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Speaker 1: Throughout this series, we'll be discussing many aspects of cancer

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Speaker 1: diagnosis and treatment, and we will be sharing several personal

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Speaker 1: stories related to cancer. Some listeners might find this content upsetting.

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Speaker 1: Please listen with Discretion.

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Speaker 2: Killer. My name is Amy and I'm a cancer survivor

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Speaker 2: from Artira, New Zealand. My family has a history with

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Speaker 2: a type of cancer called retna blastoma, which is a

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Speaker 2: cancer of the eye. However, we can also track the

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Speaker 2: history of how retna blastoma is treated in New Zealand,

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Speaker 2: starting with my dad. He was diagnosed in nineteen fifty

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Speaker 2: six with bilateral retina blastoma, meaning he had it in

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Speaker 2: both eyes. They treated him with radium, which looking back

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Speaker 2: on it obviously was not the most effective treatment. It

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Speaker 2: didn't kill any of the cancer cells, but it also

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Speaker 2: gave him mylodysplasia, a precursor to leukemia. In the end,

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Speaker 2: he had both his eyes removed so that the cancer

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Speaker 2: wouldn't spread. Diagnosed with bilateral retina blastomer in nineteen ninety

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Speaker 2: four and was given radiotherapy. Radiotherapy was quite good at

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Speaker 2: killing the cancer cells. However, it also altered the shape

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Speaker 2: of my skull and gave me other numerous side effects

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Speaker 2: which would Most of them were treated by either medication

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Speaker 2: or surgery. In two thousand, my sister Meg was diagnosed

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Speaker 2: with trilateral retina blastomer, meaning that she had the cancer

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Speaker 2: in both of her eyes, but also a brain mass.

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Speaker 2: She was treated with chemotherapy, which was still quite new

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Speaker 2: at the time, and we thought that while at the

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Speaker 2: time it was a very hard treatment, it was the

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Speaker 2: best of the three. She had very limited side effects

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Speaker 2: until she was seventeen. Now she was diagnosed with another

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Speaker 2: form of cancer called osteosarcoma, not caused by the treatment,

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Speaker 2: but a fairly common cancer to have with threatena blastomer

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Speaker 2: as well, and she again was treated with chemotherapy. However,

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Speaker 2: in the end she got chemo induced leukemia, which is

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Speaker 2: a very aggressive and rare form of cancer caused by

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Speaker 2: the thing that was meant to save her life. Unfortunately,

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Speaker 2: she passed away six weeks later. So here I said,

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Speaker 2: not being able to tell you if any treatment is amazing,

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Speaker 2: but when you're faced with the alternative, you've got to

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Speaker 2: go with what you've got.

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Speaker 1: Thank you.

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Speaker 3: Hi.

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Speaker 4: My name is Hallie and I currently work as a

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Speaker 4: nurse in the United States. I've experienced in the operating

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Speaker 4: room in your chronology and clinical trials. In each specialty,

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Speaker 4: I've seen the effects of cancer in every aspect of

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Speaker 4: one's life. It was only recently where I experience cancer

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Speaker 4: more personally, as my dad was diagnosed in August of

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Speaker 4: this year. I worked in oncology clinical trials from twenty

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Speaker 4: twenty three to twenty twenty five. For many of these studies,

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Speaker 4: patients were only considered after feeling a certain number of treatments. Essentially,

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Speaker 4: they had to be sick enough but not too sick

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Speaker 4: to qualify. For those patients who did consider being un study,

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Speaker 4: I was amazed by the courage they had despite not

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Speaker 4: knowing whether the treatment would ultimately heal or hurt them

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Speaker 4: in the long run, they chose to proceed for the

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Speaker 4: health of future patients who would inevitably come after them.

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Speaker 4: In August twenty twenty five, my dad or received the

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Speaker 4: diagnosis of stage two OR of pharyngeal HPV positive cancer

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Speaker 4: at age fifty five. It was shocking, to say the least.

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Speaker 4: My experience with clinical trials prepared me to educate my

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Speaker 4: family on what was happening and what would likely eventually

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Speaker 4: happen based on the data gathered by past clinical trial participants.

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Speaker 4: This knowledge gave my dad the confidence to share about

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Speaker 4: his experience in our community. Completed treatment in November and

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Speaker 4: has his follow up PET in January, so fingers cross

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Speaker 4: for clear scans. I learned a couple of important things

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Speaker 4: throughout these experiences. One is that cancer treatment and its

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Speaker 4: side effects can be brutal. An oncologist I worked with

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Speaker 4: one said, the goal is to.

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Speaker 3: Treat the patient.

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Speaker 4: If treating the cancer gets in the way of that,

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Speaker 4: we have to reevaluate the course of action. Number two

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Speaker 4: is that cancer is not one size fits all. It

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Speaker 4: can look like a chronic, slow growing disease and you

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Speaker 4: can still live a very long, very happy, and very

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Speaker 4: healthy life. It is not always destinance, even if the

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Speaker 4: disease is advanced technology medicine has come so far. Number

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Speaker 4: three is that cancer is so common understanding that it's

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Speaker 4: not if it infiltrates your life, but when it infiltrates

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Speaker 4: your life is very important. This is very scary, I admit,

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Speaker 4: but very comforting knowing you are not alone and knowing

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Speaker 4: there are healthcare workers there ready to fight the fight

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Speaker 4: with you when the time comes to whether it's for

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Speaker 4: you or a loved one.

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Speaker 1: Thank you all so so much for sharing your story

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Speaker 1: with us. It truly means the world. Thank you to

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Speaker 1: everyone who has written in it. These stories add such

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Speaker 1: I mean, invaluable perspective on these stories of cancer and

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Speaker 1: the experience with cancer, and we just re really, really

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Speaker 1: really appreciate it.

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Speaker 5: Yeah, we do, thank you. We actually can't thank you

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Speaker 5: enough for it. So thank you. And we have a

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Speaker 5: lot more stories that we'll be sharing throughout this series

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Speaker 5: and throughout this episode today. Truly, thank you so much

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Speaker 5: to everyone who submitted. We wish that we could have

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Speaker 5: included all of your stories. They all mean so much

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Speaker 5: to us. Thank you, they do.

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Speaker 1: Hi. I'm Aaron Welsh and I'm Erin Onmann Update and

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Speaker 1: this is this podcast will kill You.

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Speaker 6: Welcome to episode three of.

