The Emperor of All Maladies: A Biography of Cancer (96 page)

VAMP

143
If we didn’t kill the tumor:
William C. Moloney and Sharon Johnson,
Pioneering Hematology: The Research and Treatment of Malignant Blood Disorders—Reflections on a Life’s Work
(Boston: Francis A. Countway Library of Medicine, 1997).

143
“I wanted to treat them with full doses of vincristine”:
John Laszlo,
The Cure of Childhood Leukemia: Into the Age of Miracles
(New Brunswick, NJ: Rutgers University Press, 1995), 141.

143
“poison of the month”:
Edward Shorter,
The Health Century
(New York: Doubleday, 1987), 189.

144
Farber, for one, favored giving one drug at a time:
See David Nathan,
The Cancer Treatment Revolution
(Hoboken, NJ: Wiley, 2007), 63.

144
“Oh, boy,” Freireich recalled:
Emil Freireich, interview with author, September 2009.

145
“You can imagine the tension”:
Laszlo,
Cure of Childhood Leukemia
, 143.

145
First VAMP trial: E. J. Freireich, M. Karon, and E. Frei III, “Quadruple Combination Therapy (VAMP) for Acute Lymphocytic Leukemia of Childhood,”
Proceedings of the American Association for Cancer Research
5 (1963): 20; E. Frei III, “Potential for Eliminating Leukemic Cells in Childhood Acute Leukemia,”
Proceedings of the American Association for Cancer Research
5 (1963): 20.

145
“I did little things”:
Laszlo,
Cure of Childhood Leukemia
, 143–44.

145
“like a drop from a cliff with a thread tied”:
Mickey Goulian, interview with author, September 2007.

145
The patient “is amazingly recovered”:
Letter from a Boston physician to patient K.L. (name withheld). K.L., interview with author, September 2009.

146
“The mood among pediatric oncologists changed”:
Jonathan B. Tucker,
Ellie: A Child’s Fight against Leukemia
(New York: Holt, Rinehart, and Winston, 1982).

146
In September 1963, not long after Frei and Freireich:
Freireich, interview with author.

146
“Some of us didn’t make much of it at first”:
Goulian, interview with author.

146
By October, there were more children back at the clinic:
Freireich, interview with author.

147
“I know the patients, I know their brothers and sisters”:
“Kids with Cancer,”
Newsweek
, August 15, 1977.

147
morale at the institute to the breaking point:
Freireich, interview with author.

148
A few, a small handful:
Emil Frei, “Curative Cancer Chemotherapy,”
Cancer Research
45 (1985): 6523–37.

150
he triumphantly brought photographs of a few:
Harold P. Rusch, “The Beginnings of Cancer Research Centers in the United States,” 74 (1985): 391–403.

150
further proof was “anticlimactic and unnecessary”:
Ibid.

150
“We are attempting”:
Sidney Farber, letter to Etta Rosensohn, Mary Lasker Papers, Columbia University.

An Anatomist’s Tumor

151
It took plain old courage to be a chemotherapist:
Vincent T. DeVita Jr. and Edward Chu, “A History of Cancer Chemotherapy,”
Cancer Research
68, no. 21 (2008): 8643–53.

156
Hodgkin was born in 1798 to a Quaker family:
Louis Rosenfeld,
Thomas Hodgkin: Morbid Anatomist & Social Activist
(Lanham, MD: Madison Books, 1993), 1. Also see Amalie M. Kass and Edward H. Kass,
Perfecting the World: The Life and Times of Dr. Thomas Hodgkin, 1798–1866
(Boston: Harcourt Brace Jovanovich, 1988).

157
a series of cadavers, mostly of young men:
T. Hodgkin, “On Some Morbid Appearances of the Absorbent Glands and Spleen,”
Medico-Chirurgical Transactions
17 (1832): 68–114. The paper was read to the society by Robert Lee because Hodgkin was not a member of the society himself.

157
“A pathological paper may perhaps be thought”:
Hodgkin, “On Some Morbid Appearances,” 96.

157
In 1837, after a rather vicious political spat:
Marvin J. Stone, “Thomas Hodgkin: Medical Immortal and Uncompromising Idealist,”
Baylor University Medical Center Proceedings
18 (2005): 368–75.

157
In 1898, some thirty years after Hodgkin’s death:
Carl Sternberg, “Über eine eigenartige unter dem Bilde der Pseudoleu Kamie Verlaufende Tuberkuloses des Lymphatischen Apparates,”
Ztschr Heitt
19 (1898): 21–91.

