In this solo lecture, Dr. Dino Prato argues that conventional oncology treats advanced cancer like a game of checkers—using sequential, one‑size‑fits‑all regimens based on NCCN guidelines—while the disease itself behaves like a chess opponent that adapts and evolves. He highlights the stark disparity between overall 5‑year cancer survival rates (≈70% driven by early‑stage disease) and the dismal outcomes for metastatic cancers (lung 9%, pancreatic 3%, distant breast 32%, prostate 30%). To improve outcomes, he proposes a three‑step “Sicilian Defense” strategy: (1) deep tumor mapping using comprehensive molecular profiling (DNA next‑generation sequencing, full RNA transcriptomics, immune spatial biology, >1,000 biomarkers) to understand the entire board; (2) identifying the tumor’s “king” – the dominant growth pathway, escape routes, and mechanisms of immune evasion – to focus treatment on the core drivers; (3) executing a coordinated, adaptive combination therapy plan that targets tumor biology, remodels the microenvironment, activates immunity, and builds immune memory for durable control. He critiques the limited efficacy of current immunotherapies (PD‑1 benefits only ~10% long‑term) and stresses that immunotherapy must be custom‑designed based on the tumor’s immune landscape. A patient vignette illustrates how deep profiling can reveal actionable targets missed by standard care. Dr. Prato then provides four concrete questions patients should ask their oncologists about deep mapping, immune microenvironment, strategic treatment planning beyond the next drug, and surveillance. He also notes the role of prevention and early detection (e.g., infection‑related cancers) in reducing advanced disease. The talk concludes with a call to share the message, subscribe, and adopt this strategic, precision‑oncology mindset to improve survival.
Chapters
The biggest mistake in cancer care is this: we keep playing checkers against a disease that plays chess. And here's what I mean by that. In many advanced cancer cases, the system can feel just like this. Step 1, you try the standard regimen, the National Comprehensive Cancer Network that everybody does, the one size fits all for your type and stage of cancer. If it fails, you switch to the next regimen. If that fails, you try another. And then when the patient is weak, the treatment isn't working, then someone might say, maybe we should look for a clinical trial. Now, let me be fair. Standard oncology has its place, and most of its success comes in early-stage disease, usually by surgery itself, by removing it early, and some of the treatment in early stage. But in more complex late-stage cancers, these success rates drop dramatically. And in some cancers, especially when you figure people have tried everything and it hasn't worked because it's complex, late stage, the disease has mutated, the treatments aren't that effective. So we need a better approach. And the reason this occurs is because these cancers adapt. They mutate, they hide, and it changes the rules of why you're still making your last best move. And that's why so many patients feel like no one is really reading their cancer. They feel like they're being moved through protocols instead of being treated with precision and true strategy. Now here's what confuses people. You've probably seen headlines from the American Cancer Society that have reported 5-year survivals in the United States have reached 70%, and that sounds great, and that's real progress, but it's mainly in early-stage disease. But when you look at the numbers, it is an illusion. The American Cancer Society gets money from Pfizer, Big Pharma. They have their own fundraising raising for investments. And when you really look at the cancer numbers from government agencies like SEERS, distant metastatic disease does not have this kind of great outcome. They have not improved that much. The relative 5-year survival is still way down. Lung cancer, 9%. Pancreatic, 3%. Distant breast cancer, 32%. Prostate, 30%. These aren't great numbers. We should be having amazing outcomes. So yes, progress is real, but if you're facing advanced disease, you don't just need the next regimen, you need a strategy. That's what we're going to talk about in this episode. I like to call it the Sicilian Defense of cancer because the way we win in chess is often in the way you win in complex oncology— not with one move, with a plan. So give me the next 10 minutes and I'll walk you through the key plan that you should have. I'm Dr. Dino Prato, founder of Invita Medical Centers. For the last 25 years, my team and I have worked with the patients that have failed some of the top cancer hospitals across the country using precision targeting, using technology that's next level to get patients the care they need even after they failed these top hospitals. So make make sure you're working with a doctor, and let's get started. Cancer is not one disease. Over time, it evolves. You can have multiple mutations, multiple different targets within the same patient. A tumor you biopsy today may not behave in the same way months