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Speaker 1: Cancer, Cancer Cancer. It's been a journey so far.

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Speaker 5: I've learned a lot.

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Speaker 1: Yes, same same. This is three of four total episodes

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Speaker 1: on cancer. If you haven't listened to the first two,

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Speaker 1: you should definitely go check them out because they'll add

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Speaker 1: you don't have.

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Speaker 5: To, it's not like required, but there's a lot of

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Speaker 5: context contests.

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Speaker 1: Yeah, we recommend, We do strongly recommend. Yeah, And it's

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Speaker 1: just to give you a little bit of sneak peek

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Speaker 1: if you haven't listened. Number one one is all about

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Speaker 1: what is cancer clinically conceptually? How did we come by

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Speaker 1: that knowledge throughout history? Episode two is about the evolution

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Speaker 1: of cancer, the cellular basis of cancer, why makes a

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Speaker 1: cancer sell a cancer cell?

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Speaker 5: Why do we get cancer, why do we get cancer?

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Speaker 1: Cancer, and animals, et cetera.

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Speaker 5: Today's episode is all about treatment, treatment, past, present, future.

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Speaker 1: Question back. That's I mean, I think that pretty much

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Speaker 1: sums it up. Yeah. And then next week, our final

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Speaker 1: episode of the series is all about sort of getting

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Speaker 1: a sense of the current landscape of cancer around the

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Speaker 1: world in the US, and then some of the other

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Speaker 1: strategies that we can use to try to drive down

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Speaker 1: these numbers through screening and prefection.

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Speaker 5: Yeah.

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Speaker 6: I love it.

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Speaker 5: It's going to be great, And we've covered a lot already.

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Speaker 5: We have a lot more to cover. But as much

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Speaker 5: as we have packed into this series, there is a

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Speaker 5: lot that we have not been able to fit. Yeah,

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Speaker 5: So we want everyone to know that. Number one, we

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Speaker 5: have so many sources that everyone can read more about.

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Speaker 5: Whatever your favorite aspect of the series has been, there's

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Speaker 5: more reading for you, So check out our website to

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Speaker 5: see the list of sources, and these are not the

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Speaker 5: only cancer episodes that we are ever going to do.

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Speaker 5: We kind of think of this as like laying a

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Speaker 5: baseline so that in future episodes, as we explore individual cancers,

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Speaker 5: everyone's on the same page.

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Speaker 1: To start with, so we like, oh, so, what's the

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Speaker 1: difference between chemotherapy and surgery and radiation? You already have

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Speaker 1: episode yeah, yeah, And as you'll hear throughout the series,

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Speaker 1: as you've already heard, no two cancers or experiences with

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Speaker 1: cancer are exactly alike. And so again, we just want

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Speaker 1: to really express our gratitude to the first hand account

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Speaker 1: providers for giving us kind of a snapshot or a

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Speaker 1: sneak peek into just some of the myriad ways that

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Speaker 1: cancer can affect our lives, can affect the lives of

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Speaker 1: people who have been diagnosed with cancer, who are undergoing

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Speaker 1: cancer treatment, who have become unexpected care givers, whose friends

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Speaker 1: or loved ones are undergoing cancer treatment. It's this is like,

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Speaker 1: this is so important, especially because you and I talk

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Speaker 1: about cancer from a biological perspective. Right we're talking I

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Speaker 1: mean a little bit of history, biology, evolution, but we're

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Speaker 1: not talking about the experience as a cancer patient or

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Speaker 1: somebody who has you know, a loved one with cancer,

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Speaker 1: and so thank.

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Speaker 6: You, thank you.

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Speaker 5: We can't say thank you enough, like your first hand accounts,

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Speaker 5: I think really make this series and make our podcast

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Speaker 5: in general what it is.

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Speaker 6: So thank you, truly, truly.

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Speaker 1: Okay, it iss a second to lust. I have an

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Speaker 1: extra piece of yeah, I can just I'll do that

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Speaker 1: business right now before we do the final piece.

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Speaker 5: I'm excited, So tell us please sure.

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Speaker 1: Okay, So I wanted to shout out a couple episodes

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Speaker 1: of Advances and Care, so you know, in this series,

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Speaker 1: in this podcast will kill you. We're doing cancer from

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Speaker 1: like a very big picture perspective, and so if you

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Speaker 1: want to get some nitty gritty bits of information, there

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Speaker 1: are a couple of episoddes of Advances and Care that

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Speaker 1: I want to shout out.

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Speaker 7: This is the other podcast that a podcast I host, yeah,

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Speaker 7: that features interviews with and also just like experiences with

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Speaker 7: physicians and physicians scientists at New York Presbyterian.

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Speaker 1: And and so there are some just like such exciting

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Speaker 1: research that's being done and it's so cool to hear

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Speaker 1: about it like firsthand. So there's an episode episode thirty

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Speaker 1: seven features doctor Magna Trevetti who's investigating chemotherapy induced peripheral

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Speaker 1: neuropathy and how to better understand it, which is such

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Speaker 1: a significant aspect of like side effects of chemotherapy, so

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Speaker 1: really cool, important research. And then another one that's really recent.

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Speaker 1: I believe it came out last week well you know

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Speaker 1: it will come out in the future last week before

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Speaker 1: after this episode. Yeah, and it highlights work done by

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Speaker 1: doctor Scott Tagawa on the use of radiocen therapy in

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Speaker 1: metastatic prostate cancer. Really cool stuff. I just didn't I

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Speaker 1: didn't even know about it, and I was like, this

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Speaker 1: is the future. Yeaheah, that's it's amazing. So anyway, you

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Speaker 1: can find Advances and care wherever you get your podcasts.

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Speaker 5: Check it out, check it out. Okay, now for actually

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Speaker 5: the last piece of business, it's quarantine Guarantee.

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Speaker 1: Needs it's Plassy Berrita quarantine time exactly.

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Speaker 5: We announced at the first episode of this series that

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Speaker 5: we're not going to be putting alcohol in our quarantinies

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Speaker 5: any more.

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Speaker 1: Yeah, but it's a.

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Speaker 5: Great name, so we're sticking with it. What are we

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Speaker 5: drinking this week eron.

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Speaker 1: The Crab, It's an Alpagato. Check out our social media

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Speaker 1: to see me attempt to make it.

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Speaker 5: Yeah, great, it'll be great. I think you'll be able

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Speaker 5: to pull it off.

