Aging Begins at 30

Medicine Can Come From Deadly Sources

Some advances in medicine come from unlikely sources. During my officers training experience, in which we seemed to learn more about the last war than the next, we had detailed instruction in poison gas warfare. Our professor of pathology had published WW I autopsies on mustard gas victims. The lymph glands of victims were completely absent. I thought nothing of it until I came back from the navy after WWII and met research physicians injecting mustard gas-based drugs into patients with lung cancer and lymphoma, hoping to cure them. The results weren’t wonderful but the patients were living longer. Much has developed since that shaky beginning. Hormone treatment for cancer has evolved over a longer time. First, in Glasgow, ovaries were removed to treat breast cancer (1896) and in Chicago (1941), castration or estrogen (female hormone) treatment was tried for prostate cancer.

Chemotherapy can now produce long-term relief from some types of cancer. Drugs can cure some patients with choriocarcinoma (placental cancer), Hodgkin’s disease, testis cancer, and younger patients with acute lymphocytic and myelogenous leukemias, types of ovarian cancer, and types of non-Hodgkin’s lymphoma. In combination with surgery or radiation, chemotherapy has improved survival in many cancers such as breast, colon, lung, and gynecological tumors. So-called neo-adjuvant chemotherapy has reduced the size of large tumors prior to curative treatment. The first chemotherapy treatment given to a patient often provides the best chance of cure, so it should be the most effective. The importance of clinical research trials has emerged and led to clinical cooperative groups. There are more than 60 anticancer drugs on the market and hundreds more on trial under special Food and Drug Administration (FDA) license.

The Physicians Data Query or PDQ (National Cancer Institute) gives monthly updated information on the newest research. About a third of all protocols are modified monthly. The data bank contains about 1,000 treatments and information on 1,200 cancer experts, listed by zip code, on the National Library of Medicine’s MEDLARS computer system at nearly 6,000 health libraries and care organizations in the United States.

Surgery and radiation are used to treat localized cancers. Chemotherapy cures microscopic bits of tumor carried by lymph blood vessels to other parts of the body ready to grow again. Different medications kill cancer cells differently allowing us to make logical "cocktails" of drugs, or to use a single drug. Antimetabolites act like cell food, are absorbed, and jam up growth mechanisms. Descendants of mustard gas, called alkylating agents, kill all cancer cells resting or multiplying. Anticancer antibiotics insert themselves into the DNA of cancer cells and stop growth. Alkaloids interfere with chromosome spindles necessary for cell duplication. Hormones and some newer agents interrupt normal growth signals.

Biological therapy or immunotherapy started with Coley’s toxin (an erysipelas mixture first used in the late 1800s) and Bacillus Calmette Guerin (BCG), first developed to prevent tuberculosis. Now the choices include interferons, vaccines, various human cell messengers (cytokines, interleukin-2 and others), and, most recently, monoclonal antibody immune treatment. Chemotherapy treatments suppress the making of various blood cells. Human growth factors filgrastim (Neupogen) for granulocyte (defensive white cells) and erythropoietin for anemia (low red cells) can counter this suppression.

Many advances have been made in recent years. Stay tuned for more.

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