When I started my oncology career many years ago my research focus was on the immunology and immunotherapy of cancer. Our goal was to solve the puzzle as to why our bodies allowed cancer to develop in the first place, and what we could do to improve our own natural response to cancer cells in an effort to help treat the disease.
The basic question that we tried to answer early on in the development of the field of cancer immunotherapy was fairly simple: If cancer cells are abnormal, why don’t our bodies recognize them as such and destroy them, much like our bodies respond to infectious agents such as viruses and bacteria?
Unfortunately, our success was limited.
Now, we may actually have a tool that helps us put theory into practice, one that may enable our bodies to recognize the cancer cell as foreign, and destroy it.
A report published today in Sciencexpress, a highly regarded medical journal, describes what appears to be the first success in using genetic engineering applied to immune based therapy, resulting in significant disease responses in two patients with recurrent melanoma.
Our tools and our knowledge … Continue reading →
Last night I found myself on the horns of a dilemma.
I am accompanying my wife on a trip to Kansas City as she gives a course for a medical professional organization.
Being the barbecue aficionados that we are, it isn’t particularly surprising that we would find our way to a local barbecue restaurant for our dinner last evening.
So there I sat, looking at the menu, and struggling with the question of what I should have for dinner. After all, life is about choices: good vs. evil, pork, beef, chicken or—yes—fish (even barbecue restaurants these days make grilled fish available on their menus).
Maybe if I had read the articles and editorial that appeared in this week’s New England Journal of Medicine discussing the risks of premature death in relationship to body mass index, I would have made a better choice.
But, I had not done my reading until this morning.
The beef ribs won.
I have not made a secret of the fact that I have been working on overcoming some lifelong habits related to my health, my diet and exercise over the past 8 months.
In … Continue reading →
One of the most common questions I am asked is whether we are really making progress in our efforts to reduce the suffering and death from cancer.
There are many ways of saying “yes” in response to this question.
Probably the simplest answer is to comment on the increase in the 5 year survival of people diagnosed with invasive cancers from 50% in 1974-76 to 65% for those folks diagnosed between 1995 and 2001.
However a better and more detailed examination of how effective our cancer control and treatment efforts have been over the past 15 years or so recently appeared in an article and accompanying editorial in the American Cancer Society’s journal Cancer.
The net result of the discussion was not a simple pat on the back. The authors concluded that we have made progress; but we could do much better.
As noted in the article, in 1996 the board of directors of the American Cancer Society set a challenge goal for this country to reduce by half the number of deaths related to cancer between 1990 and 2015.
One important caveat that is often forgotten when our “2015 goals” … Continue reading →
We spend a good deal of time discussing targeted therapies in cancer treatment, but don’t pay as much attention to what I am going to call “targeted diagnostics.”
Yet, this is probably as important a part of the current revolution in cancer treatment since diagnostic and prognostic tests will play an increasing role in helping us improve our ability to decide which cancer patients will need treatment in which circumstances, as well as help us to more accurately provide prognostic information for patients and their physicians.
Two articles and an editorial in today’s New England Journal of Medicine point out how important these types of tests are becoming in cancer treatment.
Over the years we have developed a number of ways to help us identify which patients are going to do better or worse than others.
For example, in most cancers, we are able to provide information regarding the stage of the disease. In some cases the staging information is based on clinical data, such as physical examinations, x-rays, and so on.
In other situations, we have much more information available to stage a patient, such as surgical specimens of the … Continue reading →
I returned from vacation on Monday, and started the process of catching up on the emails and voice mails that had accumulated over the past 10 days.
One of the voice mails was from a lady I did not know. I returned the call and spoke with the woman.
I have been replaying the conversation in my mind ever since, because it reminded me of how difficult it can be for families and doctors alike when situations are not going well. And it reminded me of how important it is for doctors and patients to communicate in times of crisis and in times of need.
She said in her message that she was aware I was on vacation, but could I please call her when I returned. Her father was in the hospital with advanced prostate cancer and the doctors had told the family there was nothing more that could be done. She wanted guidance and advice on what to do next.
When I called her (let’s call her Ms. M for the purposes of this discussion), she thanked me for returning her call. But, she went on, it was … Continue reading →