158
more “capricious,” as one oncologist put it:
A. Aisenberg, “Prophylactic Radiotherapy in Hodgkin’s Disease,”
New England Journal of Medicine
278, no. 13 (1968): 740; A. Aisenberg, “Management of Hodgkin’s Disease,”
New England Journal of Medicine
278, no. 13 (1968): 739; A. C. Aisenberg, “Primary Management of Hodgkin’s Disease,”
New England Journal of Medicine
278, no. 2 (1968): 92–95.

158
the plan to build a linear accelerator:
Z. Fuks and M. Feldman, “Henry S. Kaplan, 1918–1984: A Physician, a Scientist, a Friend,”
Cancer Surveys
4, no. 2 (1985): 294–311.

159
In 1953, he persuaded a team:
Malcolm A. Bagshaw, Henry E. Jones, Robert F. Kallman, and Joseph P. Kriss, “Memorial Resolution: Henry S. Kaplan (1918–1984),” Stanford University Faculty Memorials, Stanford Historical Society, http://histsoc.stanford.edu/pdfmem/KaplanH.pdf (accessed November 22, 2009).

159
The accelerator was installed:
Ibid.

159
“Henry Kaplan
was
Hodgkin’s disease
”: George Canellos, interview with author, March 2008.

159
Rene Gilbert had shown:
R. Gilbert, “Radiology in Hodgkin’s Disease [malignant granulomatosis]. Anatomic and Clinical Foundations,”
American Journal of Roentgenology and Radium Therapy
41 (1939): 198–241; D. H. Cowan, “Vera Peters and the Curability of Hodgkin’s Disease,”
Current Oncology
15, no. 5 (2008): 206–10.

160
Peters observed that broad-field radiation could:
M. V. Peters and K. C. Middlemiss, “A Study of Hodgkin’s Disease Treated by Irradiation,”
American Journal of Roentgenology
and Radium Therapy
79 (1958): 114–21.

160
The trials that Kaplan designed:
H. S. Kaplan, “The Radical Radiotherapy of Regionally Localized Hodgkin’s Disease,”
Radiology
78 (1962): 553–61; Richard T. Hoppe, Peter T. Mauch, James O. Armitage, Volker Diehl, and Lawrence M. Weiss,
Hodgkin Lymphoma
(Philadelphia: Lippincott Williams & Wilkins, 2007), 178.

160
“meticulous radiotherapy”:
Aisenberg, “Primary Management of Hodgkin’s Disease,” 95.

160
But Kaplan knew that a diminished relapse rate was not a cure:
H. S. Kaplan, “Radical Radiation for Hodgkin’s Disease,”
New England Journal of Medicine
278, no. 25 (1968): 1404; H. S. Kaplan, “Clinical Evaluation and Radiotherapeutic Management of Hodgkin’s Disease and the Malignant Lymphomas,”
New England Journal of Medicine
278, no. 16 (1968): 892–99.

161
“Fundamental to all attempts at curative treatment”:
Aisenberg, “Primary Management of Hodgkin’s Disease,” 93.

An Army on the March

162
Now we are an army on the march:
“Looking Back: Sidney Farber and the First Remission of Acute Pediatric Leukemia,” Children’s Hospital Boston, http://www.childrenshospital.org/gallery/index.cfm?G=49&page=1 (accessed November 22, 2009).

162
The next step—the complete cure:
Kenneth Endicott, quoted in the Mary Lasker Papers, “Cancer Wars,” National Library of Medicine.

162
The role of aggressive multiple drug therapy:
R. C. Stein et al., “Prognosis of Childhood Leukemia,”
Pediatrics
43, no. 6 (1969): 1056–58.

162
George Canellos, then a senior fellow at the NCI:
George Canellos, interview with author, March 2008.

163
“A new breed of cancer investigators in the 1960s”:
V. T. DeVita Jr.,
British Journal of Haematology
122, no. 5 (2003): 718–27.

164
“maniacs doing cancer research”:
Ronald Piana, “ONI Sits Down with Dr. Vincent DeVita,”
Oncology News International
17, no. 2 (February 1, 2008), http://www.consultantlive.com/display/article/10165/1146581?pageNumber=2&verify=0 (accessed November 22, 2009).

164
As expected:
See Vincent T. DeVita Jr. and Edward Chu, “A History of Cancer Chemotherapy,”
Cancer Research
21: 8643.

164
The MOPP trial: Vincent T. DeVita Jr. et al., “Combination Chemotherapy in the Treatment of Advanced Hodgkin’s Disease,”
Annals of Internal Medicine
73, no. 6 (1970): 881–95.

166
A twelve-year-old boy:
Bruce Chabner, interview with author, July 2009.

166
“Some of the patients with advanced disease”:
Henry Kaplan,
Hodgkin’s Disease
(New York: Commonwealth Fund, 1972), 15, 458. Also see DeVita et al., “Combination Chemotherapy in the Treatment.”