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Speaker 1: We'll see. I could try. I could try. Also, check

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Speaker 1: out our website This podcast will kill You dot com

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Speaker 1: for lots of cool things, transcripts, contact us, form first

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Speaker 1: hand account form stuff like that.

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Speaker 5: Yeah, check it out, merch, Patreon, et cetera. A rate review, subscribe.

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Speaker 5: We're on YouTube.

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Speaker 1: Should we done? Let's take a quick break and then

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Speaker 1: get into it. Get into it, okay.

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Speaker 8: On October twentieth, twenty twenty four, I crossed the finish

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Speaker 8: line at the Amsterdam Marathon, qualifying for both the Chicago

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Speaker 8: and Boston marathons. Six weeks later, I found a lump

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Speaker 8: in my armpit, and two days after Christmas, I got

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Speaker 8: the call I had breast cancer. Looking back, I missed

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Speaker 8: the warning signs. In August, I noticed a small cyst

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Speaker 8: under my right nipple. I'd had cysts before, so I ignored it,

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Speaker 8: waiting for it to go away. Later, my nipple started

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Speaker 8: a flatten. That's a symptom I didn't recognize, and I

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Speaker 8: still didn't act. But when I found that lump, I

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Speaker 8: called my doctor. The diagnosis stage two HR positive hurtuo

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Speaker 8: negative invasive doctal carcinoma, the most common type of breast cancer,

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Speaker 8: except I'm a man, and that made it rare. My

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Speaker 8: initial treatment plan was the standard chemotherapy followed by surgery

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Speaker 8: and radiation, but as a patient, I wanted to understand

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Speaker 8: my options. The search for a second opinion led me

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Speaker 8: to the Dana Farber Cancer Institute in Boston and their

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Speaker 8: program for breast cancer in men. There, I joined the

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Speaker 8: Ethyn clinical trial, which replaced chemotherapy with endocrine therapy to

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Speaker 8: study the efficacy of various drug combinations, specifically for men.

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Speaker 8: I became Ethan participant number nine, and that decision gave

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Speaker 8: me clarity, direction, and purpose. I wasn't just benefiting from

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Speaker 8: the research. I became the research. It turned my breast

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Speaker 8: cancer nightmare into an adventure, and it gave me something

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Speaker 8: else too. It gave me the chance to live a

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Speaker 8: normal life. During treatment. Over the next nineteen weeks, I

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Speaker 8: was treated with a combination of medications, an aromatase inhibitor,

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Speaker 8: gonatal suppression, and a CDK four to six inhibitor, and

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Speaker 8: I kept running, even completing four marathons during treatment. That's

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Speaker 8: something I would not have been able to do if

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Speaker 8: I'd been on chemotherapy. My doctor's reactions were priceless when

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Speaker 8: I told him about the race, as I'd run since

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Speaker 8: our last visit. In June, I had a successful mestectomy

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Speaker 8: and removal of six lymph nodes, and that was followed

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Speaker 8: by radiation. As soon as I was cleared, I jumped

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Speaker 8: back into marathon training. I had Chicago coming up in

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Speaker 8: October and New York City in November, where I had

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Speaker 8: a charity bid for the Breast Cancer Research Foundation. That's

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Speaker 8: the organization that funded the Ethink clinical trial, and I'm

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Speaker 8: all set to run Boston this April. Breast cancer and

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Speaker 8: men is rare, roughly one percent of all breast cancer cases.

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Speaker 8: Most men don't even know they can get it and

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Speaker 8: wait too long to be checked. Awareness in male specific

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Speaker 8: research is needed to save these men's lives like it's

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Speaker 8: saving mine.

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Speaker 9: My name is Yalla, Europe and in September twenty twenty two,

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Speaker 9: I was forty one years old and I was diagnosed

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Speaker 9: with stage three colon cancer. I had surgery to remove

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Speaker 9: the cancer and two very large ovariansysts, and my ovaries

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Speaker 9: as well, and after that I did rounds of chemo

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Speaker 9: and was told to consider myself cured. I would go

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Speaker 9: in for a CT scan every year as a follow up,

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Speaker 9: and the first year everything looked great, but in late

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Speaker 9: twenty twenty four the scan was showing some irregularities that

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Speaker 9: needed additional scans, which led to a pet CT scan,

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Speaker 9: and that came back with the result that my original

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Speaker 9: colon cancer had metastasized to the top of my vagina

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Speaker 9: and was spreading in my pelvis. In March twenty twenty five,

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Speaker 9: I went in to have massive surgery to remove my bladder,

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Speaker 9: my uterus, my rectum, some of my intestines, and appendix,

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Speaker 9: and I woke up from surgery with a eurostomy and

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Speaker 9: a colostomy. I still have yet to accept either of these,

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Speaker 9: and the eurostomy has been difficult to deal with since

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Speaker 9: we've discovered that I also have diabetes incibitus, which is

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Speaker 9: a very bad combination with a eurostomy. As I was

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Speaker 9: recovering from surgery, I had a new CC scan for

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Speaker 9: my lungs, which showed lots of nodules that they weren't

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Speaker 9: able to diagnose at that point. These nodules turn out

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Speaker 9: to be the original colon cancer that has metastasized to

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Speaker 9: my lungs. This means that my cancer is now incurable

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Speaker 9: and I am going to die from this At some point.

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Speaker 1: Last week, we looked at cancer through an evolutionary lens.

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Speaker 1: Rather than seeing cancer as solely the enemy in an

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Speaker 1: unrelenting war, we asked a different question, what does it

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Speaker 1: mean to be a cancer cell? And why does it

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Speaker 1: exist in the first place. That perspective shift allowed us

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Speaker 1: to explore new ways to approach cancer treatment, not just

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Speaker 1: by fighting evolution, but by working with it, and it

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Speaker 1: helped us to better understand why many standard therapies may

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Speaker 1: show initial promise but then stop working for an individual.

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Speaker 1: Over the past century and a half, cancer therapy has

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Speaker 1: undergone a profound transformation, like truly hard to wrap your

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Speaker 1: head around.

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Speaker 5: Just how profound, even in the last like ten years, Yes, amazing, right, yeah.

