In 1971, when Richard M. Nixon declared war
on cancer, “conquering this dread disease” must have seemed like an ambitious
but reasonable goal. Within his lifetime, man had split the atom and walked on
the moon; now it was time to turn our wealth and our growing knowledge inward,
to expand our control over our bodies.
But 40 years later, we were still pinned
down by a wily enemy, advancing by millimeters through hostile terrain. In
1975, the U.S. mortality rate for all cancers stood at 199 per 100,000 people.
In 2015, after decades of money and human effort had been poured into research,
that figure stood at 159 .
But it’s no longer unreasonable to hope
that the battle might finally turn our way, thanks to therapies based on the
patient’s own immune system. Drugs such as Opdivo and Yervoy can weaken
restraints on our immune cells that prevent them from attacking our bodies (or,
unfortunately, our tumors). And a technique known as CAR T-cell therapy lets
scientists modify those cells and release them back into the body to hunt down
cancer cells. Some of the results achieved with these new weapons look
These miracles have so far largely been
confined to relatively rare cancers with lots of mutations. The techniques
haven’t been as effective against the cancers that start in the epithelial
cells lining organs, which account for the overwhelming majority of deaths.
Until now, that is.
A team led by Steven Rosenberg at the
National Cancer Institute is working on a new method: sequencing the genes in
the patient’s tumor, then finding immune cells that are already primed to look
for the tumor’s unique mutations. These are grown in a lab, and then infused
back into the patient’s body in massive numbers. A new paper reports that
adoptive cell therapy has kept a 52-year-old Florida woman named Judy Perkins,
who had advanced metastatic breast cancer, completely free of the disease for
2½ years. Earlier papers reported equally striking recoveries in patients with
colon and liver cancer.
Miraculous? Yes. A cure for cancer? Not
quite. As with other immunotherapies, not all patients have responded to
treatment; in this case, it’s only about 15 percent. And because it’s a small
study, where one or two outliers can skew results either way, we’ll have to see
what larger trials bring.
But then, no “medical miracle” actually
comes to us in a single, brilliant flash of insight; George Orwell died of
tuberculosis more than 20 years after the discovery of penicillin, awaiting an
antibiotic that could kill the disease without killing him. And so with cancer,
which is many diseases lurking under a single name. If adoptive cell therapy
can be refined to make it more effective, and simplified so that ordinary
hospitals can administer it, it will join a growing arsenal that might just
beat cancer back to a fraction of its former territory.
Rosenberg is hopeful that the new therapy
will be a key player in that fight: “The development of this approach holds the
best opportunities for finding effective immunotherapies for patients with the
solid cancers that last year caused over 500,000 deaths in this country.” And
his lab, he says, is “working around the clock” to develop it further:
identifying more tumor mutations to target, extracting more of the
tumor-fighting cells from lab cultures. Then the biotech industry will need to
figure out how to turn this into a standardized process that can be deployed
outside of a research center.
Which brings us to the only bad news in
this amazing story: We’re going to have to find some way to pay for our massive
new expeditionary force. Antibiotics, our last medical revolution, were
relatively cheap, and often eliminated long and costly hospital stays to boot.
But immune-based therapies are unlikely to ever be available for a few cents a
dose, especially not the personalized ones. Of the immunotherapies we already
have, Opdivo and Yervoy combination drug therapy can cost a quarter of a
million dollars; CAR T-cell almost double that.
Eventually those prices will surely fall.
But how far? And what about other weapons we discover in the meantime? Thanks
to earlier technological advances, health-care spending is already approaching
20 percent of our national income. How much is too much?
That’s not an idle question. Over a
lifetime, 1 in 3 Americans will be diagnosed with cancer; 1 in 5 will die from
it. That’s why Rosenberg’s work is such a hopeful development — and also why it
would be so expensive to make treatments like this widely available. Fighting a
total war on cancer, one that might approach something like victory, will
require an open, clear commitment to meeting those expenses.
So ask yourself: If you were diagnosed with
cancer, what object do you own, what public service do you enjoy, that you’d
rather have than a tumor-killing treatment? Frankly, I find it hard to name
anything more worthy of investment than beating cancer — which is to say, extra
years of life, liberty and the pursuit of happiness. But if you agree, you
should get ready to put your money where your mouth is.
The original version of this article appeared here.