Learning From the Lazarus Effect

This article does an excellent job highlighting two key reasons why cures for cancer have been so elusive for so long: unfathomable genetic complexity – and finding enough patients who are willing and appropriate for clinical trials.

The second reason would seem to be the easier challenge to overcome, yet a large national study of people with cancer released last week by CancerCare found that 82% of people treated at academic medical centers and 88% of those treated in community medical centers said they did not have enough information about clinical trials when they were planning their treatment.

Surprisingly, almost 25% of those surveyed said they were not getting the most advanced care available. As this article shows, some clinical trials can offer patients access to the most advanced care available today.

Findings from the six surveys that comprise this report, each completed by at least 500 diverse cancer patients, point to many aspects of care and treatment where patients don’t feel sufficiently informed about their disease or their options.

When patients are recognized and respected as true partners in their care, they are likely to be more engaged in participating in treatment, including clinical trials. For many, this could mean the difference between a fair or better outcome, a poor or good quality of life, and even life and death.

www.cancercare.org/accessengagementreport

Eric Lander is correct in saying that "it is a crime to let valuable informal go to waste when a patient wants to share it." But it is a worse crime that many. many people will not have access to the results of the resulting studies. Until we have health care, good health care for every person, we should not expect patients to give their results. People want to help each other- but I suspect they want to help everyone in their position, not just those who can afford personalized treatments.

I recall reading a study a number of years ago on the efficacy of a new chemotherapy drug a company wanted to introduce. Unfortunately, only 11% of the test subjects showed improvement - in fact, substantial improvement - almost all ending up cancer-free. But 11% was seen as a failure, so the drug was never released.

Years later, in examining the genetics of that particular type of cancer, it was discovered that the cancer was actually a number of differing sub-varieties with distinct genetic sequencing. One sub-variety, which represented 11% of the cancer family was the very one the 11% of the test subjects had. Because genetic science had not progressed significantly, a drug with an essentially 100% record of remission and cure for a particularly sequenced cancer was lost.

Continuing genetic research and the sequencing a great variety of cancers will ultimately help us to design drugs specifically targeted for each different genetic strain of cancer. Chemotherapy is still a crude tool, a cell-killing poison that attacks many cells, including healthy ones. Radiation still kills many healthy cells. Surgery is hit-or-miss, as one single metastasized cell missed in the surgery can reseed the cancer. Understanding the many different "flavors" of each general type of cancer and designing drugs that are specifically targeting a given genotype is the ultimate weapon against many cancers.

Disclaimer: on April 10, 1997 I was diagnosed with a large lesion of colon cancer. The cancer was staged at 3+ and I was given an 85%, possibly 90% chance of dying from the colon cancer or developing a secondary liver cancer and dying within 5 years. During that year I underwent state-of-the-art radiation, 2 surgeries (the second an ileostomy reversal) and six months of aggressive chemotherapy with 5-FU and Leukovorin. My surgical report showed that, of the five guard lymph nodes that had been removed, metastasized cells were found in the first four. I beat the odds (thanks primarily to one of the half-dozen most skilled coli-rectal surgeons in the country) and just recently celebrated the 19th anniversary of my original diagnosis, and the 14th anniversary of being declared totally cancer-free with no chance of recurrence.

Today, I am a Computer Scientist for the Mayo Clinic, where I write s/w to control and statistically evaluate hard organ transplants(hearts, lungs, livers, kidneys, and combinations thereof), soft transplants (bone marrow and stem cell), and certain types of cancer treatments. Unlike Nancy, below, I can see the rapid progress being made in genetic modeling every day.

As for turning a fast-moving cancer into a chronic disease - mediated by medication - who is Nancy to claim it is better to let people die soon, rather than live with their disease. I suggest she ask Magic Johnson about converting acute HIV into chronic drug-controlled HIV.

There is a kind of elegance in the idea that the same tenacity of life that allowed us to evolve from single-celled organisms to complex beings over billions of years can also turn against us and kill us.

This is riveting. The writing is I incredible. I have a vested interest in the outcome as my husband battles the monster. What we need is a way to navigate HIPAA laws that allows for study of all cancer tissue for the greater good. The writer managed to make a very complex topic very readable for the lay person. Well done. Thank you.

