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Winning the war on cancer

Yale Medicine Magazine, 2016 - Winter


Vincent T. DeVita Jr., M.D., HS ’66, had “zero interest in cancer” when he began a fellowship at the National Cancer Institute (NCI) in 1963. But he decided that even cancer research sounded better than “getting shot at in Vietnam.”

The Death of Cancer follows DeVita’s transformation from a reluctant researcher to a leader in a struggle that he says we’re winning. DeVita communicates that same optimism in the hefty subtitle of the book that he wrote with his daughter, science writer Elizabeth DeVita-Raeburn, M.P.H.: After Fifty Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer Is Winnable—and How We Can Get There.

They wrote the book, says DeVita, because, “The people who have put over $100 billion into the war on cancer have the right to know what was done with it.”

It’s a story that DeVita, now 80, has witnessed at NCI and on Capitol Hill, at Memorial Sloan Kettering Cancer Center in New York, and at Yale Cancer Center, which he directed for a decade. At NCI, part of the National Institutes of Health (NIH), he climbed the ranks to serve as director from 1980 to 1988. His daughter was there, too: “People talk about Army brats, and there was such a thing at NIH. I grew up around all the oncologists,” said DeVita-Raeburn. “I thought all men carried beepers.”

Her mantra was to make the book “relentlessly useful.” It warns that when a doctor is willing to reduce a chemotherapy dose to minimize horrible side effects, or schedules treatments based on convenience rather than the life cycles of cancer cells, that doctor might be knocking out a patient’s best chance of survival. It advises readers that no name-brand cancer center, including Yale’s, can offer optimal treatment for every type of cancer; different institutions do better with different cancers. It provides recommendations, with the caveat that they’ll soon be outdated.

The book begins by describing how DeVita thought through which prostate cancer treatments to suggest to a family friend. It closes with the story of DeVita himself, who suffered “the double curse of being a doctor who gets a disease from his own field.” The book explains how he charted his own cancer treatment. (He says he’s doing fine.)

The Death of Cancer illustrates how greed, turf wars, and myopia have often obscured the central goal of patient survival. Nonetheless, argues DeVita, “The war on cancer is being won, though the general tenor in the press is that it’s not.” That may be because reporters focus on short-term setbacks, not the big picture, says DeVita-Raeburn.

Overall cancer mortality has dropped by 25 percent since the 1990s. Due to three paradigm shifts, beginning in the 1960s with the recognition that combination chemotherapies worked better than single drugs, DeVita and colleagues designed a four-drug treatment that for the first time cured patients with advanced Hodgkin’s disease, for which he won a prestigious Lasker Award in 1972. At a time when most tumors were treated with surgeries and radiation, the treatment proved that chemotherapy could vanquish cells that escape tumors to enter the bloodstream or organs. The second shift was the advent of targeted therapies, which can turn cancer into a chronic rather than a fatal disease. The third shift derives from new approaches that use a patient’s own immune system to quell cancer.

“The best is yet to come,” said DeVita. “I think you’re going to see some really startling stuff in the next five or 10 years.”

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