Cancer is a complex disease, but progress is being made in understanding its causes and improving mortality rates. While some 300 genes may contribute to cancer, only small mutations are needed for tumors to develop. New targeted therapies and immunotherapies are helping to cure more cancer types. Detection of biomarkers allows for personalized treatment approaches that are improving outcomes for many patients. Overall cancer mortality has dropped in some countries by focusing on prevention, early detection, and innovative treatments.

1. Can We Cure Cancer ?

2. Can We Cure Cancer ?
Aladdin Maarraoui, MD, FACP.
Clinical Professor, Gulf Medical University
Consultant and Chief of Hematology Oncology
Mafraq Hospital, Abu Dhabi, UAE

3. ‫ينفعنا‬ ‫ما‬ ‫علمنا‬ ‫اللهم‬
‫علمتنا‬ ‫بما‬ ‫انفعنا‬ ‫و‬
‫الراحمين‬ ‫أرحم‬ ‫يا‬ ‫علما‬ ‫زدنا‬ ‫و‬
May Allah teach us what benefits us and benefit us of what he
taught us and increases our knowledge.

4. Who are you?
• Who are you cancer?
• Are you the Emperor of terror?
• Are you a ghost that enters without a notice?
• Are you a prison that locks patients in?
• Why are you so cruel?
• Why are you so heartless?
• How many sweet people you intend to harm?

5. The Truth is:
• You start and end with people.
• You are being defeated more and more.
• We started to know how you sneak into
bodies and we are detecting you very early.
• Your risk factors are being recognized.
• You are like a puzzle. But the puzzle pieces are
found every day.
• You cannot disguise anymore.

6. Can we improve cancer mortality?
• In the western world and since year 2000,
cancer mortality dropped by nearly 2% a year.
• This does not mean that cancer incidence is
less, but this is the result of risk factors
awareness, detection at an early stage and
new treatment strategies.

7. Trends in lung cancer mortality rates by
sex in select countries, 1950-2006.
Jemal A et al. Cancer Epidemiol Biomarkers Prev
2010;19:1893-1907
©2010 by American Association for Cancer Research

8. The First UAE Non-Communicable Disease Conference,
January, 2014
Under Patronage of H.H. Sheikh Hamdan Bin Rashed Al Maktoum.

9. Our Goal is:
to decrease cancer mortality
20% by year 2025

12. The First Cancer
Survivors Day in UAE was in 2007

16. The Human Genome Project
• It mapped the human
genome at the
University of Utah.
Started in 1990 and
completed in 2003 at
cost of 3 billion
dollars.
• Human beings have
20,500 genes.

17. [TITLE]

18. How Many Genes Give Cancer
• Not too many.
• May be 300 genes out of the 20,500 genes.

19. Gene Array

20. The problem is not with the car.
It is with the driver!

21. [TITLE]
Presented By Paul A. Bunn, MD at 2013 ASCO Annual Meeting

22. [TITLE]

23. [TITLE]

24. 1: 84 year-old Female
• Never smoked cigarettes.
• Diagnosed with locally advanced lung cancer in
10, 2010
• Her symptoms were hoarseness and dyspnea on
exertion.
• She previously received single agent
chemotherapy on and off with partial response.
• She came to Mafraq Hospital in December, 2012.

26. Gene testing
• EGFR mutation (Leucine 858 Arginine) of exon 21.
• Plans for chemotherapy and radiotherapy were put
off.
• We started targeted therapy 1 tablet per day.

27. Result

28. 11, 2015 Cancer started
to grow again

29. CT Guided biopsy

31. [TITLE]

33. On 13/11/2015 FDA Approved AZD 9291for
EGFR resistant lung cancer

34. Company stocks immediately went up!

35. I contacted the company
• Patient will get the drug for free on their early
access compassionate program.
• Ethics & Research Committee and Pharmacy &
Therapeutics Committee are notified.
• The drug is on its way.

36. 2: 53 year-old UAE Male
• Patient is a past smoker.
• Developed abdominal discomfort and bloating.
• He went to Munich, CT scans showed Lt. lower
lobe lung cancer and Liver metastasis.
• Bronchial biopsy showed lung cancer on 23/3/13.
• He underwent 1 cycle of cisplatin + Taxol
chemotherapy.

