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
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.
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.
Cancer has been fought on 1000 battlefields since 1971 and the fight goes on.
Excited to see the remarkable story of cancer research and its impact on cancer care and health presented in episode two of "Emperor of All Maladies." Public recognition of the brilliance and hard work of so many dedicated researchers and clinicians is long overdue.
Fisher challenged the dogma that cutting more would increase chance of cure in breast cancer, but it was biology that mattered.
The empirical approach to therapy went far but eventually it was realized we needed to gain basic knowledge of cancer.
Peyton Rous found a viral cause of cancer in chickens that revolutionized our understanding of cancer.
Dennis Burkitt in 1950's described an aggressive lymphoma in Africa that Epstein and Barr linked to a virus.
No viruses emerged as causes of the major killers lung, colon, and breast cancer but HPV was found and later a vaccine developed.
Cancer prevention and increased doses of chemotherapy with BMT seemed reasonable approaches to cancer in late 1980s.
Farber's choice of aminopterin was due to hi observation that leukemia patients given folic acid seemed to die more rapidly. So he decided to use and anti-folic acid and aminopterin (and later methotrexate) were used in his trials.
BMT for breast cancer was eventually shown to do more harm than good due to toxicity and the disease also relapsed.
Dr. Juliano at UCLA recognized that if the sentinel lymph node is negative surgery could be even less radical & preserve nodes.
Slamon believed in targeting oncogenes such as Her2 in breast cancer therapy.
Rowley, Druker, Sawyer studied the Philadelphia Chromosome discovered years earlier at Fox Chase Cancer Center.
Here we go. This has been an incredible series the first two nights - so informative and emotional. Can't wait to see the final chapter.
Vogelstein compared the cancer DNA to normal DNA to unravel the genetics of colon cancer.
The human genome project provided the sequence of the normal human genome that could be compared with cancer.
The Cancer Genome Atlas (TCGA) catalogued complex alterations in thousands of human tumors.
We should make common cause - within our field, with our patients, and with the public - to turn what was once a trickle of discoveries and is now a steady stream of monumental advances into a flood of progress. Having the story told, and told well, is an important achievement and an important step in that direction.