Clinical Advances in Hematology & Oncology
Volume 14, Issue 9, September 2016
It is mid-August. The air is stifling, dripping, melting—making it almost, but not quite, too oppressive to ride my bike. It is certainly humid enough to place a dense layer of fog inside my sunglasses, and over any original thoughts I might have for this month’s letter.
So, I went to my bookshelves and rummaged through my archives of Clinical Advances in Hematology & Oncology to see what I wrote about in August of 2003, our first year of publication. Memories abounded. First I chortled a bit at the picture in the upper right corner of the page of the handsome young chap with the black hair who bore the same name as a now-gray geezer. The letter was the first I had written following my departure from the National Cancer Institute after nearly 18 years. The National Cancer Institute is a splendid place to be from, and my leaving enabled me to shun the stern mantle of the government and to assume the more avuncular position of chair of the Lymphoma Committee of what was then called the Cancer and Leukemia Group B (CALGB). In the intervening years (during which the CALGB became part of the Alliance for Clinical Trials in Oncology), I completed my decade of tenure, which has been one of the most rewarding activities of my career.
In my 2003 epistle, I bemoaned the potential demise of the cooperative group system as we knew it because of lack of funding, along with the demise of the phase 1 and 2 contract program for clinical trials. Now, these 13 years later, the latter is history, and the former is a mere shadow of what it once was—a ghost of cooperative groups past. A single committee sets the agenda for a limited number of trials based on histology. As I stated then, I agree with the goals of reducing duplication and sharing resources, but the solution was overly draconian. There is no need to claim that I was terribly prescient, or that I told you so, but I was and I did.
As was the case this summer, I had just returned from speaking at the Pan Pacific Lymphoma Conference. The keynote speaker that year was Dr Andrew von Eschenbach, who was then the director of the National Cancer Institute; he subsequently became the commissioner of the US Food and Drug Administration. There had been an effort to cure cancer by the year 2000, reminiscent of Nixon’s National Cancer Act of 1971. That effort obviously foundered. Dr Eschenbach proposed a novel focus for research: instead of holding out for a cure, we might do more to decrease pain and suffering by turning cancer into a chronic disease by 2015. That was 2003 and it is now 2016, so another milestone has bitten the dust—this time, fortunately so. That goal was tantamount to admitting failure, and we have moved far ahead since then. We now have the Cancer Moonshot!
In the olden times, I would devote a paragraph of my monthly letter to the exciting papers within the pages of Clinical Advances in Hematology & Oncology. For example, the August 2003 issue included a review of the role of the then-novel agent irinotecan in lung cancer. Today we have eschewed such cytotoxic drugs, and have novel targeted agents that have improved patient outcomes. Back then, we covered the subject of thalidomide-induced hypercoagulability; now we discuss lenalidomide instead. We included a review of proteomics that is of little interest today. On the other hand, our review of the treatment of acute myelogenous leukemia would probably read nearly the same today as it did then. Despite our improved understanding of the genetics and molecular biology of the disease, the treatment landscape has not moved forward in any notable manner. Finally, we provided a description of the poorly understood entity of chemo brain, which was then, and still remains, a bit of a mystery, with no routinely effective approaches.
I am quite certain that anyone who looks back upon the current issue of Clinical Advances in Hematology & Oncology in a decade or so will grin sympathetically at what we now consider cutting-edge science, but will also take pride in the progress made.
Until next month…
Bruce D. Cheson, MD