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Speaker 1: But for most of human history, cancer was rarely treated

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Speaker 1: and never cured. Wow, right, Like that alone is monumental,

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Speaker 1: and in part it's because it remained such a mystery

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Speaker 1: to scientists and physicians. Treatment developments in the twentieth century

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Speaker 1: inspired initial hope that a cure for cancer, for all

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Speaker 1: cancer was possible. After all, if we can put a

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Speaker 1: man on the moon, why couldn't we cure cancer. The

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Speaker 1: answer is actually fairly straightforward. Besides the nature of cancer itself,

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Speaker 1: which we learned about in episode one and episode two,

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Speaker 1: the moon landing was guided by decades of foundational basic research,

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Speaker 1: whereas cancer research up through the nineteen seventies had been

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Speaker 1: centrally focused on treatment development without fully understanding the nature

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Speaker 1: of cancer itself.

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Speaker 5: They're like underpinnings of that biology.

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Speaker 1: Yeah, that makes the genetics driving cancer, the different mutation, yeah,

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Speaker 1: all these different pathways. And in fact, some early chemotherapy

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Speaker 1: researchers actually disdained funding for basic research, seeing it as

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Speaker 1: less urgent than devising treatments for the patients who were

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Speaker 1: dying in front of them, and they had seen dying

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Speaker 1: over and over again. And you know, I think my

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Speaker 1: initial reaction was, like, basic research is the backbone to everything.

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Speaker 1: It is how we understand the world. Is you need

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Speaker 1: basic research for application, bottom line. But I also do

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Speaker 1: understand that frustration and that perspective and that patients because

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Speaker 1: you know, if you think about it, these clinical oncologists

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Speaker 1: were for years watching and their patients die in front

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Speaker 1: of them, extremely limited in their ability to do anything

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Speaker 1: to save their patients or even just lessen their pain.

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Speaker 5: And it is true that there are so many medicines

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Speaker 5: that we use that we don't fully understand the mechanisms

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Speaker 5: of how exactly they're working. And they do a really

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Speaker 5: good job, and so why do we need to do

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Speaker 5: I can understand totally. I don't feel it, but I

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Speaker 5: understand that absolutely absolutely.

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Speaker 1: I think that another aspect of this is that cancer,

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Speaker 1: because of their limited ability to do anything, it challenges

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Speaker 1: your role, your identity as healer.

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Speaker 8: Yeah.

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Speaker 1: If you go into medicine to save lives and your

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Speaker 1: face with this thing that is not letting you do that,

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Speaker 1: and it's like, what, I need to do something about this? Yeah, right.

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Speaker 1: But as the decades went on, and as many new

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Speaker 1: treatments failed to live up to initial expectations, it grew

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Speaker 1: increasingly clear that if we wanted to understand why treatments

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Speaker 1: failed or to devise improved treatments, basic research was absolutely necessary.

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Speaker 1: So today I'm going to tell the story of the

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Speaker 1: three main treatment modalities that emerged over this period. Prior

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Speaker 1: to the extensive incorporation of basic research. And these are

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Speaker 1: not the only ways that we treat cancer. I know

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Speaker 1: that you're going to take us through many other really

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Speaker 1: exciting therapies, but their development of these three has profoundly

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Speaker 1: shaped the way that we think about cancer and how

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Speaker 1: we continue our search for better therapies. Part one surgery.

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Speaker 1: From the earliest descriptions of cancer until the last years

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Speaker 1: of the nineteenth century, the very last years, surgery represented

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Speaker 1: the primary, if not the only, method of cancer therapy

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Speaker 1: that showed any degree of success, but its popularity was uneven,

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Speaker 1: and this is for good reason. Consider this eighteenth century

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Speaker 1: so seventeen hundred's description of mastectomies. This is pre anesthesias,

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Speaker 1: pre aniseptic technique.

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Speaker 5: I'm just like remembering the butchering art and like, yes,

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Speaker 5: not good.

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Speaker 1: It's that's his understatement. Yeah, quote, many females can stand

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Speaker 1: the operation with the greatest courage and without hardly moaning

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Speaker 1: at all. Others, however, make such a clamor that they

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Speaker 1: may dishearten even the most undaunted surgeon and hinder the operation.

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Speaker 1: To perform the operation, the surgeon should be steadfast and

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Speaker 1: not allow himself to become discomforted by the cries of

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Speaker 1: the patient end quote.

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Speaker 6: Oh Man oh Man, oh Man, oh Man, oh Man.

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Speaker 1: Yeah. So, rather than submitting themselves to that ordeal, many

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Speaker 1: patients and physicians turned towards systemic treatments, which typically included

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Speaker 1: a toxic chemical such as mercury, lead, or arsenic, which

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Speaker 1: were our first chemotherapies. In a sense, wow, you know,

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Speaker 1: chemical cures or chemical treatments definitely not cures. When anesthesia

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Speaker 1: and antiseptic technique came on the scene in eighteen forty

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Speaker 1: six and eighteen sixty seven, respectively, surgery transformed into a science.

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Speaker 1: Surgeons could measure their progress. They could assess what worked

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Speaker 1: and what didn't work, And as more and more cancer

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Speaker 1: patients went under the knife and lived to tell about it,

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Speaker 1: surgeons noticed that while many people recovered completely, in many

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Speaker 1: more the cancer recurred, it came back. The regrowth seemed

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Speaker 1: concentrated on the margins of the original surgery. It was

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Speaker 1: like tiny seeds of invisible cancer had just been left

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Speaker 1: behind to then continue to grow. The answers to this

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Speaker 1: problem seemed straightforward, right, like just cut away more during

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Speaker 1: the initial surgery. With that, radical surgery was born, Okay,

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Speaker 1: Surgeons in the late nineteenth and early twentieth centuries pushed

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Speaker 1: the metaphoric and literal borders of excision as far as

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Speaker 1: they could, and most major solid tumors became fair game,

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Speaker 1: even those that had previously been seen as too deep

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Speaker 1: or too risky to attempt removal. Breast cancer, which had

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Speaker 1: challenged every physician that attempted to treat it, became an

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Speaker 1: early target of this radical approach, with many surgeons, notably

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Speaker 1: William Halstead, advocating for wider and wider margins, first to

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Speaker 1: the axillary lymph nodes, so the ones in your armpit

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Speaker 1: were removed, then muscle, then maybe even bone. The question

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Speaker 1: became how much could we remove while still preserving life? Wow,

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Speaker 1: radical mistectomies may preserve life if you survived the initial

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Speaker 1: surgery itself and the recovery period, but at what cost

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Speaker 1: to quality of life?