41. Gene testing
• Cancer cells showed EML4-Alk mutation in 65% of
cells.
• Chemotherapy is stopped.
• We started targeted therapy1 tablet PO BID.

42. Follow up PET CT showed complete anatomical
and metabolic response

45. [TITLE]

46. 3- Trastuzumab blocks cell proliferation

49. 4- Anti-angiogenesis

52. MRI at Baseline

53. Before Anti-angiogenic drug
(on 22/3/2010)

54. Follow up MRI

55. Before and After

56. 5-
Case of relapsed brain tumor
27 Sept 2012 12 May 2013

57. 6-

58. 1.5 Year after
..

60. 7- Carbon

61. The Carbon Atom

62. It gets accelerated to 2/3 of speed of light using a
synchrotron.

63. Speed is generated by large magnets.

64. Charged carbon ions are directed to the treatment
rooms.

65. Work Station

67. Treatment Room with Robotic Couch

68. 8-
• Survival rate of kidney cancer by stage in
2012.

69. Case of stage IV Kidney cancer. On targeted therapy pill
4 weeks on 2 weeks off
June 2011 July 2014

70. 9- Colon cancer metastatic to the Liver

71. 17 Feb, 2015

73. December, 2015

74. 10- PD-1 and PDL-1 Inhibitors

75. ONCOLOGY
S
U
R
G
E
R
Y
R
A
D
I
A
T
I
O
N
C
H
E
M
O
T
H
E
R
A
P
Y
I
M
M
U
N
O
T
H
E
R
A
P
Y

76. The PD-1 Pathway Inhibits Effector Phase of
T-Cell Activity
Quezada SA, Peggs KS. Br J Cancer. 2013;108:1560–1565.
Pardoll DM. Nat Rev Cancer. 2012;12:252–264.
Ribas A. N Engl J Med. 2012;366:2517–2519.
Keir ME, et al. Annu Rev Immunol. 2008;26:677–704.
Nishimura H, et al. Int Immunol. 1996;8:773–780.
PD-1, is a cell surface co-
inhibitory receptor
expressed on T cells that
inactivates antigen specific
T-cells in the tumor
microenvironment. Its
normal role is to down-
regulate T-cell activity in
peripheral tissues and limit
collateral tissue damage
during the immune
response.
76

77. Quezada SA, Peggs KS. Br J Cancer. 2013;108:1560–1565.
Pardoll DM. Nat Rev Cancer. 2012;12:252–264.
Ribas A. N Engl J Med. 2012;366:2517–2519.
Keir ME, et al. Annu Rev Immunol. 2008;26:677–704.
Nishimura H, et al. Int Immunol. 1996;8:773–780.
PD-1, is a cell surface co-
inhibitory receptor
expressed on T cells that
inactivates antigen specific
T-cells in the tumor
microenvironment. Its
normal role is to down-
regulate T-cell activity in
peripheral tissues and limit
collateral tissue damage
during the immune
response.
77

78. NSCLC Cells may Evade Immune Surveillance by
Exploiting the PD-1 Checkpoint Pathway
• Tumor cells may block immune
responses via the PD-1 immune
checkpoint pathway by expressing
the dual PD-1 ligands, PD-L1 and PD-
L2
• PD-L1 and PD-L2 engage the PD-1
receptor on T cells, inactivate T cell
signaling, proliferation and effector
function to allow tumor cells to
evade the immune response
Freeman G, et al. PNAS.2008;105:10275–10276.
Pardoll DM. Nat Rev Cancer. 2012;12:252–264.
Zou W, Chen L. Nat Rev Immunol. 2008;8(6):467–477.
Rozali EN, et al. Clin Dev Immunol. 2012;2012:656340.
78

80. Abu Dhabi Achievement (source HAAD)
Reduction in late stage breast
cancer, from 64% in 2007 to 16%
in 2012
Target
15-20%,
similar to
other
countries
such as UK
and US

83. DISCLAIMER: The information contained in this presentation is for general
information purposes intended for cancer patients, caregivers, and community.
The images and information are provided by Cancer Patient Care Society (CPCS) -
Rahma from various websites and resources. We endeavour to keep the
information up to date and correct, we make no representations or warranties of
any kind, express or implied, about the completeness, accuracy, reliability,
suitability or availability with respect to the source, contents or related graphics in
this presentation.