The Emperor of All Maladies: A Biography of Cancer

Mukherjee’s book describes the way in which cancer research and treatment have evolved over the centuries. Without an understanding of the mechanisms behind cancer and how it evolves, science was often a matter of guesswork. For example, when researchers at the National Cancer Institute (NCI) developed a chemotherapy cocktail called VAMP in 1961, no one knew if the trial would work. It was not until researchers understood the way genes work in the cell that they could begin to develop targeted therapies that link the cause with the cure.

In addition, different researchers developed their own camps, such as that of radical surgery for cancerous tumors. These camps were often in opposition to each other, so they did not work together to advance research. In the mid-20th century, doctors who advanced chemotherapy did not often work together with those who worked with treatments that used surgery or radiation. However, these rival camps would have advanced treatments if they had worked in cooperation with each other.

Experimental guesswork often led to advancements in cancer therapy. For example, Farber’s early chemotherapeutic drugs were successful, if briefly, in bringing about remission in leukemia patients, though no one knew if the drugs would work. However, some treatments—such as in the use of bone marrow treatments for breast cancer in the 1990s—turned out to be ineffective, though some patients and researchers believed in them until the supported data proved flawed. The author emphasizes that only the understanding of the mechanism of cancer allowed scientists to develop therapies that effected cures with minimal side effects. This type of understanding could not develop until researchers understood the working of genes.

The author describes not only the medical realities of cancer but also the political climate in which cancer treatment advanced. Sidney Farber was one of the first researchers to realize that cancer treatment could advance through fundraising, and he formed the Jimmy Fund with the support of the Boston Braves (and later the Red Sox). He later teamed up with Mary Lasker, a socialite dedicated to cancer fundraising. The money they raised helped fund the Dana-Farber Cancer Institute.

There was, however, always a tension between cancer research and fundraising. At times, the Laskerites, as Mary Lasker’s followers were known, wanted a unitary cure for cancer, and they wanted victories to excite the public and promote fundraising. However, they were at times too premature in their thinking. For example, cancer is not a unitary disease and does not have a unitary cure. Therefore, there has been a tension between the research and political wings of cancer treatment.

At times, politics have helped patients receive better treatment. For example, in the mid-1990s, initial results showed that a targeted therapy called Herceptin was effective in treating an aggressive form of breast cancer. However, Genentech, the pharmaceutical company that was formulating Herceptin, did not want to widely release the drug to patients until researchers more comprehensively tested it. The breast cancer lobby became involved to enable the drug’s wider release to help patients who were in desperate need of it.