1: Dr. Peter Attia can still remember the magazine cover he read in the waiting room while his friend and colleague Michael underwent surgery.
Michael was in his early forties. He had been diagnosed with a very large colon tumor that required immediate surgery.
“Michael is the kindest soul I think I’ve ever known,” Peter writes in his terrific book Outlive, “and his brilliance and with could make the worst day seem enjoyable during the years we worked together. I could not imagine losing him.”
The surgery proved to be a success. The pathology report “found no sign of cancer in his nearby lymph nodes, despite the advanced size of the primary tumor,” Peter shares.
A few months later, however, the news turned negative. Michael learned his cancer had been caused by a genetic condition called Lynch syndrome.Â
“People with Lynch syndrome usually know they have it, because it is inherited in a dominant fashion,” Peter notes. “But Michael had been adopted, so he had no idea he was at risk.”
The mutations that define Lynch syndrome mean there is also a very high risk for other cancers.
“Sure enough, five years after he dodged that first bullet with colon cancer, Michael called to say that he now had pancreatic adenocarcinoma,” Peter notes.Â
“This was even more distressing, because as we both well knew, this cancer is almost uniformly fatal.”
Michael’s cancer was too advanced for surgery to be an option. His life expectancy was now nine to twelve months.
“Making this all the more heart-wrenching,” Peter writes, “was the fact that Michael and his wife had just welcomed their first children, twin girls, into the world that year.”
2: There was, however, a glimmer of hope. There was a new immunotherapy he could try.
“He was immediately enrolled in a clinical trial,” Peter writes. “While it is not guaranteed to work on all such patients, it worked on Michael, turning his immune system against his tumor and eventually eradicating all signs of pancreatic cancer in his body.”
The result? Michael was cancer-free for a second time. He was “beyond grateful to have survived a disease that should have killed him when his twin girls were still in diapers. Now he gets to see them grow up.”
Michael was fortunate. Peter writes that “various immunotherapy treatments that have been approved still benefit only a fairly small percentage of patients.
“About a third of cancers can be treated with immunotherapy,” he notes, “and of those patients, just one-quarter will actually benefit (i.e., survive). That means that only 8 percent of potential cancer deaths could be prevented by immunotherapy, according to an analysis by oncologists Nathan Gay and Vinay Prasad.”
Still, just two decades earlier, Michael and countless others like him would have died.
Peter writes: “But I (and others who know much more than I do) believe that we have had only a small taste of what can be accomplished via immunotherapy.”
3: One massive benefit of immune-based cancer treatment?
When it works,” Peter writes, “it really works.”
Following chemotherapy, many cancer patients go into remission. “The problem is that it virtually never lasts,” Peter notes. “The cancer almost always comes back in some form.”
When patients respond successfully to immunotherapy, they often stay in total remission.
“Between 80 and 90 percent of so-called complete responders to immunotherapy remain disease-free fifteen years out,” he notes.
“This is extraordinary—far better than the short-term, five-year time horizon at which we typically declare victory in conventional cancer treatment,” Peter writes.
“One hesitates to use the word cured, but in patients who do respond to immunotherapy, it’s safe to assume that the cancer is pretty much gone.”
The bottom line?
“For the first time in my lifetime, we are making progress in the War on Cancer,” Peter writes. “There are now treatments that can, and do, save the lives of thousands of people who would have inevitably died just a decade ago.Â
“Twenty years ago, someone with metastatic melanoma could expect to live about six more months, on average. Now that the number is twenty-four months, with about 20 percent of such patients being completely cured.
“This represents measurable progress—almost entirely thanks to immunotherapy.”
More tomorrow.
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Reflection: Do I have a cancer story involving myself, my family, or a close friend? If so, how did this experience impact how I live my life?
Action: Journal about my answers to the questions above.
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