1: “Steve Rosenberg was still a young resident when he encountered the patient who would determine the course of his career—and, possibly, of cancer treatment in general,” Peter Attia writes in his powerful book Outlive: The Science and Art of Longevity.
The year was 1968. Steve was working on a rotation at a VA hospital in Massachusetts. A man in his sixties showed up at the hospital needing a relatively simple gallbladder operation.
“The man, whose name was James DeAngelo, already had a large scar across his abdomen,” Peter writes, “which he said was from a long-ago operation to remove a stomach tumor.
“He had also had metastatic tumors that had spread to his liver, he added, but the surgeons had not touched those.”
Huh? Steve assumed the patient was mixed up.
“It would have been a miracle if he had survived even six months with metastatic stomach cancer,” Peter notes.
But that’s what the hospital records showed.
“Twelve years earlier, he had walked into the same hospital complaining of malaise and low energy,” Peter notes. “Surgeons had discovered a fist-sized tumor in his stomach and smaller metastatic tumors in his liver.”
The doctors had removed the stomach tumor along with half of the patient’s stomach. They decided, however, not to touch the liver tumors due to the risk involved in removing them at the same time.
“And then they had sewn him up and sent him home to die,” Peter notes, “which he had obviously failed to do.”
2: Steve proceeded forward with the gallbladder surgery. During the operation, he decided to investigate James DeAngelo’s abdomen.
“He felt behind the liver, gingerly working his way under its soft purple lobes,” Peter writes, “expecting to feel lumps of remnant tumors—an unmistakable feeling, hard and round, almost alien-like—but he found absolutely no trace of any growths.”
But that wasn’t the case.
“This man had had a virulent and untreatable cancer that should have killed him quickly,” Steve writes in his 1992 book The Transformed Cell. “He had received no treatment whatsoever for his disease from us or from anyone else. And he had been cured.”
What was going on here?
“In all the medical literature, [Steve] could find only four instances of complete and spontaneous remission of metastatic stomach cancer. He was mystified.”
“But he eventually came up with a hypothesis: he believed that DeAngelo’s own immune system had fought off the cancer and killed the remaining tumors in his liver, the way we might shake off a cold. His own body had cured his cancer. Somehow.”
3: Steve felt he had stumbled across something important and began a quest to use the body’s immune system to combat cancer.
“The immune system is programmed,” Peter explains, “to recognize invading pathogens and foreign bodies among our own healthy native cells, and then to kill or neutralize the harmful agents.”
Immunotherapy is any therapy that uses the body’s immune system to fight an infection or other condition.
The problem with trying to fight cancer this way?
“While cancer cells are abnormal and dangerous, they are technically still our cells,” Peter notes.
Cancer cells have “cleverly evolved to hide from the immune system and specifically our T cells, the immune system’s assassins that would ordinarily kill foreign cells,” he writes.
For cancer immunotherapy to be successful, our body’s immune system has to learn how to identify and kill our own cells that have turned cancerous.
And that has proven to be difficult.
“Despite small successes peppered here and there, whatever phenomenon had erased James DeAngelo’s tumors proved to be elusive,” Peter writes, “for the first ten years, not a single one of Steve’s patients had survived. Not one.”
But Steve was persistent.
In 1984, a late-stage cancer patient, Linda Taylor, was put into remission by giving a high dose of an agent that plays a vital role in the immune response.
“This was a huge turning point,” Peter notes, “because it showed that the immune system could fight off cancer.”
Still, there were far more failures than successes. It took many more years, but eventually, Steve and his team developed a process that involved taking a patient’s T cells from their blood and using genetic engineering to target the patient’s tumors.
Called CAR-T, “these modified T cells could be multiplied in the lab and then infused back into the patient,” Peter explains.
In 2010, CAR-T treatment was successfully utilized with a patient who had undergone multiple unsuccessful rounds of conventional treatments.
“Other groups pursued the technique as well,” Peter writes, “and finally, in 2017, the first two CAR-T-based treatments were approved by the FDA (making them the first cell and gene therapies ever approved by the FDA), one for adult lymphoma and another for acute lymphoblastic leukemia, the most common cancer in children.”
After almost fifty years, Steve Rosenberg’s unorthodox theory generated a breakthrough with the hope of many more to come.
More tomorrow
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Reflection: What are the lessons we can learn from Dr. Steve Rosenberg?
Action: Discuss with a colleague or friend.
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