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Speaker 3: Right?

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Speaker 1: That didn't seem to rank too highly for advocates of

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Speaker 1: the radical approach, many of which who viewed a more

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Speaker 1: conservative surgical approach as a quote unquote mistaken kindness. That's

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Speaker 1: what it was often caused, because it was.

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Speaker 5: Like, I think you're being kind, but you're just leaving

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Speaker 5: cancer cancer behind.

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Speaker 1: Exactly. Amid the early twentieth century hype surrounding radical mystectomies,

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Speaker 1: a few dissenting voices began to be heard. Their question

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Speaker 1: was simple, is that kindness always mistaken? As it turns out, no,

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Speaker 1: the push towards radical mistectomies was initially spurred on by

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Speaker 1: observations of tumor recurrence, and it was reinforced by armchair logic.

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Speaker 1: It just seemed to make sense, right, You're like, of

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Speaker 1: course we want to cut more. Of course we want

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Speaker 1: to cut more. So it wasn't supported by statistical things,

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Speaker 1: at least initially that approach, the beginning of that approach,

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Speaker 1: And to be fair, the state of breast cancer diagnosis

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Speaker 1: during the late eighteen hundreds was nothing like it is today.

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Speaker 1: There was no screening, so very early stages were unlikely

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Speaker 1: to be detected, and diagnosis often followed clinical symptoms. So

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Speaker 1: by the time that you actually went to the doctor

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Speaker 1: to address something, you were like.

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Speaker 6: It's already pretty far in fast. Yeah.

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Speaker 1: So for example, in one case report, Halstea describes an

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Speaker 1: eight centimeter breast tumor as small. Oh wow, So that

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Speaker 1: is kind of like just shifting our perspective in what

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Speaker 1: breast cancer Now.

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Speaker 5: We're talking about like a matter of millimeters that you

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Speaker 5: see on a mammogram that you would never be able

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Speaker 5: to feel.

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Speaker 1: Right, Yeah, but eight centimeters being small? Wow, And the

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Speaker 1: data backing up this approach is not entirely convincing, at

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Speaker 1: least not for all cases. Three or five year survival

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Speaker 1: rates very drastically depending on how advanced the cancer was.

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Speaker 1: Staging was an emerging tool at this time, and it

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Speaker 1: left some people to question radical therapy as the universal

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Speaker 1: approach that we should use for everything. So, for localized,

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Speaker 1: slow growing tumors, a more a radical approach resulted in

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Speaker 1: greater tissue loss and disability than a more conservative surgery,

438
00:25:40,280 --> 00:25:43,480
Speaker 1: which would have likely led to the same outcome. Right,

439
00:25:42,880 --> 00:25:46,000
Speaker 1: You didn't need to cut out as much as much

440
00:25:46,160 --> 00:25:48,600
Speaker 1: because this was slow growing and wasn't going to cause

441
00:25:48,600 --> 00:25:51,240
Speaker 1: those problems down the line. But for those with more

442
00:25:51,280 --> 00:25:55,320
Speaker 1: advanced cancer, radical mistectomies seemed unlikely to remove all cancero

443
00:25:55,359 --> 00:25:57,560
Speaker 1: is tissue. It had already spread. Its not going to

444
00:25:57,080 --> 00:25:59,960
Speaker 1: be any size, right, and so it led one surge.

445
00:26:00,080 --> 00:26:03,720
Speaker 1: And to conclude, quote radical mistectomies, greater trauma is not

446
00:26:03,920 --> 00:26:07,960
Speaker 1: justified by greater cure rates. End quote. We can make

447
00:26:08,000 --> 00:26:10,120
Speaker 1: this surgery more and more painful, but it's not going

448
00:26:10,160 --> 00:26:14,320
Speaker 1: to actually increase survival. But if a tumor was small

449
00:26:14,400 --> 00:26:18,240
Speaker 1: at the time of surgery and aggressive and had not spread, yeah,

450
00:26:18,280 --> 00:26:20,800
Speaker 1: a radical mistectomy might have been the way to go,

451
00:26:20,920 --> 00:26:24,040
Speaker 1: might be the way to go. There was no one

452
00:26:24,560 --> 00:26:28,160
Speaker 1: right answer. And again this like highlights this theme as

453
00:26:28,280 --> 00:26:33,480
Speaker 1: cancer of cancer being incredibly unique and requiring a personalized approach.

454
00:26:34,359 --> 00:26:37,240
Speaker 1: But despite the mostly unconvincing data and support of radical

455
00:26:37,240 --> 00:26:41,440
Speaker 1: mistectomies and the robust opposition to it, this approach dominated

456
00:26:41,480 --> 00:26:45,240
Speaker 1: surgical treatment for breast cancer until the nineteen seventies or

457
00:26:45,280 --> 00:26:49,199
Speaker 1: so wow. Yeah, and in the nineteen eighties also, But

458
00:26:49,359 --> 00:26:53,280
Speaker 1: like it did fade over time. But then this was

459
00:26:53,320 --> 00:26:55,879
Speaker 1: sort of more of the turning point where like a

460
00:26:55,880 --> 00:27:00,440
Speaker 1: more balanced and personalized approach became you know what to do?

461
00:27:00,720 --> 00:27:03,560
Speaker 1: So and there were there were many things that changed this.

462
00:27:04,200 --> 00:27:07,280
Speaker 1: The first was pushback from feminist groups who demanded that

463
00:27:07,280 --> 00:27:11,840
Speaker 1: physicians consider the patient in these major treatment decisions. And

464
00:27:11,880 --> 00:27:14,240
Speaker 1: the second was a large scale study published in the

465
00:27:14,280 --> 00:27:18,880
Speaker 1: nineteen eighties that compared survival, remission, and morbidity between radical

466
00:27:18,920 --> 00:27:22,440
Speaker 1: and non radical approaches that showed no difference in survival

467
00:27:22,480 --> 00:27:27,560
Speaker 1: and remission, but greater morbidity with radical mistectomies. And then

468
00:27:27,600 --> 00:27:30,199
Speaker 1: the third thing was that there were better advancements in

469
00:27:30,240 --> 00:27:33,920
Speaker 1: cancer diagnosis, so like via x X ray and CT scans,

470
00:27:34,040 --> 00:27:37,280
Speaker 1: and then also treatment like radiation and chemotherapy had come

471
00:27:37,320 --> 00:27:39,040
Speaker 1: onto the scene, right, and so it was like, we

472
00:27:39,119 --> 00:27:43,359
Speaker 1: can we can do do other things than a radical approach. Yeah.

