People who are now dying of cancer could be cancer free if they knew the right questions to ask and where to go for the answers, says award-winning journalist and author Charles Graeber in his new book.
In his new book “The Breakthrough: Immunotherapy and the Race to Cure Cancer” Graeber points the way to answers and hope, with news that revolutionary, curative advances in treating the disease are here. “Cure isn’t a word thrown around lightly by oncologists,” writes Graeber, “but now the top scientists in the cancer field are willing to bandy the word about aloud, publicly, and often.”
The Big C. The C-word. Whatever you call it, cancer is the diagnosis patients dread most, and with good cause. More than a half million people in the United States die annually from some form of cancer, second only to heart disease. Many of us have a family member, friend, or colleague who has had cancer. Some of us have fought it ourselves.
Graeber, who has taken the measure of disasters, daredevils, scofflaws, and murderers, gets both the big picture and the private battles with cancer. A friend of his was diagnosed with cancer and died during the writing of the book, and another got a stage 4 diagnosis. Members of his family have been stricken by cancer and similar illnesses.
In print, Graeber has profiled a world champion lock-picker, a hotdog cross-country driver, an international computer data pirate, and a nurse who’s probably the greatest serial murder in U.S. history. His work has appeared in Daily Beast, GQ, Men’s Journal, The New Yorker, New York Magazine, Salon, and Wired, for which he is a contributing editor.
In “The Breakthrough” Graeber chronicles good guys: trailblazing doctors and scientists who are on the verge, if not there already, of finding lasting cures for cancer. With Graeber’s record of timely reporting, it comes as little surprise that immunologists James P. Allison and Tasuku Honjo, co-recipients of this year’s Nobel Prize in the physiology of medicine, are featured sources in “The Breakthrough.”
Expect the book to capture wide attention, on par with Graeber’s acclaimed 2013 true-crime account “The Good Nurse,” which chronicles the deadly acts of nurse Charles Cullen, who administered lethal doses of medication to dozens of patients, maybe as many as 400, in up to 10 hospitals over 16 years. That book, which Graeber finished in the attic of his family’s Nantucket home, was compared favorably by reviewers to Truman Capote’s “In Cold Blood” and was nominated for an Edgar Award by the Mystery Writers of America. A movie based on “The Good Nurse” is in the works, with twice Oscar nominated Jessica Chastain and Oscar winner Eddie Redmayne planned for lead roles.
Cancer in its many forms
Yours won’t be your father’s cancer. The disease arises in many different forms including benign or malignant tumors, blood-borne leukemia and multiple myeloma, glioblastoma of the brain, breast and ovarian cancer, mesothelioma, skin cancer and melanoma, sarcomas, and cancers of the organs. Each case has its own DNA “sequencing,” unique to the body where it appears.
Historically, depending on the cancer, doctors have used one of three ways or a combination thereof to treat the disease, with varying odds for remission. A doctor would slash it out through surgery, cremate it with radiation, or drown it in chemotherapy, or as Graeber calls the methods: “cut, burn, and poison.” Those approaches currently cure cancer in about half of those with the disease, according to Graber, but they often cause damage to healthy parts of the body.
What Graeber details in “The Breakthrough” is an “entirely different approach to the disease,” as he wrote in a recent email. Where cancer is concerned, this is its “penicillin moment,” akin to development of the life-saving family of antibiotics that have saved millions of people from infections since being discovered in 1928.
Immunotherapy is and isn’t new. Since the late 1800s, doctors have observed examples of it happening “in the wild,” when patients with cancer went into remission, sometimes after being infected with bacterial infections that appeared to make the disease disappear. As researchers know now, what happened in those “miracle” cases was an ignition of the body’s own immune system to fight and kill cancer cells, with the secondary infections being the triggering mechanism.
Biologists have known for centuries that humans are capable of producing their own substances to fight off certain diseases, often with great efficiency. Small pox inoculations, using pathogens from scabs caused by the disease to combat it, were first used in China in the 16th century That led to inoculations internationally by the late 1800s and to the smallpox vaccines of today. This once crude process represents an early form of immunotherapy, a way to treat and possibly prevent disease by stimulating a response within the human body rather than cutting away, radiating, or poisoning the offending tissue and its diseased cells.
Consider how profound was that discovery. Smallpox, a scourge of humans for 3,000 years, which killed an estimated 300 million in the 20th century alone, was declared officially eradicated worldwide in the late 1970s.
The details of developing immunotherapies and how they work might be an impenetrable word soup to some readers. They can be so even for those of us who’ve been Sherpas through the medical maze for our loved ones with cancer or have slogged through the system with our own Big C.
In “The Breakthrough,” Graeber fires out the info in brisk, efficient prose. The technical terms and biochemical nomenclature can seem daunting: helper cells, cytokines, CD4 and CD8, B cells, T cells, PD-1 / PD-L1, et. al. To fully grasp what Graber reports and explains you won’t need a biochemistry textbook or medical encyclopedia nearby, but you might want to pore over some sections again. He helps by winding down each chapter with chatty, informal recaps that frame what he just laid out. Stories of real patients, who benefitted or not from these new therapies, make “The Breakthrough” vivid and compelling throughout.
The shorthand explanation
In brief, researchers have discovered biochemical components and mechanisms that enable or, conversely, deter cancer from growing. “Handshakes,” or ways of cells interacting, happen at the molecular level between good cells and bad ones. Cancer cells fool the body into believing they’re not a danger when, in fact, they can be deadly invaders.
Immunotherapy researchers and pharmaceutical companies have developed “checkpoint inhibitor” drugs that “see cancer” and unleash the immune system to fight off the bad invaders. Newer drugs use a patient’s own genetic material to customize therapies and target them for that individual and his or her specific cancer, by blocking the handshakes between cells from happening. Improved and newer drugs continue apace in development. The particular breakthrough drug that drew Graeber’s interest to this topic — Graeber calls the word “drug” a misnomer since he’s talking about a broad therapeutic approach — has already become “a few thousand in clinical trials and a dozen on the shelf.”
In a recent interview, Graeber conceded “It’s almost impossible to write about the topic without being so technical,” but his aim was to “write a version where readers enter the story seamlessly and want more.” Information may not guarantee power,” noted Graeber, “but you can’t be powerful without it.” However challenging “The Breakthrough” might seem, if you or someone you care for has cancer, this is your latest manual for survival. As Graeber cautions, “The guy in the white coat might not know everything.”
Like happened with smallpox, is the eradication of cancer in our future? Probably not in our lifetimes, according to Graeber, but important and rapid progress goes on. “I was very careful in this book not to offer any promises or false hope,” Graber said. “We’re in, shall we say, the end of the beginning.” Because cancer is a disease of mutation, new forms are bound to appear in the general population and for individuals. Even with these advanced approaches, there isn’t yet a “silver bullet,” Graeber added. Patients featured in his book died. A more realistic expectation is that scientists and doctors will figure out how to keep people with cancer alive until newer and even more effective treatments appear.
“The Breakthrough: Immunotherapy and the Race to Cure Cancer” is published by Twelve Books. For more on the book and Graeber, see charlesgraeber.com. This article, in a longer version, appeared originally in MahonAboutTown.com.