goal. What might change, if the disease is not too aggressive, and if the outcome is consolidated, is that a patient’s induction period can be shorter or longer. Therein lies the difference.
- Dr. Núñez, would you say your treatment cures cancer?
- That would go against everything I just explained. First, cancer cannot be cured, it can be controlled. Then, I would just say that this therapeutic tool is of added value in the management of cancer patients. I couldn’t refer to a cure since I don’t think cancer, which I consider it to be a chronic disease, can be cured.
- Dr. Núñez, if you or a loved one had cancer, would you apply your treatment?
- Definitely. Moreover, I already had a relative, an uncle, who had cancer and the first thing I did was give him the treatment. Fortunately this happened 17 years ago and he is doing very well today. And if it were me or my parents, I would definitely use it.
A while ago I explained how cancer is generated, and that it takes a long time for it to develop; it can take years and therefore tumor expression might take years as well. So I suggest, if God permits, and if this flourishes even more, that this treatment can also be used as prevention. So much so, that now all my family and even I are all taking the treatment as a prevention measure.
- Doctor, can your treatment be used as prevention and also in parallel to other treatments?
Yes, indeed. I have patients who do not trust chemo, or radio, do not trust conventional treatments and take immunotherapy. I have patients who believe in conventional medicine and we take it from there, in parallel. As I explained before, we need to validate the patient and his/her nature. Not locking ourselves in the therapeutical aspect, the therapeutic arsenal and its possibilities, but we also need to consider the patient’s context. If a patient does not want chemo, he must not be forced to receive something he does not trust, because emotionally, he won´t thrive and unfortunately this has not yet been validated by evidence-based medicine, but I do think is important to validate.
- Doctor, in your opinion, do emotional, physical and mental factors contribute to cancer?
- In reality, it is hard to answer something that I don’t know so much in depth, but I would dare say, that just as a human being is a unit made of different things, lifestyle could be also seen as a unit. Thus, I could take the emotional aspect; depression, persistent anxiety, chronic stress, and all of those scenarios, as a unit of spirituality. Hence, yes indeed, they are very important.
I consider that the emotional aspect is part of spirituality or is the same unit. Unfortunately we don’t have concepts that could link them to be able to establish units as to how to manage a patient considering those aspects. But yes, definitely in my experience, the emotional aspect would be by far the most important one of all, before nutrition and physical activity.
- Doctor, how long have you been working with immunotherapy and cancer?
- Overall, I’ve been working 25 years, but since Dr. Giles passed away, my mentor in immunotherapy, 15 years.
- Doctor, I remember a personal experience you shared with me on my first appointment. Could you share it with us?
- It is hard to establish patterns because the nature of evolution for each patient is very different, it is very personal, but this will be an experience and not evidence. Life expectancy, considering lifestyle has to be taken as a whole, meaning I am not what I eat but HOW I eat it. I am not what I do but HOW I do it. Linking then the nutritional aspect with the emotional one and with the motor or physical activity of the patient (taken as a unit) is what I call interdependent factors. This is something that is being studied by science as well, interdependent factors.
For instance, I can go to Kentucky Fried Chicken and someone might say:
“That is junk food, very bad food!”
OK, but I can be with my family, I´m relaxed, I’m really enjoying the moment and I am not judging what I eat. I am not really analyzing beforehand whether that food is unhealthy, I am only enjoying it. And someone else might be eating healthy fish, vegetables and natural juice but worried, full of uncertainty, prejudice or problems and is conveying those feelings to the moment he eats. Question now is: who is eating better? So then, saying that the person eating at KFC is not eating well might be challenged, since, to tell the truth, emotions do play a very important role when eating. Emotions, nutrition, physical activity cannot be separated: they have to be taken overall. But you need to know your patient deeply enough above all things to be able to link all three aspects, which is hard, but not impossible.
- Doctor, what would you say to someone who has been recently diagnosed with cancer?
- It’s a very hard question. What I always say to connect with a patient is that cancer is not a death sentence. Cancer is a chronic disease and we need to try to control it. I try to eradicate this idea that unfortunately the media, and we have taken as a given: that cancer is a monster and a scourge. I try to remove this idea from the patient’s mind and make him see that this is a disease that might be managed. And avoid creating this dichotomy where I will either live or die, or that I will turn into a hero, or not. No, I will simply try to prevent this disease from expressing. Just as a diabetic patient, if this patient is controlled he will die 50 years after without expression of diabetes but WITH diabetes. Same thing wit