473
00:27:43,440 --> 00:27:46,520
Speaker 1: And so while for this surgical section I focused mostly

474
00:27:46,560 --> 00:27:49,760
Speaker 1: on breast cancer, surgery was an integral and often the

475
00:27:49,800 --> 00:27:53,040
Speaker 1: only treatment for many types of cancers throughout the late

476
00:27:53,080 --> 00:27:56,560
Speaker 1: eighteen hundreds, and a radical approach was justified in some

477
00:27:56,640 --> 00:28:01,240
Speaker 1: cases more than others. Today, surgery remains a cornerstone of

478
00:28:01,280 --> 00:28:08,000
Speaker 1: cancer treatment, along with radiation and chemotherapy. Part two radiation, Okay,

479
00:28:08,280 --> 00:28:10,119
Speaker 1: doing these in chronologically.

480
00:28:09,480 --> 00:28:10,040
Speaker 5: I love this.

481
00:28:10,160 --> 00:28:14,080
Speaker 1: Yeah. In the eighteen nineties, around the same time that

482
00:28:14,200 --> 00:28:18,640
Speaker 1: Halstead was spreading the word about radical mistectomies, two massive

483
00:28:18,920 --> 00:28:22,760
Speaker 1: breakthroughs by three scientists were about to change the world forever.

484
00:28:23,400 --> 00:28:28,240
Speaker 1: Like not an exaggeration. The first William Ropkin's discovery of

485
00:28:28,400 --> 00:28:32,199
Speaker 1: X rays in November eighteen ninety five, and the second

486
00:28:32,400 --> 00:28:36,679
Speaker 1: Marie Sklodowska Curie and Pierre Curie's discovery of radium and

487
00:28:36,720 --> 00:28:40,680
Speaker 1: polonium in eighteen ninety eight. It's amazing to me how

488
00:28:40,880 --> 00:28:42,960
Speaker 1: those two things happened with just in a few.

489
00:28:42,880 --> 00:28:44,320
Speaker 6: Years, a couple of years apart, I know.

490
00:28:44,480 --> 00:28:48,720
Speaker 1: Yes, And within a few years of these discoveries, physicians

491
00:28:48,760 --> 00:28:53,200
Speaker 1: were utilizing radiation as a treatment for cancer, really, which

492
00:28:53,240 --> 00:28:57,360
Speaker 1: is probably like the fastest turnaround time between initial discovery

493
00:28:57,360 --> 00:28:59,280
Speaker 1: and application for anything ever.

494
00:29:00,200 --> 00:29:00,400
Speaker 6: Wild.

495
00:29:00,400 --> 00:29:03,200
Speaker 5: They were just like everything, Wow, this thing, you could

496
00:29:03,360 --> 00:29:04,160
Speaker 5: kill things with it.

497
00:29:05,360 --> 00:29:08,920
Speaker 1: That's exactly what it was, Okay, yeah, yeah. And these

498
00:29:08,920 --> 00:29:11,520
Speaker 1: were not like the kinds of scientific discoveries like I

499
00:29:11,520 --> 00:29:13,440
Speaker 1: feel like we're so used on the podcast being like

500
00:29:13,480 --> 00:29:16,400
Speaker 1: and then somebody discovered this and then they were a

501
00:29:16,440 --> 00:29:20,560
Speaker 1: discovered in this obscure journal right rais and years later Yeah. No,

502
00:29:20,800 --> 00:29:25,760
Speaker 1: It just instantly excited the broader scientific and medical community,

503
00:29:26,240 --> 00:29:28,160
Speaker 1: and there were there was no shortage of people who

504
00:29:28,160 --> 00:29:31,880
Speaker 1: were willing to work on X rays and radium. Wow, yep.

505
00:29:32,720 --> 00:29:35,800
Speaker 1: And it didn't take long for these new radiation scientists

506
00:29:35,800 --> 00:29:41,960
Speaker 1: to notice strange rashes after exposure to radiation, strange side effects,

507
00:29:42,040 --> 00:29:45,240
Speaker 1: things like your hair would fall out, you would get

508
00:29:45,280 --> 00:29:49,480
Speaker 1: these swollen skin, some kind of rash would emerge rather

509
00:29:49,520 --> 00:29:53,760
Speaker 1: than evoking alarm. That alarm would come later. This led

510
00:29:53,800 --> 00:29:56,720
Speaker 1: people to wonder whether radiation could be used to kill

511
00:29:56,720 --> 00:30:00,640
Speaker 1: a harmful tissue or cells like cancerous tumors or bacteria.

512
00:30:01,720 --> 00:30:04,719
Speaker 1: There's some controversy over who should hold the rightful title

513
00:30:04,800 --> 00:30:09,160
Speaker 1: of first radiation therapist, which shows just how popular radiation

514
00:30:09,280 --> 00:30:13,120
Speaker 1: therapy was in the early years, like right after its discovery.

515
00:30:13,480 --> 00:30:16,640
Speaker 1: But from my reading, the front runner appeared. There are

516
00:30:16,680 --> 00:30:20,160
Speaker 1: like multiple papers on this. The front runner appears to

517
00:30:20,200 --> 00:30:24,480
Speaker 1: be a French physician, Victor Despines. Okay if that's I

518
00:30:24,480 --> 00:30:27,680
Speaker 1: don't know how you say his name, despig nes t

519
00:30:27,880 --> 00:30:32,360
Speaker 1: do it? Yeah, we were talking about it. Despine's inspiration

520
00:30:32,480 --> 00:30:36,440
Speaker 1: came from early reports demonstrating the bacteriocytal effects of X rays.

521
00:30:37,280 --> 00:30:42,200
Speaker 1: Guinea pigs inoculated with tuberculosis and then subsequently radiated did

522
00:30:42,240 --> 00:30:46,160
Speaker 1: not develop the disease. Okay, okay, So if you think

523
00:30:46,160 --> 00:30:49,400
Speaker 1: back to the first episode in this series, cancer was

524
00:30:49,560 --> 00:30:53,560
Speaker 1: commonly thought to be caused by pathogens around this time,

525
00:30:54,280 --> 00:30:58,320
Speaker 1: so operating under this assumption in July of eighteen ninety six,

526
00:30:59,120 --> 00:31:00,920
Speaker 1: let me just remind you that X.

