Mea culpa: Lab Notes was missing in action last week because I couldn’t tear myself away from interviewing oncologists for the story in this week’s magazine  about the war on cancer. I wanted to chart the progress that has been made against the disease in the 37 years since Richard Nixon launched the war on cancer, and that meant talking to researchers and clinicians who have been in trenches for several decades.
Their stories were heartbreaking, not only for the patients they lose but for the missed opportunities.
Gerold Bepler, chief of the division of thoracic oncology (that’s lung cancer) at H. Lee Moffitt Cancer Center, started his Ph.D. thesis on Hodgkin’s lymphoma
in 1980 and then turned to lung cancer as a post-doctoral fellow.
He recalled that the big breakthroughs in lung-cancer chemotherapy 25
years ago let patients with small-cell lung cancer survive a year
instead of six-to-eight weeks, as had been the case before cisplatinin
and other drugs were developed. “With non-small-cell lung cancer,” he
recalls, “the response rate was much lower, maybe 15 to 20 percent, and
it had remarkable toxicity. You wondered, were you really helping people
if you made them so sick for the little extra time that you kept them
“The next breakthroughs were anti-nausea drugs in the mid-1980s to
early 1990s. Cisplatinin became much easier to give. I remember people
throwing up for a week at a time, before these drugs, when they got
chemo once every three weeks. Suddenly, with the anti-nausea drugs,
chemo became tolerable,” Bepler told me.
And what counts as progress against lung cancer? In the 1990s, 14 to
15 percent of patients lived at least five years. Today, Bepler said, 16
to 17 percent do. “It’s a very small number, and we are far, far, far
from being able to cure this disease.”
Like so many of the scientists I interviewed, Bepler points to many
missed opportunities over the 37 years of the war on cancer. In his
case, he proposed a study in the mid-1990s in which researchers would
have taken samples of lung cancers, analyzed and stored them, and then
determined which molecular profiles predicted response to which existing
or future chemo drugs. “I struggled to get NCI [National Cancer
Institute] approval,” Bepler said. “What gets funded depends on what
people think at the time is hot, or in. I’ve served on NCI study
sections [those are the panels of, usually, outside scientists who
review grant proposals and score them, determining which get funded] so I
can see it from both perspectives. When you start reading the
applications, you are automatically drawn to the ones perceived to be
interesting,” sometimes losing sight of the fact that the goal here is
to treat cancer and not (only) discover cool things about the molecular
biology of cancer. “In my case, people thought the idea couldn’t be
implemented in patients because they didn’t think patients would be
willing to have repeated biopsies,” which is what would have been
required to match their tumor to a particular chemo drugs.