Perhaps interestingly or merely coincidentally but worth an investigation, there may be a commonality with the other article in today's NYT about a "miracle" cancer cure of 2-year-old Andrew Levy with leukemia, in that both patients appear to have had recurrent related bacterial infections that could have also activated the individual's own immune system in an unexpected and significant way to augment or perhaps super-charge their traditional and experimental medical treatments.

In the article, the author wrote:

"All of us begin as a relatively formless embryo, and from there the cells follow an elaborate program. They grow rapidly. They migrate and specialize, taking on roles like nerve or skin or the production of hormones in the thyroid. Cells that are no longer needed die willingly. All of this activity is ordained in our DNA and orchestrated by an elaborate system of cellular communication in which genes activate and deactivate one another as needed. It is hard to imagine, but this cooperative dance is what allows an unshaped mass of cells to become something as perfect and graceful as a baby’s tiny hand, with each fingernail sculpted just so."

And this is why I reject Darwin's theories and believe that "in the beginning, God created..."

Imagine the progress that could be made if money were no object--as in war. If we weren't spending so many billions on defense, we might be able to defend the whole human race against cancer. Pie in the sky? I'm sure generations of humans never imagined that smallpox could be eliminated either, but it has been.

There is a lot missing from this article. The approach described here is not medicine but research. It's cost is beyond imagining. This approach has sucked up tons of money with very little to show for it. The NIH just reported that only 2.5% of patients whose tumors were sequenced could be matched to a drug targeted to their tumors. That is a disaster. There are so many better ways to improve the public's health at a fraction of the cost - including in terms of cancer deaths. How does one justify the approach described here except as long term experimental work? As for turning cancer into a chronic disease - that is almost the same as admitting we have lost the war on cancer. Unless perhaps you run a drug company.

Speaking of which - shouldn't you include here any conflicts of interest? Didn't Mr. Lander found Millennium? And advise the government to spend money on this particular approach to cancer? How about Mr. Baslega? That should be front and center of any such opinions.

The breakthroughs in cancer have not come from targeted therapy as everyone thought they would for the last 30 years, but from surgery, radiation, chemotherapy, a handful of drugs, and perhaps most of all cancer prevention and screening. The only medical miracle has been the surprise of immunotherapy - with 22% of patients with advanced cancers showing miraculous responses. Sequencing genomes to cure disease has been non-stop hype and failed hopes. Enough already.

I, too, am a Lazarus, having been diagnosed with Stage IV lung cancer in 2008; yesterday, I enjoyed a beautiful Spring day paddling my canoe with a friend. I was treated with radiation -- " this can only be palliative," said my oncologist -- that eased the pain from a spinal tumor and largely turned the lung lesion into scar tissue. I proved to be allergic to conventional chemotherapy, and the cancer, although somewhat reduced, continued to be active. Then we heard from Memorial-Sloan Kettering, where I had gone for a second opinion and which did genetic testing of my biopsy samples. My lung tumor contained a mutation of the Epidermal Growth Factor that made it susceptible to treatment with a drug, Tarceva, in the form of a daily pill. With it, I might eke out an extra few months, according to the research literature.
We have done that, and more. I am grateful to all involved, but also suspicious of a system and a profession that seems to have had little curiosity about my experience. Have they learned anything from me, other than the little bit gleaned from my reports of side effects? I haven't detected any systematic effort to collect information.
I live far from the center of medical research action. But we are not ignorant hicks; my oncologist trained in Boston and worked under Vincent DeVita at NIH.
If there were a pipeline into which he and others could feed information, they would. Then many more patients like Grace would have more to give.

It seems to me that one way to attack cancer and other diseases is to perform DNA and tumor sequencing on each and every cancer patient. In this way we could build a sufficiently large data base to get to the very heart of the illness.
There exist computer programs that could analyze this information and perhaps, just perhaps, come up with better treatment options.

The best cure for cancer is to prevent it by boosting the body's immune system, consuming prebiotics, probiotics and fiber, according to Russell Jaffe, MD, PhD, CCN. Digestion and the Gut Microbiome are important.

I'm 75 and a chemist who has been exposed to numerous toxic industrial chemicals, including known and probable carcinogens for the past 50 years. But I recognized early that cancer cells are always present in my body and that my immune system kills them. As a result, I have been to avoid a diagnosis of cancer by boosting my immune system.

I'm fortunate because I had adopted this prevention strategy early in my career and continued it aggressively with increasing age.

I've lost too many friends and lab colleagues are dead because of the Emperor of All Maladies. I firmly believe that food is medicine and medicine is food.