by Yeong Sek Yee & Khadijah Shaari
Dr Robert A. Nagourney, MD is no ordinary medical doctor. He is board certified in internal medicine, medical oncology, and hematology. He earned his BA in Chemistry, from Boston University, and graduated with distinction in Biochemistry. He received his MD at McGill University in Montreal, Canada, where he was a University Scholar. After completing his residency in Internal Medicine at the University of California, Irvine, Dr. Nagourney received fellowship training in Medical Oncology at Georgetown University in Washington, DC. He then completed a second fellowship in Hematology at the Scripps Institute in La Jolla, California.
The book under review spans nearly 30 years and offers insight into how our understanding of cancer and cancer treatment has and, in some cases, has not changed in the more than forty years since the famous “War on Cancer” began. Since then, the death rate from cancer in the U.S. has decreased just 5%, and cancer is poised to claim the lives of more people than heart disease in the near future.
In Outliving Cancer, Dr. Nagourney describes the scientific rationale for his particular approach to cancer medicine, beginning with an interest in cancer as a disease and his good fortune to work with many accomplished researchers along the way. Readers will come to understand that cancer is not what it once appeared to be, that its management has often been ill conceived and ill applied. This informative book also demonstrates that cancer doesn’t grow too much but rather that it dies too little and why that matters.
Many years ago, as an oncology fellow, Nagourney’s lifelong desire to be a healer and a physician had been replaced by his role as what he calls “an administrator of toxic, ineffective chemotherapies.” He said he felt as if he had made a terrible mistake–that his patients weren’t only dying, he was poisoning them. He resolved that the remainder of his career would be dedicated to finding better, innovative ways to treat cancer. By rethinking what cancer is and how it behaves, Nagourney developed what he considers a smarter, more effective way to treat cancer patients, and he established Rational Therapeutics.
Rational Therapeutics is a pioneering cancer research institute that specializes in the “functional profiling” of human tumors through the application of a laboratory platform known as the Ex-Vivo Analysis of Programmed Cell Death (EVA-PCD). Using human tumor micro spheroids isolated directly from surgical specimens, these scientists measure which drugs, combinations and new targeted therapies can induce cell death (programmed cell death, one form of which is apoptosis). This process eliminates the “one size fits all” administration of cancer treatments, enabling physicians to provide personalized cancer care.
In layman terms, this is called “chemosensitivity testing/assay” which can identify which drugs would be effective for that particular cancer or which ones would be ineffective or harmful. Rather than prescribe a standard chemotherapy combination without knowing whether or not it would be effective, some oncologists are choosing to test tumor cells in advance of treatment. A chemosensitivity assay can help determine which drugs will most likely shrink the tumor, kill the cancer cells, and give patients the best outcome.
Is chemosensitivity testing being practiced in Malaysia? Not to our knowledge. Is it widely used in US and Europe? So far, only integrative oncologists like Dr John Forsythe, Dr Keith Block, Dr Robert Zieve, Dr Jurgen Winkler and a few others will only treat patients after the correct type of chemo drug has been determined suitable.
Why conventional oncologists are not interested and still prefer the one-size-fits-all approach to chemo drug selection? The American Cancer Society says the chemosensitivity testing is not scientifically proven and one local (Malaysian) oncologist commented that it is not “reliable.” Is this true? The following comment by Dr Joe Brown, ND (in “Defeat Cancer”) sums up the answer:
- In a perfect world, patients would get a chemotherapy sensitivity test when they are first diagnosed with cancer, to determine their cancer’s sensitivity to specific drugs.
- In the real world, however, it’s as if doctors are more or less saying to their patients: “You have….cancer. We’re going to give you this drug, because it’s the standard. If it does not work, then we will try another. If that does not work, then we’ll try a third” and so on.
(Comment—by the way, this approach is definitely more lucrative).
Outliving Cancer is full of patient stories, showing that many are not just surviving but are living cancer free and thriving up to 15 years later. By utilizing assay-directed treatment, Dr. Nagourney has taken the guesswork out of treating cancer and improving patient outcomes. Through the study of an individual’s cancer cells in the lab, personalized cancer treatment has come of age.
In an earlier part of the book, Dr Nagourney described his encounters /experience as an oncologist. Here are some notable comments:
- …cytotoxic chemotherapy is a double-edged sword with a razor-sharp back edge.
- …in the middle of the first year of my oncology fellowship, every single patient under my care died a miserable death. No one got better, not anyone ever.
- My lifelong desire to be a physician, healer, and comforter had been replaced by my role as a tormentor. Patients weren’t only dying, I was poisoning them. I hated oncology. I was beginning to hate medicine.
- Many (cancer patients) responded and a few cured, but absolutely every one of them suffered toxicities.
- With each passing course of radiation, a new area of disease would crop up. Further radiation, more disease.
Elsewhere in the book, Dr Nagourney also made some very blunt comments on conventional chemotherapy/radiation treatments:
- Cancer patients aren’t cannon fodder (cannon fodder is an informal, derogatory term for military personnel who are regarded or treated as expendable in the face of enemy fire). It is not their (the cancer patients) duty to be martyred at the altar of drug development.
- …most cancer patients don’t respond very well to chemotherapy and we certainly don’t need help finding bad drugs. There are already plenty of those around. What patients need is help finding drugs that work.
- The operative term here is “standard”….this means “average patient, average outcome” approach. Average outcomes are what these guidelines are designed to provide and they are exactly what you get.
- Cancer medicine, it seems, is subject to the same types of trends that drive women’s fashion. Like fitted suits or short skirts, doxorubicin for breast cancer is in and then it’s out. But it will be back again.
- All the while, patients suffer through dose intensity, dose density, bone marrow transplantation, and targeted therapies only to find out that the conceptual underpinnings that led their doctor to treat them accordingly were wrong and everyone’s going back to the drawing board. This happens because there are no absolutes in drug selection. There is only opinion and opinions vary.
- …our most advanced therapies today are little more than diet plans.
- …the human genome project has provided us the world’s most expensive telephone book.
In concluding, let us share one more quotation by Dr Nagourney which sums up what he is doing:
- “You don’t go to a restaurant to find out what they aren’t serving. You don’t go to an airport to find out where they aren’t flying. And you don’t go to your oncologist to find out what treatment not to take. Laboratory assays that measure growth and proliferation can only tell you what not to get. That is why I (Dr Nagourney) departed from that technology two decades ago to use newer, more accurate techniques and will never go back.”
Is your oncologist using the newer techniques or is he still basing his drug selection on the recommendations of the drug supplier?
1) ARTICLE: WHY I DO CHEMOSENTIVITY TESTING
2) ARTICLE : CHEMOSENSITIVITY TESTING FOR BREAST CANCER TREATMENT
3) WEBSITE OF RATIONAL THERAPEUTICS
4) YOUTUBE: DR FORSYTHE EXPRESSES HIS EXCITEMENT ABOUT CHEMOSENSITIVITY TESTING.
5) ARTICLE: WHY ONCOLOGISTS DON’T LIKE IN VITRO CHEMOSENSIVITY TESTS.
6) ARTICLE: CHEMOSENSITIVITY TESTS: WHAT DOES BIG PHARMA KNOW ABOUT THEM AND WE DON’T?
7) ARTICLE:CHEMOSENSITIVITY TESTING-CUSTOMIZING CANCER TREATMENT.