The Emperor of All Maladies - Part Two Summary
The second part of Mukherjee’s compelling biography of cancer details the early stages of a war against cancer. The section begins by introducing a new protagonist in our story, Mary Lasker, the “fairy godmother” of cancer research. With friends in high places and an insatiable motivation to pour more money into battling diseases, she was the perfect teammate for Sydney Farber, who was looking to expand his own cancer research efforts. In many ways, this partnership led to an all-out war against cancer, starting with an intense searche for any drugs that could join Farber’s antifolates in killing cancer cells. This task proved incredibly difficult, walking a fine line between not killing enough of the cancer cells and killing too many of the patient’s own cells.
Mukherjee proceeds to introduce a series of other characters in the realm of cancer research who were willing to push the boundaries of chemotherapy treatment in an effort to effectively eradicate tumor cells. Two of these men, Emil (Tom) Frei and Emil Freirich collaborated at the National Cancer Institute, brought on by the NCI’s director, Dr. Gordon Zubrod, to advance clinical trials with new chemotherapeutics. Taking a cue from another daring researcher, Min Chiu Li, they began testing combinations of drugs and continuing treatment even after the cancer seemed to have disappeared. This led them to the VAMP treatment (named for the four drugs it combined: vincristine, amethopterine, methotrexate, and prednisone), which at first appeared to be surprisingly effective at treating leukemia. However, before long, the children who had undergone VAMP came back to the clinic with neurological symptoms, the cancer having spread to their brain, where the chemotherapy drugs were unable to reach.
Despite these struggles, the efforts continued, with a particular highlight being Dr. Kaplan’s success treating Hodgkins lymphoma using high-energy targeted radiation. This showed that if a tumor is sufficiently localized, effective treatment is indeed possible. In other efforts to treat systemic cancers, further combination treatments were developed, including “MOMP” (mechlorethamine, vincristine, melphalan and prednisone) and “MOPP” (mechlorethamine, oncovin, procarbazine, prednisone). Increasingly intense treatments seemed to culminate in Dr. Donald Pinkel’s “total therapy”, which pushed the toxicity to new and even more dangerous levels, combining chemotherapy with extreme radiotherapy. However, remarkably, many (about 80%) of the child leukemia patients emerged cancer free, giving researchers and the public reason to hope for a “cure” for cancer.
Scattered throughout this part are discussions on the roles of fundamental scientific research vs. development of targeted treatments without a full understanding of the underlying processes. This issue comes to a head as the Jim/my Fund turns 21 and Lasker and Farber campaign for hundreds of millions of dollars of federal government funding for new cancer research. People had started to believe they understood what caused cancer (viruses, or so it was thought) and that there could conceivably be a single “cure” for this terrible disease. Furthermore, the moon landing increased public faith in science, and a “NASA for cancer” began to sound quite reasonable. While the Nixon administration was largely on board, some scientists cautioned that it was too early to make such a push for a cure for cancer, that not enough was understood yet. In the end, a compromise was reached, which left Farber and Lasker feeling somewhat defeated despite the large amounts of money the government had pledged for cancer research. Part 2 ends soon after this, with the death of Sydney Farber, the figurehead of early cancer research. We are left to wonder how this will impact the direction of cancer research as the story continues.
Emmet Francis is a PhD candidate in the Heinrich Lab at UC Davis.
Lindsey Mooney is a graduate student in the UC Davis Psychology Department. You can follow her on Twitter @Linz_Mooney.