NARRATOR: One in three Americans will be diagnosed with cancer in their lifetime.
I have cancer?
Like getting hit by a truck.
♪ ♪ GEORGE KEAYS: The PET scan showed that I had eight metastases in the chest.
♪ ♪ YOUSUF ZAFAR: They become anxious because their options become more and more limited.
NARRATOR: Some take matters into their own hands.
You know, I'm not trying to break the law.
But I'm also not gonna die.
NARRATOR: Even if it's illegal to get treatment where they're going... (Cuban dance music playing) ...Cuba.
(music continues) (music ends) ♪ ♪ NARRATOR: How did a small nation cut off from modern medical technology become a world player in cancer science?
Cuba was forced to think outside the box.
(shouting in Spanish) NARRATOR: Castro had a vision.
KELVIN LEE: If there's a two-percent chance the science is right, we need to be there.
♪ ♪ LEE: And there's nothing in the United States.
NARRATOR: Can scientists whose countries are political adversaries now work together to fight cancer?
If you are isolated, you are dead in science.
Cooperation is everything.
BILL BLANCHET: We added the Cuban vaccine, and his cancer gets smaller, and disappears.
♪ ♪ NARRATOR: "Cuba's Cancer Hope."
NARRATOR: Right now, on "NOVA."
♪ ♪ (breathing heavily) KEAYS: Life isn't meant to be fair.
It's meant to be lived.
♪ ♪ NARRATOR: George Keays has always loved the outdoors.
He's 67 years old.
KEAYS: I was very active-- runner, swimmer, loved mountain sports, skiing, snowboarding, and that kind of thing.
♪ ♪ NARRATOR: Today, he's preparing for an unusual trip.
♪ ♪ It's a matter of life or death.
George has stage IV lung cancer.
KEAYS: So this was really kind of a shock.
Something like this put a crimp in your style.
♪ ♪ NARRATOR: This isn't George's first encounter with the deadly disease.
KEAYS: My wife was diagnosed years ago and my daughter was, uh, ten and my other daughter was 20, and then she passed away when they were 14 and 24.
It was tragic; they were, you know, very, very close to their mom.
♪ ♪ NARRATOR: One in three Americans will have cancer in their lifetime.
It's one of the leading causes of death worldwide.
When I first received the diagnosis of stage IV pancreatic cancer, I was like, "Huh?
I have cancer?
"Like, other people have cancer, I don't have cancer-- what are you talking about?"
It was, uh, definitely like getting hit by a truck-- unexpected, for sure.
I said, "Did you just drop the bombshell on me that I think you did?"
And I think that's when it finally clicked.
And he said yes.
I'm about to be 35 in two weeks.
It's been two years that I'm living with metastatic breast cancer at stage IV.
NARRATOR: There are more than 100 different types of cancer.
In the U.S., they kill an estimated 600,000 people a year.
The havoc cancer wreaks on patients and families is devastating.
My mom passed because of breast cancer, and my dad passed because of lung cancer.
So for me... cancer was death.
There's a period between Christmas and New Year's one time where I didn't get out of bed for that entire... entire period, you know?
(voice breaking): My one daughter came in and said, "Hey, Dad?
You ever... (voice catches in throat) Are you ever going to come play with me again?"
KEAYS: You go from being very healthy, suddenly, "Well, you have six months to live."
It hit my daughters very, very hard.
My oldest daughter said, um... "I just love you so much."
♪ ♪ NARRATOR: When George was diagnosed, he discovered patients like him, where lung cancer metastasizes throughout the body, often don't live much longer than a year.
That was four years ago.
George is convinced what's helping him stay alive is a new treatment that goes beyond the radiation and chemo he's received.
It's actually a lung cancer vaccine.
♪ ♪ It's one of a new wave of treatments that are transforming some cancers from a death sentence into a chronic condition like diabetes or high blood pressure.
♪ ♪ ELIZABETH JAFFEE: We're really in a scientific revolution, particularly when it comes to cancer research.
Because there are a number of patients with deadly cancers, we can turn them into chronic diseases where they're living years.
♪ ♪ NARRATOR: But the cancer vaccine George is receiving is not available in the U.S.
In fact, it's against the law for him to go where he's been going for this cutting-edge treatment.