167
“no track record, uncertain finances, an unfinished building”:
Joseph V. Simone, “A History of St. Jude Children’s Research Hospital,”
British Journal of Haematology
120 (2003): 549–55.

168
“an all-out combat”:
R. J. Aur and D. Pinkel, “Total Therapy of Acute Lymphocytic Leukemia,”
Progress in Clinical Cancer
5 (1973): 155–70.

168
“in maximum tolerated doses”:
Joseph Simone et al., “‘Total Therapy’ Studies of Acute Lymphocytic Leukemia in Children: Current Results and Prospects for Cure,”
Cancer
30, no. 6 (1972): 1488–94.

168
it was impossible to even dose it and monitor it correctly:
Aur and Pinkel, “Total Therapy of Acute Lymphocytic Leukemia.”

168
senior researchers, knowing its risks:
“This Week’s Citations Classic: R. J. A. Aur et al., “Central Nervous System Therapy and Combination Chemotherapy of Childhood Lymphocytic Leukemia,”
Citation Classics
28 (July 14, 1986).

169
“From the time of his diagnosis”:
Jocelyn Demers,
Suffer the Little Children: The Battle against Childhood Cancer
(Fountain Valley, CA: Eden Press, 1986), 17.

170
In July 1968, the St. Jude’s team published:
Donald Pinkel et al., “Nine Years’ Experience with ‘Total Therapy’ of Childhood Acute Lymphocytic Leukemia,”
Pediatrics
50, no. 2 (1972): 246–51.

170
The longest remission was now in its sixth year:
S. L. George et al., “A Reappraisal of the Results of Stopping Therapy in Childhood Leukemia,”
New England Journal of Medicine
300, no. 6 (1979):269–73.

170
In 1979, Pinkel’s team revisited:
Donald Pinkel, “Treatment of Acute Lymphocytic Leukemia”
Cancer
23 (1979): 25–33.

170
“ALL in children cannot be considered an incurable disease”:
Pinkel et al, “Nine Years’ Experience with ‘Total Therapy.’”

The Cart and the Horse

171
I am not opposed to optimism:
P. T. Cole, “Cohorts and Conclusions,”
New England Journal of Medicine
278, no. 20 (1968): 1126–27.

171
The iron is hot and this is the time:
Letter from Sidney Farber to Mary Lasker, September 4, 1965.

171
In the late fifties, as DeVita recalled:
Vincent T. DeVita Jr. and Edward Chu, “A History of Cancer Chemotherapy,”
Cancer Research
68, no. 21 (2008): 8643–53.

171
“A revolution
[
has been
]
”:
Vincent T. DeVita Jr., “A Selective History of the Therapy of Hodgkin’s Disease,”
British Journal of Hemotology
122 (2003): 718–27.

171
The next step—the complete cure:
Kenneth Endicott, quoted in “Cancer Wars,” Mary Lasker Papers, Profiles in Science, National Libraries of Medicine. Also see V. T. DeVita Jr., “A Perspective on the War on Cancer,”
Cancer Journal
8, no. 5 (2002): 352–56.

172
“The chemical arsenal,” one writer noted:
Ellen Leopold,
A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century
(Boston: Beacon Press, 1999), 269–70.

173
“one cause, one mechanism and one cure”:
“Fanfare Fades in the Fight against Cancer,”
U.S. News and World Report
, June 19, 1978.

173
Peyton Rous:
Heather L. Van Epps, “Peyton Rous: Father of the Tumor Virus,”
Journal of Experimental Medicine
201, no. 3 (2005): 320; Peter K. Vogt, “Peyton Rous: Homage and Appraisal,”
Journal of the Federation of American Societies for Experimental Biology
10 (1996): 1559–62.

173
Peyton Rous’s work on sarcomas in chickens: Peyton Rous, “A Transmissible Avian Neoplasm (Sarcoma of the Common Fowl),”
Journal of Experimental Medicine
12, no. 5 (1910): 696–705; Peyton Rous, “A Sarcoma of the Fowl Transmissible by an Agent
Separable from the Tumor Cells,”
Journal of Experimental Medicine
13, no. 4 (1911): 397–411.

174
“I have propagated a spindle-cell sarcoma”:
Rous, “A Transmissible Avian Neoplasm.”

174
Richard Schope reported a papillomavirus:
Richard E. Shope, “A Change in Rabbit Fibroma Virus Suggesting Mutation: II. Behavior of the Varient Virus in Cottontail Rabbits,”
Journal of Experimental Medicine
63, no. 2 (1936): 173–78; Richard E. Shope, “A Change in Rabbit Fibroma Virus Suggesting Mutation: III. Interpretation of Findings,”
Journal of Experimental Medicine
63, no. 2 (1936): 179–84.