All language subtitles for NOVA.S47E05.Cubas.Cancer.Hope.1080p.AMZN.WEB-DL.DDP.2.0.H.264-GNOME_track3_[eng]

One in three Americans
will be diagnosed with cancer

in their lifetime.

I... I have cancer?

Like getting hit by a truck.

The PET scan showed that I had

eight metastasizes in the chest.

I become anxious

because their options

become more and more limited.

Some take matters
into their own hands.

You know, I'm not
trying to break the law.

But I'm also not gonna die.

Even if it's illegal
to get treatment

where they're going...

Cuba.

Wow...

In Cuba, jeez.

What could come out of Cuba

that we don't already know?

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.

Castro had a vision.

If there's a 2% chance
the science is right,

we need to be there.

And there's nothing
in the United States.

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.

Mosquito. Yeah.

We added the Cuban vaccine,

and his cancer gets smaller,

and disappears.

"Cuba's Cancer Hope."

Don't cry.

Right now, on "NOVA."

Life isn't meant to be fair.

It's meant to be lived.

George Keays has
always loved the outdoors.

He's 67 years old.

I was very active...

runner, swimmer,

loved mountain sports,
skiing, snowboarding,

and that kind of thing.

Today, he's preparing
for an unusual trip.

It's a matter of life or death.

George has stage IV lung cancer.

So this was really

kind of a shock.

Something like this
put a crimpin your style.

This isn't George's
first encounter

with the deadly disease.

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.

One in three Americans will
havecancer 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... 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.

There are more than 100
different types of cancer.

In the U.S., they kill anestimated
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?

My one daughter came
in and said, "Hey, Dad?

You ever...

Are you ever going to
come playwith me again?"

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."

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
likediabetes or high blood pressure.

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.

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 goingfor
this cutting-edge treatment.

You know, I'm not
trying to break the law.

I'm not, but I'm
also not gonna die.

To fill his prescription,
George has to fly 2,000 miles...

to Cuba.

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?

Cuba's advances in cancer
treatment are largely unknown

to most Americans.

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
knowabout what was going on.

Kind of, you know, what
could come out of Cuba

that we don't already know?

Cuba is a small country
with big contradictions.

Even though the
island is impoverished,

it continues to provide
freehealthcare to all its citizens.

One of them is Marta Reymo.

She shares her small
apartment in Havana

with her family,
including her grandson.

Yes, yes, I smoked.

But, like a year before I got
the disease, I quit smoking.

Why?

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.

The popularity of Cuba's
famouscigars and cigarettes

contributes to lung cancerbeing
the deadliest cancer here,

as it is in the U.S.

Some time in 2009, Marta
just wasn't feeling like herself.

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 growthin my right lung.

Like George Keays,
she was diagnosed with

inoperable stage IV lung cancer.

Saying that disease,
I thought the worst.

I thought I was going to die.

Not only did Marta lose
her sister to lung cancer,

but Marta's daughter...

who is a nurse... lost
her husband as well.

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.

Marta's lung cancer began
the way all cancers do.

Cancer is

our own body going awry,

starting with a single cellin
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.

The bloodstream becomes
cancer'shighway to reach other organs.

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
showsa fracture in my spine.

The cancer made that.

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
takinga 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
systemto fight cancer.

They're called immunotherapies.

Immunotherapy
broadly is essentially

using the immune system

to fight human disease.

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, aresignaled
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.

I feel that after
all these meds,

I have gotten my life back.

I've been getting
treatment for ten years now.

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.

We have been able to extend
her life, and quality of life,

that's the most important thing.

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 countryas
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 thatoverthrows
the Cuban government.

The revolution establishes
a one-party Communist state

with Castro as its
authoritarian leader.

It was not only a
change of government.

It was mainly a change
of economic, political,

and social structure

of the country.

Medical science is at the heart

of Castro's vision.