You know, I'm not trying to break the law.
I'm not, but I'm also not gonna die.
♪ ♪ (latch clicks open) NARRATOR: To fill his prescription, George has to fly 2,000 miles... ...to Cuba.
("Havana Son" by Alexander Wilson and Davide Giovannini playing) (men singing in Spanish) (horn honking) (singing continues) ♪ ♪ NARRATOR: But why is George risking a trip to Cuba, when some of the most advanced cancer medicine in the world is back in the U.S.?
What could a small communist nation embargoed by the U.S. for over 50 years bring to the fight against cancer?
(car horn honking) ♪ ♪ Cuba's advances in cancer treatment are largely unknown to most Americans.
♪ ♪ LEE: I think everybody here thought that Cuba was stuck in "I Love Lucy" days-- you know, the 1950s, old cars, can't possibly be any good science going on.
I mean certainly I did not know about what was going on.
Kind of, you know, what could come out of Cuba that we don't already know?
NARRATOR: Cuba is a small country with big contradictions.
♪ ♪ (speaking Spanish) (horn honking) ♪ ♪ (speaking Spanish) NARRATOR: Even though the island is impoverished, it continues to provide free healthcare to all its citizens.
♪ ♪ One of them is Marta Reymo.
♪ ♪ She shares her small apartment in Havana with her family, including her grandson.
♪ ♪ (speaking Spanish) (translated): Yes, yes, I smoked.
But, like a year before I got the disease, I quit smoking.
Because I had a sister who had the same thing I have today.
And when she had cancer and the doctor talked about smoking and such, I quit too, but, well, the damage was already done.
NARRATOR: The popularity of Cuba's famous cigars and cigarettes contributes to lung cancer being the deadliest cancer here, as it is in the U.S.
Some time in 2009, Marta just wasn't feeling like herself.
(speaking Spanish) (translated): I went in for my X-ray and an ultrasound and I had a CT scan.
After all the tests, they told me that I had a growth in my right lung.
NARRATOR: Like George Keays, she was diagnosed with inoperable stage IV lung cancer.
(Marta speaking Spanish) REYMO (translated): Saying that disease, I thought the worst.
I thought I was going to die.
NARRATOR: Not only did Marta lose her sister to lung cancer, but Marta's daughter-- who is a nurse-- lost her husband as well.
(speaking Spanish) (translated): My husband died six months before this, from the same disease, and now I have to face the situation again with my mother.
It was really hard for me, very difficult.
NARRATOR: Marta's lung cancer began the way all cancers do.
ZAFAR: Cancer is our own body going awry, starting with a single cell in our body that stops listening to the signals to stop growing, or stop behaving in a certain way.
And when that cell stops listening to those signals, it starts growing out of control, and it turns into cancer.
NARRATOR: The bloodstream becomes cancer's highway to reach other organs.
RICE: And so then she says, um... "You have it in multiple areas of your body, "it's already spread.
"It's in your ovary, it's in your liver, "it's in your pancreas, and you got a couple areas in your lungs."
One day when I was working, I heard something, like... breaking, and they took me to the emergency room, took the pictures, and it shows a fracture in my spine.
The cancer made that.
NARRATOR: Historically in the fight against cancer, treatment options have been surgery, radiation, and chemotherapy.
Marta's found another option.
For ten years she's been taking a cancer vaccine called CIMAvax-EGF.
Cuban clinical trials show that it extends life by three to five months on average.
And about 15% of patients, including Marta, have survived five years or more.
CIMAvax is one of a class of new drugs that activates the immune system to fight cancer.
They're called immunotherapies.
Immunotherapy broadly is essentially using the immune system to fight human disease.
♪ ♪ NARRATOR: Our immune system protects us from infection and disease by identifying foreign threats like bacteria or viruses that are dangerous to the body.
When a threat is identified, immune cells, like killer T-cells, are signaled to attack and destroy.
But it was only in the last few decades that scientists realized they could use the immune system to not only attack foreign invaders, but also attack cancer.
(speaking Spanish) (translated): I feel that after all these meds, I have gotten my life back.
I've been getting treatment for ten years now.
♪ ♪ (man singing in Spanish) NARRATOR: Marta's daughter works the day shift as a nurse.
