The Breakthrough
The Breakthrough

The Breakthrough

The answer is, it does, or tries to. But cancer uses tricks to hide from the immune system, shut down our defenses, and avoid the fight. We don’t stand a chance, unless we change the rules. (Location 74)

But throughout history, physicians had recorded rare cases of patients whose cancers apparently cured themselves. In a prescientific age these “spontaneous remissions” were seen as the work of magic or miracle; (Location 90)

By the year 2000, cancer immunologists had cured cancer in mice hundreds of times, but could not consistently translate those results to people. Most scientists believed they never would. (Location 94)

The news of the ninety-one-year-old president’s miraculous recovery4 surprised everyone, including the former president himself. For many people, “that Jimmy Carter drug” was the first and only thing they’d heard about cancer immunotherapy. (Location 104)

Immunotherapy has gone from being a dream to a science. Right now there are only handful of immunotherapies available. Less than half of all cancer patients have been shown to respond to these drugs. (Location 114)

Fred Stein—deathly ill from an inoperable tumor, an open surgical wound on his neck, and infected by erysipelas—was assumed to be doomed. Instead, as the fire spread and Stein’s fever raged, his surgeons noted something unusual. His tumor mass appeared to be melting away. (Location 573)

Macrophages have an innate ability to recognize simple invaders. These foreign, or non-self cells, are recognizable as foreign because they look different—that is, the fingerprint of chemical arrangements of proteins on their (Location 853)

surfaces is different. Macrophages look for anything they recognize as foreign, then grab and gobble it. (Location 855)

But more recently evolved critters on the tree of life—vertebrates with jaws, like us—also have an additional type of immune army, one capable of adapting to meet new challengers. This is the “adaptive” immune system, and it is able to face, fight, and remember unusual suspects: invaders that the body has never encountered before. (Location 868)

Before these immune cells migrate into our bloodstream, they mature from stem cells in the marrow of our bones. B cells4 have a unique method of defending us against the stuff that causes disease. They don’t kill disease cells directly. Rather, they are factories that spit out antibodies—sticky, Y-shaped molecules that grab and hold on to foreign or non-self cells, and mark them for death. (Location 880)

ingenious random genetic mix-and-match process that allows for 100 million different antibody variations. (Location 889)

There are an estimated 3 billion B cells riding around in your bloodstream, each covered with sticky antibodies designed to match up with the antigens of diseases it will probably never meet, and which may not even exist.5 B cells spend most of their short lives floating around until they happen to get lucky and come across the corresponding unique antigen of a pathogen (such as an unfamiliar bacteria, virus, fungus, or parasite). (Location 894)

They also seem to stimulate the appetites of “nature’s little garbagemen” (a process known as opsonizing, from the German word that means “prepare for eating”). The foreign invader cell gets stuck, then gobbled. (Location 905)

that ramps up a response to a new disease in about a week. When the threat is over, most of the B cell army dies off, but a small regiment sticks around, remembering what happened, ready to snap back into action if the threat shows up again. (Location 907)

But some of these B-like cells seemed to take an extra side trip into a mysterious butterfly-shaped gland located just behind the sternum in humans, called the thymus; more of these cells were observed pouring back out of the thymus into the bloodstream. (Location 916)

Meanwhile, the B and T cells of the adaptive immune system have started ramping up a response by making billions of copies of themselves, a clone army of the version of the lucky cell that happened to recognize the foreign antigen. That takes five to seven days. (Location 941)

safeguard the body, that infected cell needs to be killed. If a virus does make it into a normal body cell and infects it, that cell changes. It starts expressing different proteins on its surface; it looks different, foreign. (Location 948)

Cancer was different. It was a sick body cell, no longer a self cell. But it wasn’t infected—it was mutated. It was a disease that T cells didn’t seem to recognize. (Location 958)

T’s were the immune cells that recognized the unfamiliar proteins on the cells of donor organs, leading to organ rejection and graft-versus-host disease. If the T cell could distinguish one human from another, surely they could distinguish a healthy self cell from its cancerous mutant cousin. Some mouse studies had suggested that T cells might (Location 1041)

Even some of those who survived both treatment and cancer suffered traumatic flashbacks for years afterward. (Location 1163)

That fall, the New England Journal of Medicine accepted a paper from Rosenberg et al. that cautiously reported the result from twenty-three patients. (Location 1170)

And as high as public hope had soared on that exposure, it now suddenly came crashing back to earth with a vengeance. (Location 1207)

But his colleagues were ignoring the data, even as they became surprisingly, personally indignant at its implications. (Location 1640)

He had good, hard data suggesting that blocking this cytokine in mice had made them more susceptible to cancer. (Location 1647)

“Here we had developed beautiful data, and people negated the science by saying, ‘I don’t believe that the immune system can see the tumor.’” (Location 1653)

Finally they realized the only way forward was to overwhelm the ignorance with a tsunami of more: more experiments, more mice, and much, much more data, data so big and beautiful and clean that “even the most critical (Location 1657)

This time he wasn’t surprised at the intellectual fireworks, though he still cringes a bit remembering some of the heated exchanges at scientific conferences. “It got to the point that people actually started (Location 1660)

But in mice with intact immune systems, what Schreiber and Old saw was essentially a stronger herd: stronger, fitter cancer. (Location 1673)