On March 30 through April 1, 2015, PBS aired a three-part documentary film by Ken Burns entitled "Cancer: The Emperor of All Maladies". The film is based on a book by Dr. Siddhartha Mukherjee entitled "The Emperor of All Maladies".
The film is a comprehensive account of the history of cancer, dating back to the late 1800's, tracing the evolution of cancer treatment from early experimental drugs, to surgery, radiation, and chemo-therapy, to current cutting-edge treatments like immunotherapy and oncogene-specific therapy.
Highlights of the first episode, Magic Bullets:
- In the late 1800's, Dr. William Stewart Halsted performed the first radical mastectomy in the U.S., setting a standard method for the treatment of breast cancer that extended into the 1970's
- Several years after the development of the "X-ray" in 1896, radiation was introduced as a treatment for cancer
- In the early 1900's, Dr. Paul Ehrlich hypothesized that specific chemicals might be able to selectively target cancer cells like a "Magic Bullet"
- In 1947, using an experimental drug called aminopterin, Dr. Sidney Farber conducted clinical trials and had some success in treating children with Leukemia, the results of which are published in The New England Journal of Medicine in an article entitled "Temporary Remissions in Acute Leukemia in Children Produced by Folic Acid Antagonist, 4-Aminopteroyl-Glutamic Acid (Aminopterin)"
- In the 1940's and 50's, Mary Lasker became a "public force" in an effort to increase public spending for medical research (including cancer), and she along with her husband Albert Lasker gave birth to the American Cancer Society
- In the 1940's, Mary Lasker joined forces with Dr. Sidney Farber, discovering combinations of drugs that caused leukemia to go into remission
- The passage of the National Cancer Act of 1971, designed to accelerate the pace of cancer research and provide better cancer treatment
Highlights of the second episode, The Blind Men and the Elephant:
- In the 1970's, breast cancer was one of the leading causes of death among women, and about one-third of women who had undergone a radical mastectomy later relapsed
- Dr. Bernard Fisher challenged the idea of radical mastectomy as the standard treatment for breast cancer proposing instead the removal of less tissue with a lumpectomy, and an eight-year study published in The New England Journal of Medicine in an article entitled "Eight-Year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Lumpectomy with or without Irradiation in the Treatment of Breast Cancer" showed that the survival rate of patients undergoing radical mastectomy vs. lumpectomy was the same
- The cancer research community began to focus on trying to understand what causes healthy cells to divide and reproduce the way they do to become cancer cells, proposing three general theories: 1) viruses, 2) chemicals in the environment, and 3) genes
- Research conducted by Dr. Ernst L. Wynder and Dr. Evarts Graham linking cigarette smoking and lung cancer, published in The Journal of the American Medical Association in an article entitled "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of Six Hundred and Eighty-four Proved Cases"
- The 1964 report released by the Advisory Committee to the U.S. Surgeon General entitled "Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service" documenting the health hazards of cigarette smoking
- Collaborative cancer research by Harold E. Varmas and J. Michael Bishop from 1970-1993, which discovered that cancer originates in genes
- The combination of high-dose chemotherapy and bone marrrow transplantation, researched by Emil Frei and William Peters in the 1980's, the results of which showed no difference than other forms of treatment ("Interim Results of Large Trials of High-Dose Chemotherapy With Bone Marrow or Stem Cell Transplants for Breast Cancer")
- In the early 1970's, the first clinical trials for the drug Tamoxifen.
- In the early 1990's, the development of the drug Herceptin by Dr. Dennis Slamon, which targeted only cancer cells with the HER2 oncogene, revolutionizing the treatment of breast cancer
Highlights of the third episode, Finding the Achilles Heel:
- In the 1980's, research by Dr. Bert Vogelstein comparing the DNA of mutated cancer genes with normal genes, and the discovery that cancer is a multi-step process involving multiple genes
- The completion of the Human Genome Project in 2003 which maps all human genes
- The Cancer Genome Atlas (TCGA) project (2005-2008) which identified and cataloged all of the mutated genes in all of the different types of human cancer, followed by the development of many different drugs designed to target specific, mutated genes
- In the 2000's, the continued use of chemo-therapy using combinations of drugs as a standard treatment for cancer, partly because the cost of using targeted drugs is so high and often only extends life for a short period of time instead of causing remission
- Cancer prevention, including the campaign to stop smoking which began in 1964, the last smoking ad to appear on television in January of 1971, the 1989 commercial airlines ban on smoking, the HPV vaccine, colonoscopy, mammograms, and PSA testing
- The work of Dr. Mary-Claire King, who discovered a link between two different genes, BRC1 (breast cancer 1, early onset) and BRC2 (breast cancer 2, early onset), which when mutated result in a higher risk of breast and ovarian cancer
- The work of Dr. Steven A. Rosenberg and Immunotherapy where the idea is to make human immmune cells (T cells) recognize and kill cancer cells
- The work of Dr. James P. Allison and his discovery of how human T cells are activated so they will find and kill cancer cells, which ultimately led to the creation of the drug Yervoy
- The work of Dr. Carl H. June and Adoptive T cell therapy where genetically-modified T cells are transfused into cancer patients
- The promising results of Emily Whitehead, a young girl who was diagnosed with Acute Lymphocytic Leukemia and treated using Adoptive T cell therapy
The American Cancer Society website has good information about the evolution of cancer treatments:
- Evolution of cancer treatments: Surgery
- Evolution of cancer treatments: Radiation
- Evolution of cancer treatments: Chemotherapy
- Evolution of cancer treatments: Immunotherapy
- Evolution of cancer treatments: Targeted therapy
- Evolution of cancer treatments: Hormone therapy
More:
- Cancer: The Emperor of All Maladies | kenburns.com
- Siddhartha Mukherjee | Wikipedia
- Siddhartha Mukherjee: The cancer puzzle | Pop Tech
- Mukherjee on Practicing Oncology, the Pulitzer, and His Next Book | Medscape
- Review: In ‘Cancer: The Emperor of All Maladies,’ Battling an Opportunistic Killer | The New York Times
- How Cancer Acquired Its Own Biographer | The New York Times
- Ken Burns' Magisterial "Cancer: The Emperor of All Maladies" | Forbes
- The Three Things Ken Burns Gets Wrong About Cancer" | Bloomberg News
- Lessons From the Woman Who Discovered the BRCA Cancer Gene | Time
- National Human Genome Research Institute | genome.gov
- The Lasker Foundation
- 'Empress of All Maladies:' Mary Lasker | The Hill
- The National Cancer Act of 1971 | legislative.cancer.gov