He was a person who clearly

was obsessed with
public healthand 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 wasthe
most fundamental human right

that existed in the world.

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.

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.

Juan Vela Valdés was
minister of higher education.

In 1958, we had 6,500
physiciansin our country.

From '59 to '62, in three years,

half of the doctors flew
away from our country.

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.

Agustín Lage was later
chosen to be the first director

for the Center of
Molecular Immunology,

one of Cuba's leading
biopharma research centers.

Getting training

in biochemistry
and cancer biology,

my... my supervisor

is Luc Montagnier,
discoverer of the AIDS virus.

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.

The forces of Communism

are not to be underestimated

in Cuba or anywhere
else in the world.

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.

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.

Castro developsa
self-sustaining medical sector

to manufacture medicines

for Cuba's public
health service.

Throughout his regime,
Castro continues to emphasize

the importance of human
capitaland science as Cuba's future.

Today, Cuba reports
health statistics

that rival the U.S.

But some researchers
caution these may be unreliable

due to manipulated data.

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.

For nearly two years,

George Keays has been
coming here for treatment and rest.

Everyone knows George.

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
officeand 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 hadeight
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.

Lung cancer is the leading
causeof cancer deaths worldwide...

more than 1.6 million each year.

More than breast, colon, and
prostate cancers combined.

Here is a reconstructedCAT scan.

This is the metastasis.

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...

This was distressing news

for George, a non-smoker.

His lung cancer cells had been
growing undetected for years.

At that point, you know, the
prognosis was pretty grim...

less than two years,
probably less than a year.

Late-stage lung cancer
progresses very quickly.

Historically there hasn't
reallybeen much to do other than

try chemotherapy, try radiation,

try some maybe targeted therapy,

and then keep
people comfortable...

until they die.

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.

Watching the news one
evening, George learns about

new treatments emerging in Cuba.

A lung cancer vaccine,
developed in Cuba...

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.

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."

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.

Even into the 1980s, researcherswho
believe they can harness

the immune system against
cancerare 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
somethingagainst cancer,

and everybody's
sort of laughing, right.

But it turns out theimmune
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 cancerand
the cancer trying to escape.

If the cancer learns how to
maskitself from the immune system,

it can gain the
upper hand and grow.

So by the time the cancer
actually grows large enough

to be detected by
our normal tests,

it's already figured out how toget
away from the immune system.

But finally, researchers
learnedhow cancer masks itself.

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.

The body has natural mechanismsthat
stop the immune system

so it won't damage
ordinary cells.

These are called checkpoints.

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.

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
canrecognize the cancer and attack.

It took 30 years ofunderstanding
the immune system

before we could understand
how to make the immune system

recognize cancer.

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.

A substance known
as interferon...

The body produces
interferonin minute amounts.

the body's natural
first line of defense

against viral infection.

In the 1980s, interferon
was a science sensation...

the first breakthrough drug
madefrom the body's own immune cells

with the potential
to fight cancer.

Interferon is a major defense
mechanism the body uses

when it is infected with a
virusor has a cancer growing in it.

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.

In 1980,

renowned American oncologist
Randolph Lee Clark visits Cuba

and tells Castro
about interferon.

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.

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.

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.

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.

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.

The genetic engineering
processHerrera 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.

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.

That was the beginning
of the whole biotechnology

development in Cuba.

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.

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
dataon a large number of patients.

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.

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?" You know?

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.

But now American patients
could be on their way

to having access toCuban
cancer treatments legally.

And it all started
with a cold call

to Roswell Park
Comprehensive Cancer Center

in Buffalo, New York.

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, myinitial
response was skeptical.

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.

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.

And so, that was what I
recall from it, is, "Wow.

In Cuba, jeez."

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.

Cuban scientists claim to
havefound 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
atRoswell Park goes back to 1981.

A young scientist
named Rolando Pérez

is investigatingepidermal
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.

We wanted to know
whether human breast tumors

were dependent on
EGF for their growth.