At night, she helps organize her mother's care.
Most of the medicines distributed to patients like Marta are manufactured in Cuba.
(translated): We have been able to extend her life, and quality of life, that's the most important thing.
♪ ♪ NARRATOR: The CIMAvax cancer vaccine Marta's taking is now used to treat thousands of patients in Cuba and other countries.
How is it possible for a country as poor and isolated as Cuba to come up with cutting-edge medicines like this?
Cuba's unique approach to medical research stretches back 60 years-- to the time of the Cuban Revolution.
♪ ♪ 1959.
Fidel Castro, a former lawyer, leads a revolution that overthrows the Cuban government.
(in Spanish): (crowd cheering) The revolution establishes a one-party Communist state with Castro as its authoritarian leader.
♪ ♪ VELA VALDÉS: It was not only a change of government.
It was mainly a change of economic, political, and social structure of the country.
NARRATOR: Medical science is at the heart of Castro's vision.
CASTRO (in Spanish): JOHN KIRK: He was a person who clearly was obsessed with public health and education.
In 1960, year one of the revolution, he talked about the need for, for science in Cuba.
So from the very beginning, he saw science as an opportunity to bring Cuba kicking and screaming into the modern era.
He claimed on several occasions that access to healthcare was the most fundamental human right that existed in the world.
♪ ♪ NARRATOR: Castro promises free healthcare-- a promise later written into the new constitution.
♪ ♪ But as the new government nationalizes business, confiscates private wealth, and tears lives apart, many professionals-- including doctors-- flee the country.
KIRK: If you were part of the white urban middle class in Havana, you had everything to lose by staying.
Most of the doctors decided that it was in their best interest to, to leave.
NARRATOR: Juan Vela Valdés was minister of higher education.
(ship horn blares) VALDÉS: In 1958, we had 6,500 physicians in our country.
From '59 to '62, in three years, half of the doctors flew away from our country.
NARRATOR: Cuba has to rebuild the healthcare system from the ground up.
Castro establishes new universities, clinics, and medical schools across the island.
And he sends thousands of medical students and doctors abroad to study at some of the top medical universities in the developed world.
During the '60s and the '70s, many people were sent abroad to study science.
I spent two and a half years in Paris.
NARRATOR: Agustín Lage was later chosen to be the first director for the Center of Molecular Immunology, one of Cuba's leading biopharma research centers.
LAGE: Getting training in biochemistry and cancer biology, my... my supervisor is Luc Montagnier, discoverer of the AIDS virus.
NARRATOR: When they return to Cuba, many of these students and doctors are tasked with building the country's new public health service-- the difficulty heightened by political tensions and economic isolation.
JOHN F. KENNEDY: The forces of Communism are not to be underestimated in Cuba or anywhere else in the world.
NARRATOR: In 1962, at the height of the Cold War, President Kennedy announces an expanded trade embargo against Cuba.
Today, Cubans call it "el bloqueo"-- "the blockade."
♪ ♪ The American embargo would include hospital equipment, medical supplies, and even ordinary antibiotics.
KIRK: As a result, Cuba was forced to think outside the box, particularly in terms of medical research.
One of the things that-that allowed it to do was to start producing its own medicines.
♪ ♪ NARRATOR: Castro develops a self-sustaining medical sector to manufacture medicines for Cuba's public health service.
Throughout his regime, Castro continues to emphasize the importance of human capital and science as Cuba's future.
CASTRO: ♪ ♪ NARRATOR: Today, Cuba reports health statistics that rival the U.S.
But some researchers caution these may be unreliable due to manipulated data.
(bus engine rumbles) Free medical care for ordinary Cubans is provided often at clinics with scarce equipment or serviced by physicians who drive cabs to make ends meet.
That's not the case at La Pradera.
It was designed to attract international patients who pay in hard currency.
So we're going to turn... here.
NARRATOR: For nearly two years, George Keays has been coming here for treatment and rest.
Everyone knows George.
(woman speaking Spanish, George repeating) (George speaking Spanish) (woman laughs) My mother in Cuba.
I think it was March of 2015, and I went for an annual physical with my primary care doctor.
He said at that time, "You know, your cough looks kinda like maybe an allergic cough."
But the cough was getting worse and so ordered a CAT scan.