later, and this creates treatment pressure and failure. That's why the one-size-fits-all sequence that's used in standard oncology by the National Comprehensive Cancer Network guidelines that all the major hospitals across the world use— and most of those were built by double-blind placebo clinical trials for that type of stage of cancer— the problem is nobody is a one one size fits all. And when you do the testing, you'll see that everybody's actually very different. That's the point. So wait, watch, and switch is the typical game in standard oncology. That may be the pathway, but it's not always the correct strategy. And cancer loves an opponent that only reacts. So what does a strategy look like? In chess, the Sicilian Defense is not about panic. It's about position. It's about intelligence. It's about controlling the board before you try to force the win. Cancer requires the same mindset. So step 1, stop guessing, start mapping. This is where where precision oncology really wins for patients. You need to understand the entire board, not just one marker, not just one scan, not just one lab value, the entire board. And that's why you need to include things like DNA next-generation sequencing so you can see the mutations, the ones that may be dividing, and whether there's targets for that and vulnerabilities. And that's a good start. But then there's full RNA transcriptomics, 1,000+ markers. This looks at the genes and it shows us the pathways that are active right now and how the cancer might escape, so you can completely treat those. And then there's immune spatial biology, getting the tumor's information to see if the cancer is exhausted, to see what microenvironment around the tumor looks like, so you can stop the immune system from being suppressed and inflamed and dysregulated and unable to properly recognize and get rid of the cancer. I've said this before, the first and last defense against cancer is immunity, and most patients do not have good immunotherapy on board. I'd say the majority do not. So if you don't know where your pieces are, you're not playing chess, you're moving blindly. That's number one, deep testing. And the reason I bring that up is because if you look at standard of care oncology, You have a biopsy, tumor marker, imaging. If you're lucky, you'll get some DNA biomarkers. The most here you're going to have is 24 to maybe a few hundred markers. That is not enough. The type of testing I'm talking about is well over 1,000 markers that helps you identify the right target. So let's move to step 2, identify the king. In chess, you don't win by chasing every piece around the board. You win by finding the king and building a sequence that leads to checkmate. In cancer, the king is often 3 things: the dominant growth pathway keeping the tumor alive, the escape routes where the tumor uses under treatment pressure to kind of continue living and evade treatment, and immune evasion, the mechanism that keeps hiding the tumor from the immune system. So the real question is not just what drug are we using next. The real question is what is keeping this tumor alive even under pressure? And the question changes everything because it allows you now to see the cancer at a deeper level. And once you have that, you can build the right treatment plan. Step 3: attack and coordinate the moves. Not just random moves, not one therapy thrown with the other therapy seeing what sticks. No, a coordinated plan that may include targeting the tumor biology, precision-based therapies, getting direct to tumor, improving the tumor microenvironment, making a cold tumor hot. This actually changes the game. So when you're activating direct to tumor responses, you're not just stimulating it, but you're making it now finally effective. And that's the key, because not only do we want the immune system involved, but we want to build immune memory. So now your body can recognize the cancer and go after it. That's the end game, because the ultimate goal is not just a temporary shrinkage. You'll see a lot of these new drugs that are fast-tracked, you'll get 30-40% shrinkage, and cancer comes back. We want to see it gone forever. It's not just about stable for now. It's about helping the immune system recognize these abnormal cells and respond effectively and maintain the surveillance over time. That's how you reduce the chance of recurrence. Now, immunotherapy does change the conversation. In some cancers, it's created durable responses, but that's only for 10% of the population. According to Frontiers in Oncology, PD-1 inhibitors have only helped 10% of the patients long-term. So it's not the right immunotherapy. You need to custom build it for each patient. So immunotherapy is not magic. It still requires planning. Some patients respond beautifully, but some don't because their tumors are cold and need to become hot. They need more planning, more targeting, and that's one of the reasons patients do not get the responses they want. If you don't understand the tumor biology and the immune landscape first, you can miss the move that makes immunotherapy work. So