From 'zero to 60' in cancer care
Larry Shulman, MD, Dana-Farber's chief medical officer, reflected recently on the past three decades in this field. Here are excerpts from that interview:
Larry Shulman, MD
"I started getting interested in oncology in 1972, when chemotherapy was first being used to treat acute lymphoblastic leukemia and Hodgkin lymphoma [and shortly after President Nixon declared the nation's "War on Cancer"]. It was terribly exciting to go from zero to 60, because all those patients had been dying previously, and suddenly large numbers of them seemed to be cured.
Our entire focus back then was on getting the cancer to go away, which was a remarkable thing. You saw a chest X-ray where a patient had a big mass, and you gave him/her MOPP chemotherapy [a four-drug combination] and the X-ray returned to normal, so you thought, 'That's it' and declared victory.
In the 1980s, we started to realize that things might be more complicated and began following [survivors] over a longer period. We also realized that although we'd had great success with cancers like Hodgkin and non-Hodgkin lymphomas and several leukemias, the approach of mixing and matching cancer drugs was not going to cure everybody. For women with metastatic breast cancer, for example, we tried for years to mix drugs in different ways, with no increased benefit. So the decade between the early '80s and the early '90s was a tough one.
Fortunately, enough people in the field maintained their enthusiasm, and by the mid-'90s it started to get exciting again, and we started to see progress. We went from 20-plus years of mixing standard toxic chemotherapy drugs different ways with much less success than we had hoped, to suddenly translating cancer cell biology into targeted therapies and beginning to move the results in a positive way. At the same time, we were better able to control symptoms, and started to realize that if we were able to eradicate a cancer or put it into remission, we ought to pay attention to the long-term effects on the patient.
Now it's an incredibly exciting field. You see many patients doing well and living a good quality of life. But we still have a lot of work to do, especially in understanding the late effects of treatment.
The best part of my job is still seeing my patients. It keeps me grounded on why we're here."