And I remember I left the office and the doctor called me.
"Get back in here.
You have a growth in your lung."
♪ ♪ So, then I went for a full-body PET scan to determine how far this had spread.
It showed that I had eight metastasizes in the chest along the lymph nodes, one in the shoulder and it had spread to my brain, so I had a brain tumor as well.
♪ ♪ NARRATOR: Lung cancer is the leading cause of cancer deaths worldwide-- more than 1.6 million each year.
More than breast, colon, and prostate cancers combined.
Here is a reconstructed CAT scan.
This is the metastasis.
NARRATOR: One reason lung cancer is so deadly, is that often, by the time there are symptoms-- like coughing, back pain, or difficulty breathing-- the disease has already spread.
The large tumor here... NARRATOR: This was distressing news for George, a non-smoker.
His lung cancer cells had been growing undetected for years.
KEAYS: At that point, you know, the prognosis was pretty grim-- less than two years, probably less than a year.
MARY REID: Late-stage lung cancer progresses very quickly.
Historically there hasn't really been much to do other than try chemotherapy, try radiation, try some maybe targeted therapy, and then keep people comfortable... until they die.
♪ ♪ KEAYS: I had had 15 radiation treatments in the clinical trial program.
And one radiation treatment to the brain.
I was taking gene therapy.
And then cancer mutates, it basically starts to get smart about what you're... what you're treating it with.
NARRATOR: Watching the news one evening, George learns about new treatments emerging in Cuba.
A lung cancer vaccine, developed in Cuba... KEAYS: I actually saw it on television where people from Roswell Cancer Center in New York went to Cuba, and they were looking at alternative treatments.
NARRATOR: His research convinces him the Cuban drugs might help him more than what is available in the U.S. George wants in.
His doctor urges him to call Havana.
And they said, "Yeah, we think that, you know, "you, you could... you could come down here, and see if a vaccine might work."
NARRATOR: Immunotherapies, including Cuba's cancer vaccines, are a medical breakthrough.
For years, scientists believed the immune system could not attack cancer cells, because unlike an invading virus or bacteria, they are considered to be part of us.
Cancers are really 99% you.
They're 99% normal.
So the immune system largely sees them as normal.
NARRATOR: Even into the 1980s, researchers who believe they can harness the immune system against cancer are considered renegades.
I was a graduate student in the late '70s at Stanford.
People were suspicious of the ability to actually provoke an immune response against the cancer cells.
We're saying we can do something against cancer, and everybody's sort of laughing, right.
♪ ♪ NARRATOR: But it turns out the immune system does fight cancer.
The battle begins as soon as normal cells mutate into cancer cells.
Long before anybody knows that they have cancer, there's this ongoing war of the immune system trying to control the cancer and the cancer trying to escape.
NARRATOR: If the cancer learns how to mask itself from the immune system, it can gain the upper hand and grow.
LEE: So by the time the cancer actually grows large enough to be detected by our normal tests, it's already figured out how to get away from the immune system.
♪ ♪ NARRATOR: But finally, researchers learned how cancer masks itself.
(applause) And in 2018, Tasuku Honjo and James Allison won the Nobel Prize for discovering how to unmask cancer and let the immune system do its job.
This is how it works.
When you and I get an infection... ♪ ♪ usually the immune system revs up.
But at some point, the immune system has to stop and rest.
NARRATOR: The body has natural mechanisms that stop the immune system so it won't damage ordinary cells.
These are called checkpoints.
ODUNSI: But, it turns out that these same mechanisms that tells the immune system to stop have been hijacked in cancer.
The cancer is sending a signal to the immune system to stop.
NARRATOR: Honjo and Allison figured out how to turn the immune system back on.
Their discoveries led to checkpoint inhibitors-- drugs that can turn cancer's signal off.
Now, the immune system can recognize the cancer and attack.
It took 30 years of understanding the immune system before we could understand how to make the immune system recognize cancer.
♪ ♪ NARRATOR: How did scientists learn to use the immune system as a weapon against cancer?
For Cuba, and the rest of the world, it all starts with interferon.
REPORTER: A substance known as interferon... REPORTER 2: ...the body produces interferon in minute amounts.
...the body's natural first line of defense against viral infection.