the Sicilian Defense approach says this: don't just try immunotherapy and hope. Build the conditions that improve the odds of response. That's strategy. Let me paint you a picture. This is not one patient. This is patterns I've seen over and over again. Over 27 years. A woman comes in with a stage 4 breast cancer. She's already been through multiple regimens of standard of care oncology, the top hospitals, and she didn't respond. She's exhausted, scared, losing hope. And one of the first things she's asked is, why didn't anyone do the deep testing that you provided for us that shows us now what I didn't see before, what the right targets are? The DNA, the RNA, the immune profiling, the immune spatial biology. One of the common things we hear from patients is, why didn't anybody else do this? It's so common sense. The answer is actually quite simple but unfortunate. The The system is a one-size-fits-all. You get some basic markers and you get put into a regimen. You fail that regimen, you go into another regimen. Two people with the same types of cancers have totally different markers. It's called heterogeneity. So tumor behavior is going to be different for each person. And so suddenly when you have testing, it unveils the story. It shows us the best regimen. It shows us that two people don't have the same targets and treatments necessarily. So she felt like nothing was working previously, and now that she has the targets on board, she starts to respond better. It wasn't just luck. This is targeted strategy. With a model that works with detailed planning. And once you can read the board, you can build a real plan, not just the next move. See, that's the difference between chess and checkers. It's not just the next move, it's reading the entire board, a sequence. That's the difference between reacting and strategizing. So what should you do next, especially if you or someone you love has cancer, facing cancer? Here are 4 questions you should ask your oncology team. Number 1, have we deep mapped this tumor? Do we have DNA, RNA, immune spatial biology and profiling? Ask what types of tests are we looking at? 1,000+ markers? Do we have a comprehensive molecular plan for immunotherapy and immune targeting? And if the answer is no, we don't do that, find another doctor. Number 2, what does my immune system microenvironment look like? Do you understand why my immune system is not responding? Can you turn my cold tumor hot? If the answer is no, we don't know, we don't understand, we don't do that, find another doctor. Are immune cells getting in to actually kill the tumor? That's another question you want to ask because that's important. And if it's not happening, the chance of long-term remission is not likely. Number 3, what's strategy beyond the next drug? What's my move 2 and 3? How are we going to adaptively test so we can see if treatment's working and make the right changes if mutations or other immune evasion occurs? And if the answer is, I don't know, we don't do that, find another doctor. Because see, this is the difference between precision oncology and just being treated blindly. We want surveillance. We want to see if recurrence is coming way before we see it in imaging and a tumor marker. We can look at circulating tumor cells, methylation scores, and see that way ahead. So now we know what's going on. Better outcomes are not only about better drugs, it's about Prevention, early detection, risk reductions matter too. And even the World Health Organization has shown us that you can get rid of substantial amounts of cancer by testing for infections and really getting rid of some of the root causes that we can prevent. This can eliminate cancer before they become advanced and late stage. So here's the bottom line: cancer is chess. And if you're facing an advanced disease, you need more than just guesswork. You need a strategy that sees the whole board— DNA, RNA, immune mapping, immune profiling and tumor behavior, adaptive pathways. And the endgame is immunity and immune memory. If this is the kind of content that you have found helpful and practical, help me get this to the world, because patients need to know if they— if their doctors can think like this, if the medicines can be custom designed for each patient, then patients are going to live longer and respond better to care. It's taken me 25 years plus to build a team and an infrastructure that focuses on this type of strategy, but I want to encourage others to follow the same pathway so we can save lives. So please share this with someone you love that needs a better strategy or to think in a different way, and drop a comment below if you like the Sicilian Defense, because I think that was a good term to kind of explain the difference between chess and checkers and cancer treatment. So I know that many of you that are watching this are not subscribed, so please subscribe because it helps the algorithms to push the information around the world so more people can get access to precision oncology. I hope you found this helpful, and may the Lord bless you on your journey to healing. Sam.
