THE FIRST CELL

A welcome argument that we are overdue for a change in the paradigm for treating cancer.

Raza (Medicine/Columbia Univ.) decries the “protocol of surgery, chemotherapy, and radiation—the slash-poison-burn approach to treating cancer” that has remained unchanged for decades.” She points out the billions spent on research to find and target a single mutated gene or a faulty signaling pathway at a time when a seasoned tumor has evolved into a chaotic mass of malignant cells reproducing in multiple clones with varying genetic and cellular derangements. In this approach, researchers study human tumors as static entities in tissue culture or injected into mice whose immune systems and microenvironments are in no way comparable to the cancers seen in mostly elderly patients. Consequently, it’s not surprising that candidate cancer drugs fare dismally in human trials and that the few that offer some hope extend the life of patients by only weeks—and at great cost. The author does not ignore the recent success with immunotherapy, but she notes that the therapy remains limited and comes with its own risks and side effects. What she wants instead is research to address prevention and the initiation of the cancer process—find and eliminate the first faulty cells. Her approach may be inspired in part by her own research on a pre-cancer syndrome that can develop into acute myeloid leukemia. She describes her efforts in that area as well as new research aimed at finding blood or tissue biomarkers of those first cancer cells. Her explanation of the science and her brief history of cancer research would be enough to recommend this volume to general readers, but it is in the case histories of cancer patients she has treated, including her late husband’s, where Raza’s eloquence is on full display. With elegant literary references and a compassion that deeply personalizes her interactions with patients and families, she engages readers in a commitment to finding a better way.

Intelligence, empathy, and optimism inform the argument for new research on cancer that could obviate the suffering prevalent today.