NARRATOR: In the 1980s, interferon was a science sensation-- the first breakthrough drug made from the body's own immune cells with the potential to fight cancer.
LEE: Interferon is a major defense mechanism the body uses when it is infected with a virus or has a cancer growing in it.
♪ ♪ NARRATOR: Interferon can prevent viral infection from spreading and signals immune cells to attack the virus.
Interferon was our very first immunotherapeutic drug that could be made in large quantities.
NARRATOR: In 1980, renowned American oncologist Randolph Lee Clark visits Cuba and tells Castro about interferon.
LUIS HERRERA: (speaking Spanish) (translated): Dr. Clark explained to Fidel that interferon was one of the promising drugs for cancer treatment.
That's what drove him to want to make interferon.
NARRATOR: Castro sends doctors first to study with Clark in Texas and then to Helsinki, Finland, where they learn how to purify interferon from white blood cells.
When they return to Havana, the doctors are taken straight to a house refitted with a new laboratory... House 149.
♪ ♪ Castro gives them a simple instruction: make interferon for Cuba.
HERRERA (in English): They worked constantly every day until 10:00 or 11:00 at night.
♪ ♪ Fidel came here almost every day, just making questions.
It was very, very, very intensive.
♪ ♪ NARRATOR: It takes scientists in other countries as long as a year to replicate the purification process.
The Cuban doctors master it in 42 days.
But around the same time, a new technology, first developed in California, is gaining ground worldwide: genetic engineering.
Castro sends Luis Herrera to Europe to investigate.
HERRERA: I remained in Europe some time getting that information.
I came back, and I met Fidel.
And then he started to make questions concerning genetic engineering.
NARRATOR: The genetic engineering process Herrera brings back to Cuba is transforming science across the globe.
In the laboratory, scientists remove a section of DNA from a human cell that codes for a specific protein.
They then insert that DNA into the DNA of a bacterial cell.
As the bacteria replicates, it carries the code for the human protein in its own DNA.
And you can put the bacteria in a fermenter, and you have millions of flasks of interferon.
♪ ♪ NARRATOR: It turned out interferon only works against a few cancers.
But the process of making interferon took immunotherapy science to a new level.
Genetic engineering started a new approach to fighting cancer around the world and in Cuba.
By this time, Castro's ambitions were clear.
That's the first time I heard him to say that we can become a medical power.
HERRERA: That was the beginning of the whole biotechnology development in Cuba.
♪ ♪ NARRATOR: Cuba would go on to build a world-class biotech industry.
Research, development, quality control, and distribution are all the responsibility of one government agency: BioCubaFarma.
FINN: They're a small country, the communication is much quicker and faster.
They can, um, immediately make a drug available to all the patients who qualify for that drug and immediately collect the data on a large number of patients.
NARRATOR: Cuba's 30-plus bio-pharma facilities hold over 2,000 international patents for drugs and processes in use around the world.
But the trade embargo makes all these treatments unavailable in the U.S. Like Vaxira, the cancer vaccine George Keays has been taking for nearly two years.
KEAYS: I get one to two calls a week from people who have heard about me, have heard that I'm coming here, and ask questions, like, "Where do you get the vaccine?
How did it work for you?"
I think there are some people for whom this might not work, but I think there are a lot of people for whom this can be beneficial.
NARRATOR: But now American patients could be on their way to having access to Cuban cancer treatments legally.
(phone ringing) And it all started with a cold call to Roswell Park Comprehensive Cancer Center in Buffalo, New York.
(phone ringing) ODUNSI: I was sitting in my office, and my secretary came to me and said, "There's a telephone call for you from someone who is from Cuba."
♪ ♪ When I picked up the phone, what she talked about was the fact that they have some innovative approaches in Cuba that she would like to discuss with Roswell Park.
I have to tell you, my initial response was skeptical.
♪ ♪ (pencil scratching) So, my first question is, "Why are you talking to us?
And she talked about the fact that this is one of the few institutions in the United States where the discoveries in Cuba could be taken to the next level and make sure it benefits a wide range of patients, not only in Cuba but across the world.
♪ ♪ NARRATOR: Eventually, the researcher from Cuba's Center of Molecular Immunology, or C.I.M., is invited to make a presentation on the lung cancer vaccine CIMAvax-EGF, the same vaccine that Marta Reymo has been taking.
