Book Review

The Cancer Treatment Revolution: How Smart Drugs and Other New Therapies Are Renewing Our Hope and Changing the Face of Medicine

N Engl J Med 2007; 357:1058-1059September 6, 2007

Article

The Cancer Treatment Revolution: How Smart Drugs and Other New Therapies Are Renewing Our Hope and Changing the Face of Medicine
By David G. Nathan. 262 pp. Hoboken, NJ, John Wiley & Sons, 2007. $24.95. ISBN: 978-0-471-94654-0

Oncology is a relatively young field. Although surgical and radiation treatments for cancer have long histories, the development of effective anticancer drugs began just 50 years ago. David Nathan is among the physicians who have witnessed the entire field unfold, from the earliest experiences with single agents to the current efforts to develop therapies that work at the molecular level. In his new book, he recounts the progress that has been made in the treatment of cancer, with special emphasis on “smart drugs” — agents that target the specific molecular causes of cancer.

Nathan uses the experiences of three patients with cancer to illustrate the progress that has been made in cancer treatment: Mario, a 19-month-old boy with a mixed-lineage leukemia; Joan, a 62-year-old woman with breast cancer; and Ken, a 48-year-old man who received a diagnosis of gastrointestinal stromal tumor just as the new generation of tyrosine kinase inhibitors was making its way into clinical trials. The book is written for a broad audience and comes complete with an extensive glossary of technical terms, yet it is thoroughly enjoyable reading for physicians and other health care professionals.

Nathan is at his best when he describes the cases of Mario and Ken. His experience at the National Institutes of Health (NIH) treating patients who had leukemia without the benefit of sophisticated antibiotics or platelet support underscores the amazing courage of these patients and their families. Just as admirable is the perseverance of the clinical researchers who finally proved that durable remissions of acute leukemia were possible. Nathan shows how steady advances have taken us “from an era of hopelessness in the 1950s to an era of huge accomplishment in the first part of the 21st century.” The sophistication with which leukemias are classified, the new drugs that can now be added to regimens, and the continued increases in cure rates all reinforce the value of our investment in this research.

In telling Ken's story, Nathan takes us back to 1910 and the discovery by Peyton Rous that a virus caused the sarcomas that were rampant in U.S. chicken coops. The molecular cause of the sarcomas turned out to be the first oncogene, c-src, so named because of its connection to these sarcomas. The c-src gene regulates a family of tyrosine kinases, including ABL and c-KIT. A translocation involving the ABL gene causes chronic myelogenous leukemia (CML), and a mutant c-KIT gene is involved in gastrointestinal stromal tumor. It is not news that drugs such as imatinib block the function of these oncogenes and induce remissions in most patients with CML or gastrointestinal stromal tumors. New agents currently in clinical trials may prove even more effective. But Nathan conveys the excitement of this story well; the thread of scientific discovery spanning a century makes for compelling reading.

Polarized-Light Micrograph of Crystals of the Cancer Drug Taxol.

Joan's story allows Nathan to discuss adjuvant chemotherapy, which is a routine treatment today but in the 1970s was criticized because it was a toxic therapy that was administered to women who were clinically well — devoid of all detectable traces of their breast cancer. Surprisingly, Nathan gives short shrift to tamoxifen, one of the smartest, most effective, and most widely prescribed anticancer agents in history. Today, additional hormonal treatments that use aromatase inhibitors are advancing the treatment of breast cancer even further. These drugs also markedly delay and might even prevent the appearance of breast cancer in women who are at high risk for the disease, opening up the possibility of true cancer prevention in the years ahead.

The revolution in the treatment of cancer has been brought about by research. Nathan is silent on the plight of the NIH since 2003. Without a reversal of the erosion of NIH support that has been brought on by several years of flat funding, the pace of discovery will slow and the development of the next generation of smart drugs will take longer than is necessary.

It is impossible to read this book without being impressed by the remarkable progress that has occurred in the treatment of cancer. The layering of one discovery on top of another, the fits and starts, and the caprice of observations filling in blanks all contributed to the unrelenting march forward. Nathan has done a wonderful job of bringing this science to life and giving us renewed hope for even better treatments in the years ahead.

Allen S. Lichter, M.D.
American Society of Clinical Oncology, Alexandria, VA 22314
lichtera@asco.org