527
00:31:00,960 --> 00:31:01,520
Speaker 2: Ray in.

528
00:31:03,520 --> 00:31:06,920
Speaker 5: Ninety five wow, Wow than a year yep.

529
00:31:07,960 --> 00:31:10,560
Speaker 1: Despines used X rays to treat a fifty two year

530
00:31:10,600 --> 00:31:13,280
Speaker 1: old patient of his who had stomach cancer. He traced

531
00:31:13,320 --> 00:31:16,800
Speaker 1: the outline of the tumor to track progress. At the

532
00:31:16,920 --> 00:31:21,400
Speaker 1: end of treatment, Despines claimed improvement, not cure, but his

533
00:31:21,480 --> 00:31:25,080
Speaker 1: conclusions have since been called into question. Whether he had

534
00:31:25,160 --> 00:31:29,800
Speaker 1: success or not he probably didn't, whether his scientific reasoning

535
00:31:30,000 --> 00:31:37,720
Speaker 1: was sound It wasn't. Definitely wasn't. Victor Despin's was likely

536
00:31:37,760 --> 00:31:40,840
Speaker 1: the first person to apply radiation to a patient with

537
00:31:40,920 --> 00:31:44,520
Speaker 1: the intention of shrinking a cancerous tumor. How interesting isn't

538
00:31:44,520 --> 00:31:48,920
Speaker 1: that not Emil grub Grub who was often claimed even

539
00:31:48,960 --> 00:31:50,920
Speaker 1: by me, I was like, wait a second, I didn't

540
00:31:50,960 --> 00:31:52,240
Speaker 1: think it was this. I thought it was this other

541
00:31:52,280 --> 00:31:54,200
Speaker 1: guy who did it, and I went back to our

542
00:31:54,240 --> 00:32:00,600
Speaker 1: radiation notes from years ago, and no, Well, his story

543
00:32:00,640 --> 00:32:03,120
Speaker 1: has been discarded because the first time he wrote about

544
00:32:03,160 --> 00:32:05,880
Speaker 1: it was not at the time, but like thirty something

545
00:32:05,960 --> 00:32:08,400
Speaker 1: years later he was like, oh, yeah, that was me.

546
00:32:08,520 --> 00:32:09,120
Speaker 6: I was the first.

547
00:32:09,120 --> 00:32:12,200
Speaker 1: I did it because I had this idea. Okay, there's

548
00:32:12,240 --> 00:32:17,320
Speaker 1: no like, no it yeah, okay, so it doesn't matter.

549
00:32:17,360 --> 00:32:19,920
Speaker 1: I like the reason I find this so interesting, This

550
00:32:20,040 --> 00:32:23,320
Speaker 1: debate over priority is because it shows just how excited

551
00:32:23,360 --> 00:32:26,120
Speaker 1: people were about radiation. There were so many, many different

552
00:32:26,160 --> 00:32:30,600
Speaker 1: things at the time. Yeah, radiation, I mean it was

553
00:32:30,800 --> 00:32:33,680
Speaker 1: it felt magical. It was science made magic, right. It

554
00:32:33,720 --> 00:32:36,800
Speaker 1: allowed you to peer inside the body without using a knife,

555
00:32:36,840 --> 00:32:39,640
Speaker 1: It made things glow in the dark, It emitted heat,

556
00:32:39,720 --> 00:32:45,240
Speaker 1: It killed bacteria. What couldn't this precious substance do. Over

557
00:32:45,240 --> 00:32:49,040
Speaker 1: the late eighteen hundreds and early nineteen hundreds, lab based

558
00:32:49,080 --> 00:32:53,400
Speaker 1: empirical science had established itself as the standard for developing

559
00:32:53,480 --> 00:32:56,560
Speaker 1: and testing new treatments, So there was this increasing pressure

560
00:32:56,680 --> 00:33:00,400
Speaker 1: to demonstrate the efficacy and safety to a lesser degree

561
00:33:00,600 --> 00:33:04,920
Speaker 1: of a drug before administering it. Okay, For some physicians,

562
00:33:05,280 --> 00:33:09,200
Speaker 1: this was an unwelcome affront that challenged or undermined the

563
00:33:09,240 --> 00:33:13,160
Speaker 1: traditional role of doctor as healer. Like what are you doing?

564
00:33:13,320 --> 00:33:13,520
Speaker 8: Right?

565
00:33:14,040 --> 00:33:17,080
Speaker 1: If treatments were being developed and tested by scientists in

566
00:33:17,200 --> 00:33:20,680
Speaker 1: labs and then given to physicians to administer, didn't that

567
00:33:20,920 --> 00:33:25,240
Speaker 1: just make physicians glorified drug dispensers. What were they actually

568
00:33:25,320 --> 00:33:29,080
Speaker 1: doing then, if they weren't testing out therapies on their patients?

569
00:33:29,120 --> 00:33:30,600
Speaker 5: So interesting, Aaron.

570
00:33:30,680 --> 00:33:33,360
Speaker 1: Yeah, I mean also painting with a broadbrush et cetera.

571
00:33:33,480 --> 00:33:36,360
Speaker 1: But I do think that there was initial pushback against

572
00:33:36,480 --> 00:33:40,600
Speaker 1: this the science in medicine and like using statistics rather

573
00:33:40,640 --> 00:33:45,000
Speaker 1: than experience. Okay, you know, an individual experience. Yeah. And

574
00:33:45,080 --> 00:33:48,560
Speaker 1: so with radiation, physicians were not content to just sit

575
00:33:48,640 --> 00:33:51,040
Speaker 1: around and wait for the scientists to figure it out.

576
00:33:51,480 --> 00:33:53,400
Speaker 1: They were going to forge ahead.

577
00:33:53,080 --> 00:33:56,720
Speaker 7: With radiation therapy regardless, regardless, they're like, we got this.