♪ ♪ It is a standing room only event.
Well, I think, scientists, we're all a little crazy.
And so we all... we all want to, uh, hear something really interesting.
It sparked curiosity of how it came to be.
NARRATOR: Cancer vaccines are already in development around the world, but what surprises Roswell Park researchers is the science that makes this vaccine work.
They had thrown out the first chapter of any basic immunology textbook to actually accomplish the science.
NARRATOR: Cuban scientists claim to have found a new way to fight cancer by first getting the immune system to do something it's never supposed to do: attack a healthy human protein.
♪ ♪ The research Cuba presents at Roswell Park goes back to 1981.
A young scientist named Rolando Pérez is investigating epidermal growth factor, or EGF.
It's a natural protein in the body that tells cells to multiply.
Pérez is one of many scientists around the world trying to understand the role EGF might play in cancer.
PÉREZ: (speaking Spanish) (translated): We wanted to know whether human breast tumors were dependent on EGF for their growth.
(speaking Spanish) What we found was a high expression of EGF receptors in about 50% of tumors.
NARRATOR: A receptor is a protein molecule on the cell's outer surface.
When an EGF protein connects with an EGF receptor on the cell's surface, the protein sends a signal to grow and multiply.
PÉREZ: (speaking Spanish) It was really a surprise to find that there were tumors which had a high dependence on EGF.
NARRATOR: At Roswell Park, researchers show how live cancer cells use EGF to grow into the beginnings of a tumor mass.
♪ ♪ LEE: In the culture that has epidermal growth factor, you can see a layer of lung cancer cells that over time are dividing and growing and getting bigger and bigger.
In the culture that has the lung cancer cells but has been depleted of EGF, you can see that the lung cancer cells have in fact stopped growing.
♪ ♪ NARRATOR: Pérez's research points out some tumor cells have thousands more EGF receptors than healthy cells.
♪ ♪ To prevent cancer from using EGF to grow, the Cubans came up with a novel idea: starve the tumor by removing EGF from the equation.
To do this, they would have to vaccinate the body against EGF and convince the immune system this normal human protein is a threat.
But it wouldn't be easy.
If you vaccinate a human being with human EGF, nothing happens, because the immune system interprets that this is self.
NARRATOR: A typical vaccine includes a weakened dose of the virus or bacteria being targeted.
Once it's injected into the body, the immune system produces antibodies that attach to the invader and attract other immune cells to destroy it.
Memory cells remember it in case it comes back again.
To get the body to recognize EGF as a threat, Cuban scientists attached a protein from the meningitis bacteria to the EGF protein.
So, then the invention was to link human EGF with a protein that is coming from a bacteria, from the meningitis bacteria, by the way.
And as the bacteria protein is there, then the immune system interpret, "This is non-self and dangerous."
NARRATOR: The attached bacterial molecule causes the immune system to see all EGF as a threat.
Antibodies signal immune cells to eliminate the EGF.
The idea is to starve lung cancer cells of something they depend on to multiply but leave enough EGF in the body for ordinary cells to function.
As it turns out, CIMAvax is most effective for lung cancer patients like Marta, who already have high levels of EGF in their blood.
You are making a trick to the immune system, no?
You trick the immune system, because you present something self as if it were non-self.
NARRATOR: When Roswell Park researchers learn the science behind CIMAvax, many are convinced it could be a game-changer.
They urge president and C.E.O.
Candace Johnson to consider the possibility of a partnership.
It was really a couple of individuals that decided to really press this.
"And let's, let's see what we can do.
"Let's reach out to these folks in Havana and see if we can establish some sort of relationship with them."
NARRATOR: Then, in 2014... Good afternoon.
NARRATOR: History opens a door.
Today, the United States of America is changing its relationship with the people of Cuba.
NARRATOR: President Obama begins normalizing relations with Cuba.
And New York Governor Andrew Cuomo leads a trade delegation to Havana.
JOHNSON: So, the governor wanted to take a group of leaders from around the state, and he chose me.
I could bring one person, and I took Dr. Lee.
So here we all go into Cuba, we're only there for 36 hours.
