Friday, February 06, 2009
This morning in the post I received this remarkable picture. "What's remarkable about it?" you may ask, "Just an old couple cutting a cake." Edith and John are celebrating their Diamond Wedding anniversary.
Eighteen years ago John had been given just a few weeks to live. He had been diagnosed with kidney cancer which was regarded as inoperable. His lungs were almost totally replaced by secondary cancer and he had very large lymph nodes in his abdomen. There was no effective chemotherapy for kidney cancer, and in fact the recommended treatment was the female sex hormone, progesterone. This did no good, but it was pretty harmless.
About that time there had been a television program about a new type of agent called interleukin-2 (IL-2). It was a terrible treatment. Patients suffered terrific shivering attacks, their blood pressures dropped, they went into kidney failure, some died of heart failure, some developed horrific rashes, but some got better.
John came to see me. I wasn't sure who mentioned IL-2 first, it may well have been him. Ar first I dismissed it out of hand. It was not a licensed product. It was impossibly expensive (£9000 then seemed an awful lot of money when you find it difficult to get the NHS to pay an extra £300 for mitoxantrone).
John offered to raise the £9000 but even then there was a rule that if you paid for your drugs privately your whole treatment had to be private. Had we gone down that route we would have been talking about £25,000+.
Instead I suggested that John make a contribution to our research fund so that we could start a clinical trial of interleukin-2 in kidney cancer. I wrote a protocol and got ethical approval even though I knew that without funding I would only be able to treat one patient.
We weren't really sure what to expect, but my team were up for it and we gave John the drug. The toxicity was bad, though not as bad as it had appeared on television. All the secondaries disappeared and the cancerous kidney shrunk to such a size that it could be removed.
When we took this result to the company that made it, they funded me to treat another 24 kidney cancer patients, 25 melanomas and 10 colon cancer patients. We had one other kidney cancer complete remission, and she also is still alive, and 5 complete remissions in melanoma patients, but they all relapsed within a year. One of the colon cancer patients had a partial remission.
Several points to learn from this. The median is not the message, as Stephen J Gould said. Despite a poor median survival, some patients do very well on strange treatments that have no apparent survival benefit. Patient drive and determination is sometimes the most important factor. The looser arrangements for clinical trials that used to obtain had their good points as well as their bad ones.
In 1991 I was at the peak of my powers. Everything I touched turned to gold. My confidence was high and I felt I had magic in my fingers. What a dangerous state for any man to aspire to! If I felt like that now I would seek absolution.