What we found was ahigh
expression of EGF receptors

in about 50% of tumors.

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.

It was really a surprise to
find that there were tumors

which had a high
dependence on EGF.

At Roswell Park,

researchers show
how live cancer cells

use EGF to grow into the
beginnings of a tumor mass.

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.

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
EGFfrom 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.

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 EGFas 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."

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
bodyfor 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.

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 folksin Havana

and see if we can establish
somesort of relationship with them."

Then, in 2014...

Good afternoon.

History opens a door.

Today, the United
States of America

is changing its relationship
with the people of Cuba.

President Obama
beginsnormalizing relations with Cuba.

And New York
Governor Andrew Cuomo

leads a trade
delegation to Havana.

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.

Roswell Park scientists
believeCuba's CIMAvax could add

to the arsenal of weapons
available for cancer patients.

The Cubans hope for access
toresearch data from Roswell Park

and even technologies that
couldimprove their immunology drugs.

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.

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.

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.

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.

At Johns Hopkins Kimmel
Cancer Center in Baltimore,

Bruce Toma is being treated

for stage IV pancreatic cancer.

One more.

He's participating
in a clinical trial

combining checkpoint inhibitors

with a cancer vaccine developed

by Dr. Elizabeth Jaffee.

This is how goodyour
work has done.

Nobody can believe...
It's, it's so exciting.

that I'm stage IVmetastasized
pancreatic cancer.

I don't know how much
of your scans you've seen.

First one. The first one.

So what we're
reallyexcited about

is that you had all
of this tumor here

at the peritoneum. Mm-hmm.

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.

Immunotherapies are
incredibly expensive.

And not everyone has
the same success as Bruce.

And we don't know why.

If we can understand

why certain patients do
benefitfrom immunotherapy

while others don't
benefit from treatment,

we can make great leaps
forwardin our cancer treatment.

Anything else going
on? Any headaches...

But for now, many patients...

no matter what therapies
they are receiving...

will likely reach a point

when they run out
of treatment options.

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
handand 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.

It's no pain, because
the needle is so thin.

No, I see, mm-hmm. Mosquito.

Yeah.

At La Pradera,

oncologists administer
George's Vaxira prescription.

Okay.

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.

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.

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."

But could Cuban
drugs like Vaxira

become available in the U.S.?

In science, cooperation
is everything.

So if you are isolated,
you are dead in science.

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."

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
acheckpoint 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.

Two years later, Cuba's
Center of Molecular Immunology

and Roswell Park double
down on their partnership

and make history again.

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!

The two agree to build a
new biotech facility in Cuba

dedicated to cancer drugs,

jointly owned by
Roswell Park and C.I.M.

Eventually, we
will build factories.

And at some point of time

we will reachthe
medical community

in Cuba and the U.S.

with new medicinesfor
the people.

The embargo will continue to
beone of the biggest challenges

for the Roswell Park-C.I.M.
research partnership.

Even after the FDA
approved clinical trials in 2016,

Roswell Park worried the
embargowould 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.

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.

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 tobrain tumors,

where the data thatwe
have is pretty good.

Then there is nothing
in the United States...

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.

I hope, I really hope,

that this won't be stopped

because this is
cancer treatment,

and these are American
citizensbeing treated

by cancer vaccines
manufacturedhere in this small country.

Even as political tensions
risebetween their two countries,

Cuban and American
scientists continue on

in the hopes of improving
cancer treatment

and one day finding a cure.

If we work together

to raise the quality of
the lifeof our peoples,

that will bring us together.

Science is going to move
relationships forward.

The promise of lifting
theburden 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.

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.

How do you feel today?

Very good, very good. Very good?

No pain. Okay.

No pain.

Before going home,

George meets once more

with Dr. Anabely Garcia,

chief of his Havana
medical team.

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.

Don't cry.

Thank you.

I'll see you again in May.

Yes, of course.

Hasta luego.

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.