And Dr. Lee and I decided that this was an opportunity to really do this.
NARRATOR: Roswell Park scientists believe Cuba's CIMAvax could add to the arsenal of weapons available for cancer patients.
The Cubans hope for access to research data from Roswell Park and even technologies that could improve their immunology drugs.
ERNESTO CHICO: We have limited resources, because of... we are in a poor country.
We have also limited resources, because the best and the most efficient technology are usually coming from the U.S., and we don't have access to that.
NARRATOR: One example is this American-made flow cytometer.
It suspends samples in a fluid and whisks them through multiple lasers, one cell at a time.
Tens of thousands of cells' characteristics are rapidly analyzed.
In the U.S., the device is standard for advanced research and clinical trials.
So, in this case, we're measuring the T-cells in the patient's blood in order to determine what type of T-cells are present.
NARRATOR: One department at Roswell Park has over 20 of these expensive machines.
The data they could yield for Cuban research would be invaluable.
There are only two such devices at C.I.M.
One is broken.
So, we had this equipment broke for one year, because we had to send the equipment to Germany.
If this equipment has more than ten percent of the American component, we can't buy.
♪ ♪ NARRATOR: Despite these limitations, Cuban science makes important strides, even as American discoveries in immunology treatment continue to lead the world.
For Roswell Park, a partnership with Cuba could allow them to combine C.I.M.
's cancer vaccine with immunotherapy treatments already available, like checkpoint inhibitors.
What we're realizing now is that you have to combine immunotherapy agents.
So, we're seeing studies that are testing vaccine with immune checkpoint agents.
NARRATOR: At Johns Hopkins Kimmel Cancer Center in Baltimore, Bruce Toma is being treated for stage IV pancreatic cancer.
NARRATOR: He's participating in a clinical trial combining checkpoint inhibitors with a cancer vaccine developed by Dr. Elizabeth Jaffee.
TOMA: This is how good your work has done.
Nobody can believe...
It's, it's so exciting.
...that I'm stage IV metastasized pancreatic cancer.
JAFFEE: I don't know how much of your scans you've seen.
The first one.
So what we're really excited about is that you had all of this tumor here at the peritoneum.
JAFFEE: Your most recent scan, there's nothing there.
We can't detect it.
It's totally gone.
Oh, wow, yes, I can see the difference.
NARRATOR: Immunotherapies are incredibly expensive.
And not everyone has the same success as Bruce.
And we don't know why.
ZAFAR: If we can understand why certain patients do benefit from immunotherapy while others don't benefit from treatment, we can make great leaps forward in our cancer treatment.
Anything else going on?
Any headaches... NARRATOR: But for now, many patients-- no matter what therapies they are receiving-- will likely reach a point when they run out of treatment options.
ZAFAR: As their cancer grows, and the treatment that I'm giving them fails, I become anxious, because with every step, their options become more and more limited.
Mum, she took the scissors, and she started just chopping off her own hair.
I'll never forget it.
My sister and I just stood there just awestruck.
It was a very emotional experience.
And Kathy was willing to try anything.
And it was tough on her when they, when they said, "That's it, there-there is no more, and treatment would only make you worse."
But Kathy held the doctor's hand and said, "I understand."
They say usually it's three years, the time.
I'm exactly at third year.
The doctor said I have one more year to live.
(waves crashing) (birds chirping) ANABELY GARCIA: It's no pain, because the needle is so thin.
No, I see, mm-hmm.
NARRATOR: At La Pradera, oncologists administer George's Vaxira prescription.
♪ ♪ Okay.
NARRATOR: George's doctor and close friend Dr. William Blanchet is in Havana to lend support.
The cancer was growing, the cancer markers were getting bigger on this agent.
His oncologist increased the dosage; the cancer continued to get bigger.
We added the Vaxira, and his cancer gets smaller.
And so, on the three-year anniversary of being diagnosed with horrible stage IV lung cancer, this guy runs a ten-K run and puts an offer down on a house.
Those are things that people three years into stage IV lung cancer tend not to do.
NARRATOR: But George is not cured.
Cancer continues to be a daily struggle.
In addition to Vaxira, he's undergoing a number of treatments in the U.S.
Despite this, his doctors recently discovered a new metastasis in his liver.
