Cancer: A Time for Skeptics

The Death of Cancer

by Vincent T. DeVita Jr. and Elizabeth DeVita-Raeburn
Sarah Crichton Books/ Farrar, Straus and Giroux, 324 pp., $28.00
Robert Pope: Radiation, 1989
Art Gallery of Nova Scotia/Robert Pope Foundation
Robert Pope: Radiation, 1989

In his valedictory State of the Union address this January, President Obama endorsed Vice President Biden’s proposal of last October that the US needed something like a “moonshot” to cure cancer. “Tonight, I’m announcing a new national effort to get it done,” Obama said. “For the loved ones we’ve all lost, for the families that we can still save, let’s make America the country that cures cancer once and for all.”

The loved one I lost was my mother. At the age of sixty-seven, she developed breast cancer. She openly told family and friends of her diagnosis, and what followed: surgery, to remove the breast mass and adjacent lymph nodes containing deposits of the tumor, and a combination of chemotherapy agents to reduce the risk of recurrence.

Several years later, the cancer returned. She knew then that the disease was incurable, but she also knew that there was hope to extend her life with treatment. “I am playing leapfrog with the cancer,” she told me. There were times when the chemotherapy took its toll, my mother too fatigued to do daily chores, attend synagogue, or see a movie or play. But there were also periods when life was lived fully.

Twelve years after the initial diagnosis, her oncologist, a thoughtful and dedicated doctor, told her that the cancer was growing quickly and treatment options were few. A drug had recently been approved by the FDA for pancreatic cancer. It was called gemcitabine, and there had been much controversy over its value. The clinical trials showed that the drug extended survival for several weeks, and critics decried the idea that a toxic drug with such minimal benefit would be brought to market. But soon after it became available, oncologists began studying its use in other cancers, including breast cancer, and there were some early encouraging data that it might be beneficial.

In addition, another way of targeting cancer, attempting to cut off its blood supply with a so-called anti-angiogenesis agent, Avastin, had been approved by the FDA. Although there was no formal protocol for doing so, her oncologist suggested combining gemcitabine with Avastin. There were real risks of toxicity, to be sure, and he was not pressing my mother to comply with his advice. But she very much wanted to live, and did not believe that the end was near. Remarkably, dual treatment resulted in fourteen months of remission, the cancer in her bones and liver shrinking markedly. She was able to visit me in Boston and go to concerts in New York, all the while taking the drugs.

Ultimately, the effects waned and the cancer grew explosively. Her oncologist said that she might enter so-called phase 1 studies, where new drugs are tested primarily to assess side effects with little expectation of benefit. She thought…


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