Why do our patients ask for "more agressive therapies"? Why?
They are politely reminding us of the sobering fact- most of the FDA approved targeted agents do not have curable potential neither as single agent nor in combinations with other targeted agents (not considering neoadjuvant or adjuvant aspects since cure is partly coming from other modalities as well.).
On the other hand we have a disease such as acute promyelocytic leukemia (APL), which can be cured with non-chemotherapeutic regimen (I do not like to say, "non-toxic" since all medications have serious side effects and it gives patient false reassurance; prefer to use "relatively non-toxic" or " non-chemotherapeutic"). A good proportion of patients with APL have curable prospect with ATRA and arsenic. In my experience, majority of these patients don't beg for "more toxic regimens".
Furthermore, chronic myelogenous leukemia, acute lymphocytic leukemia and chronic lymphocytic leukemia treatment paradigm is evolving with respect to "cure" not stabilizing or improving progression free survival (PFS) with "non-chemotherapeutic" approaches. Two studies in CML (STIM and TWISTER studies) and few studies in CLL and ALL (published in NEJM) have been reported in reputable journals.
Syed A Abutalib
Regrettably, the documentary may initially induce fear of cancer therapy in the minds of patients and their families, by focusing on toxic side effects which we were not able to control in the "early days". What we need to stress to the public and especially our patients is how much outcomes have increased, and control of side effects has markedly improved, both of the cancer itself as well as of the therapy. we need to suggest more dialogue between patients and their doctors to discuss management of side effects and improved outcomes, as well as encourage second opinions when we cannot overcome their fears.
Dr Chodak -- absolutely. One focus of tomorrow's episode is carcinogenesis, including the role that viral and environmental/behavioral factors play.
Medicine has changed since the days of Sidney Farber when a young patient with leukemia was given aminopterin.
I hope that viewers will afterwords take the opportunity to read the book, which is so compelling. But the programs may enhance the experience of the book by showing actual patients which will give the viewer a greater realization of the importance of the cancer issue in addition to the history of cancer. the programs will be a biography of the malady plus a snapshot in time of current patients with the malady. I am looking forward to sharing my comments on the entire 3 part program.
Times have also changed when people didn't talk about cancer.
Farber was ostracized by his colleagues at times, but he did not have to deal with the regulatory environment that many investigators contend with today.
Wow - watching the 18month old and her family right now. The book is exquisite but really couldn't capture this human emotion.
In the early 20th century patients and physicians such as Farber were brave to try chemotherapy such as aminopterin for leukemia.
The film really does an incredible job of balancing the personal stories of young leukemia patients with the determination of the earliest cancer pioneers, who believed deeply in what they were doing against great odds.
Virchow in the late 19th century recognized that every cell came from another cell and pointer to surgery as a possible cure.
Halstead got to use the scalpel to see how far he could go to eradicate the tumor; the radical mastectomy was very deforming, but helped some survive.
X-rays were discovered and pointed at a breast tumor before 1900. Curie then used radium in early 1900's to treat cancer.
Halstead has a complicated legacy in the history of cancer. Will highly aggressive chemotherapy have the same complicated legacy decades from now?
Both surgery and radiation seemed to help only if cancer had not spread; something was still missing for the systemic disease.
At the time - all of these therapies were innovative and revolutionary! The revolutionary treatments we are developing today, future generations may look back on with the same aghast that we are looking back these early interventions now.
Such heavy risk and benefit discussions.
In both the scientific and family story sections, the film really presents risk vs benefit as a common thread of the oncology story.
For hundreds of years many chemical remedies were tried to treat cancer. Ehrlich discovered dyes that selectively stained some cells suggesting selective targeting may be possible.
1942 Goodman & Gilman rediscovered anti-cancer effects of nitrogen mustard & treated patient with lymphoma.
Leukemia became resistant to aminopterin as it has to many drugs since Farber's time.
Leukemia due to prior cancer treatment had to be dealt with e.g. with BMT.
The goodwill of philanthropists historically helped the fight against cancer; the story of the Jimmy Fund.
Siddharatha Mukherjee dedicated his book, on which the series is based, to Robert Sandler, the young twin who was among the first pediatric leukemia patients Sidney Farber treated with aminopterin. It is important to consider how patients and their courage factor largely in the history of cancer research.
The history of cancer therapy is one of toxicity; the future promise is targeted therapy with less side effects.
More than 60 years later this quote still has incredible impact: "The amount of money that is available for research is totally inadequate in the United States...less is spent on cancer research than we spend on chewing gum." - Mary Lasker
Mary Lasker resented medicine's limits; ironic Mr. Lasker made wealth from promoting cigarettes but she raised $
Mary Lasker supported the American Cancer Society; Albert Lasker died of colon cancer.
Mary Lasker teamed up with Sidney Farber to raise public awareness to support cancer research and the NCI.
Zubrod brought Frei and Freireich together at NCI to look for new treatments and created chemical library.
Heartrending to watch a treating pediatric oncologist describe participating in a clinical trial as the most difficult decision parents of children with leukemia have to make.
Combination chemotherapy was tried at NCI but the leukemia relapsed and the side effects were deadly.
amazing how much progress has been made, just in terms of side effect control. A year in bed! Now its all outpatient!
David Nathan believed in combination chemotherapy while Farber stuck with monotherapy to avoid higher toxicity
Early combination chemotherapy led to some cures of leukemia but not all; similar questions today about responders.
400M was amount proposed by Kennedy & Javitz in cancer act in 1971.
December 23, 1971 congress passes national cancer act announced by President Nixon 1.6B over 3 years.
Much has been accomplished in 50 years of cancer therapy.