KEAYS: It's a hell of a thing to have to take a risk with, you know, your-your wellbeing that you... that somebody could say, "Well, you're breaking the law."
♪ ♪ NARRATOR: But could Cuban drugs like Vaxira become available in the U.S.?
LAGE: In science, cooperation is everything.
So if you are isolated, you are dead in science.
LEE: Our legal department saying, "How are we going to do this?
Is this going to be worth it?"
And I said, "If there's a two-percent chance that the science is right, we need to be there."
♪ ♪ NARRATOR: Cuba and Roswell Park come to an agreement to cooperate.
In 2016, CIMAvax becomes the first Cuban drug ever approved by the FDA for clinical trial in the U.S. At Roswell Park, it's being combined with a checkpoint inhibitor, nivolumab, that could make CIMAvax even more effective.
And the flip side is the way CIMAvax works, it may make nivolumab work better as well.
Think of it like, can one plus one equal to five?
So that's the ultimate goal of testing.
NARRATOR: Two years later, Cuba's Center of Molecular Immunology and Roswell Park double down on their partnership and make history again.
REPORTER: The president and C.E.O.
of Roswell Park announced the first-ever biotech joint venture between the United States and Cuba.
We did it!
(applause) NARRATOR: The two agree to build a new biotech facility in Cuba dedicated to cancer drugs, jointly owned by Roswell Park and C.I.M.
CHICO: Eventually, we will build factories.
And at some point of time we will reach the medical community in Cuba and the U.S. with new medicines for the people.
NARRATOR: The embargo will continue to be one of the biggest challenges for the Roswell Park-C.I.M.
Even after the FDA approved clinical trials in 2016, Roswell Park worried the embargo would make it almost impossible to ship CIMAvax safely from Havana to Buffalo.
So they tried a test run with water in a temperature-controlled box.
♪ ♪ LEE: It actually got from Havana to Canadian customs; and the FDA was expecting it, because we told them there it would come.
Got to U.S. customs.
Apparently, if you're on the embargo list in the United States, your country is not in the electronic database.
So, the box went back to Canada and sat there for, I think, two days.
So the box is good for holding temperature for 72 hours.
NARRATOR: Nearly 200 hours after being packaged in Cuba, the box arrived in Buffalo.
The real vaccine would have been destroyed.
♪ ♪ These kinds of challenges are critical to overcome for the research partnership to succeed.
Both sides are convinced it's worth it.
...let's come to brain tumors, where the data that we have is pretty good.
LEE: Then there is nothing in the United States... REID: It's a precedent-setting event.
You know, these are American scientists working so closely with Cuban scientists.
They are presenting us with very novel drugs.
CIMAvax has the potential to work as a vaccine to prevent lung-cancer formation, and that has a substantial public-health implication.
LAGE: I hope, I really hope, that this won't be stopped because this is cancer treatment, and these are American citizens being treated by cancer vaccines manufactured here in this small country.
NARRATOR: Even as political tensions rise between their two countries, Cuban and American scientists continue on in the hopes of improving cancer treatment and one day finding a cure.
(people talking in background) LEE: If we work together to raise the quality of the life of our peoples, that will bring us together.
Science is going to move relationships forward.
The promise of lifting the burden of cancer in all peoples is going to move the relationship forward.
I'm handling it, and I want to keep going because I have things that I want to do, I have things I want to see.
I have things I want to... complete with my children.
I'm so lucky that I see things, that I feel things on my skin, and I don't want to lose it.
I want to live my life the fullest.
(birds chirping) KEAYS: If I can't walk, I'll be on my knees.
If I can't be on my knees, I'll crawl.
But I'll continually try to get back up.
And that will be my life.
GARCIA: How do you feel today?
Very good, very good.
NARRATOR: Before going home, George meets once more with Dr. Anabely Garcia, chief of his Havana medical team.
GARCIA: And, here, we put in the date that you receive.
You have vaccines until August, okay?
Yes, that's right.
We wait for you next May or June.
Oh, no, no, no, no, no.
♪ ♪ I'll see you again in May.
Yes, of course.
BLANCHET: Hasta luego.
♪ ♪ KEAYS: One of the things you learn is to live in the moment.
I may not be here in six months, I-I don't know.
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