The Prepared Patient
Scarcely more than a year ago I became a cancer patient. I have myeloma, a form of blood cancer widely regarded as incurable. I tell friends that it‘s a result of having taken my professional ambition to better understand cancer way too seriously! As a physician scientist I’m sometimes asked whether “knowing too much” is a burden. To the contrary, I find that my understanding of cancer helps me cope as a patient.
The genomics revolution has revealed that cancer is more complex than previously imagined. Every cancer is unique, built upon a combination of genetic changes different from any other cancer that has ever existed or ever will exist. Compounding this complexity is that each of the >1 billion malignant cells that invade a cancer patient can acquire additional changes, some of which may promote treatment resistance, relapse and eventually, death. Although evolutionary theory is still disparaged in some quarters, all of us have witnessed this display of evolution in loved ones lost to cancer, and these countless personal experiences affirm that evolution is a formidable opponent.
In October 2013, dozens of my colleagues, my wife (a community oncologist specializing in breast cancer), and I began a clinical trial for patients with an exceptionally aggressive form of breast cancer. In our trial we extensively characterize the molecular features of our patients’ tumors, enlist experts from diverse scientific disciplines to interpret findings and predict effective therapies, and allow these predictions to be tested in the patients themselves, learning from their outcomes to help future patients.
Deploying the same infrastructure I have transitioned from investigator to a subject of investigation. We found that a drug developed for some forms of leukemia might work for me, and though we won’t act on this information now, it’s empowering to think several steps ahead.