NEJM Audio Summary - Dec 22, 2011

Excerpted Script

"The Emperor of All Maladies — The Beginning of the Beginning"
A perspective article by Robert Schwartz from Tufts Medical Center, Boston.
 In his Pulitzer Prize–winning book, Siddhartha Mukherjee explores the twists and turns, successes and failures, and hopes and despairs that led to our understanding of cancer's biology and its treatment, up to the point of the development of imatinib. A high point of this surge on oncology occurred in the late 1990s, when Brian Druker and Nicholas Lydon developed a new kind of drug for treating chronic myelogenous leukemia (CML). The novelty of this compound, imatinib (Gleevec) is its ability to interfere specifically with the out-of-control tyrosine kinase that causes CML.  Imatinib's specificity and clinical effectiveness raised hopes that oncology had at last found a magic bullet. “Targeted treatment” became the shibboleth of the pharmaceutical industry, spurring on a multibillion-dollar search for targets in other cancers.  But the research direction set by imatinib has yielded few useful drugs. In contrast with the single causal genetic change in CML, multiple complex genetic abnormalities are the rule in most neoplasms.  Other new approaches to discovering molecular targets in cancer cells, based on astute exploitation of the molecular biology of certain cancers, show promise.

今年、CNNやNYTには、「40年戦争」なる言葉が踊った。1971 年12月、ニクソン大統領はNational Cancer Actに署名し、米国は「がんとの戦争（War on Cancer）」と形容される国をあげてのがん征圧のための戦いを開始し、40年が経過したことによる。そんなタイミングでピューリッツァー賞を受賞したSiddhartha Mukherjee医師の著作に関する寸評。