578
00:33:57,040 --> 00:34:03,080
Speaker 1: Yeah. And because radiation was accessible to physicians, and this

579
00:34:03,200 --> 00:34:05,800
Speaker 1: is reflected in early case reports, so most experiments with

580
00:34:05,920 --> 00:34:09,400
Speaker 1: radiation therapy were carried out by physicians in private practice

581
00:34:09,520 --> 00:34:14,080
Speaker 1: rather than those in academia or public institutions. Yeah. And

582
00:34:14,120 --> 00:34:16,799
Speaker 1: because no one could yet explain how it worked, it

583
00:34:16,880 --> 00:34:20,960
Speaker 1: added to the quote unquote professional mystery of medical practice,

584
00:34:21,080 --> 00:34:25,719
Speaker 1: reinforcing this boundary between physician and patient. And to be fair,

585
00:34:25,719 --> 00:34:28,880
Speaker 1: these physicians weren't drawn to radiation therapy solely because it

586
00:34:29,320 --> 00:34:32,719
Speaker 1: lent them this aura of like expertise or wanted to

587
00:34:32,760 --> 00:34:35,600
Speaker 1: help that they wanted to help their patients. They were

588
00:34:35,600 --> 00:34:40,040
Speaker 1: sold on the hope that radiation promised. Many patients who

589
00:34:40,080 --> 00:34:44,680
Speaker 1: received radiation therapy truly underwent a transformation. Their pain lessened,

590
00:34:44,760 --> 00:34:48,480
Speaker 1: their tumors shrink disfiguring rashes disappeared, and not just when

591
00:34:48,480 --> 00:34:50,640
Speaker 1: it came to cancer, but like all sorts of ailments

592
00:34:50,680 --> 00:34:55,600
Speaker 1: where radiation was used. With radiation therapy, physicians could take action,

593
00:34:56,000 --> 00:35:02,080
Speaker 1: especially in cases that previously had appeared beyond their help ability. Gradually,

594
00:35:02,200 --> 00:35:06,360
Speaker 1: as case reports of radiation therapy accumulated, guidelines were created,

595
00:35:06,480 --> 00:35:09,440
Speaker 1: like how much radiation to administer, how often, how long

596
00:35:09,520 --> 00:35:13,560
Speaker 1: that sort of thing, what types of different yeah, and

597
00:35:13,719 --> 00:35:18,840
Speaker 1: hazards were recognized. Radiation, it seemed, could not only shrink tumors,

598
00:35:19,160 --> 00:35:23,480
Speaker 1: but cause them, like with radical surgery. Initial enthusiasm for

599
00:35:23,560 --> 00:35:28,240
Speaker 1: radiation therapy gave way to tempered expectations. It's the same

600
00:35:28,280 --> 00:35:32,239
Speaker 1: thing over and over again. But combining these two therapies

601
00:35:32,280 --> 00:35:35,560
Speaker 1: improved outcomes. But by the nineteen thirties, those outcomes had

602
00:35:35,640 --> 00:35:39,000
Speaker 1: largely plateaued. It was like, we've kind of reached our point.

603
00:35:39,080 --> 00:35:42,000
Speaker 5: We've come as far as we can with this these technologies.

604
00:35:42,600 --> 00:35:49,480
Speaker 1: Yeah, Part three chemotherapy. All right, So, this quote from

605
00:35:49,480 --> 00:35:53,279
Speaker 1: a nineteen thirty seven article in Fortune magazine sums up

606
00:35:53,320 --> 00:35:56,600
Speaker 1: the state of cancer therapy at the time. Quote. The

607
00:35:56,640 --> 00:36:00,319
Speaker 1: startling fact is that no new principle of treatment, whether

608
00:36:00,400 --> 00:36:04,200
Speaker 1: for cure, or prevention has been introduced, the methods of

609
00:36:04,239 --> 00:36:07,960
Speaker 1: treatment have become more efficient and more humane. Crude surgery

610
00:36:08,000 --> 00:36:11,520
Speaker 1: without anesthesia or as acepsis has been replaced by modern

611
00:36:11,640 --> 00:36:16,799
Speaker 1: painless surgery with its exquisite technical refinement. Biting caustics that

612
00:36:17,000 --> 00:36:19,760
Speaker 1: ate into the flesh of past generations of cancer patients

613
00:36:19,840 --> 00:36:23,239
Speaker 1: have been obsoleste by radiation with X ray and radium.

614
00:36:23,960 --> 00:36:28,000
Speaker 1: But the fact remains that the cancer cure still includes

615
00:36:28,080 --> 00:36:32,920
Speaker 1: only two principles, the removal and destruction of disease tissue.

616
00:36:33,120 --> 00:36:37,240
Speaker 1: No other means have been proved end quote nineteen seventeen

617
00:36:37,280 --> 00:36:41,640
Speaker 1: thirty seven. Okay, the stagnation in cancer treatments was not

618
00:36:41,760 --> 00:36:44,920
Speaker 1: due to a lack of will or need. As medicine

619
00:36:44,960 --> 00:36:48,520
Speaker 1: made headway against infectious diseases, cancer rose to prominence as

620
00:36:48,560 --> 00:36:52,160
Speaker 1: a leading cause of disability and death in many countries

621
00:36:52,200 --> 00:36:56,160
Speaker 1: around the world, but the funding landscape for medical research

622
00:36:56,360 --> 00:37:00,319
Speaker 1: lagged behind the shifting trends in mortality, and cancer had

623
00:37:00,400 --> 00:37:03,160
Speaker 1: ranked consistently low on the priority list for a number

624
00:37:03,160 --> 00:37:06,560
Speaker 1: of years. That Fortune article that I just quoted from

625
00:37:06,719 --> 00:37:09,280
Speaker 1: was not alone in raising the alarm on the limited

626
00:37:09,320 --> 00:37:13,440
Speaker 1: success for existing cancer therapies and the dismal funding allocated

627
00:37:13,480 --> 00:37:17,480
Speaker 1: for cancer research. This outcry, which is just like so

628
00:37:17,520 --> 00:37:20,720
Speaker 1: many people were like, we demand something change, We demand

629
00:37:20,840 --> 00:37:24,080
Speaker 1: that you pay attention to this. It led to Congress

630
00:37:24,080 --> 00:37:26,840
Speaker 1: passing a bill to create the National Cancer Institute in

631
00:37:26,920 --> 00:37:31,000
Speaker 1: nineteen thirty seven. Okay, yeah, and things were nineteen thirty

632
00:37:31,000 --> 00:37:33,800
Speaker 1: seven were on the eve of World War two. Essentially

633
00:37:34,080 --> 00:37:37,720
Speaker 1: things slowed down to focus on wartime efforts for basically

634
00:37:37,840 --> 00:37:41,400
Speaker 1: until the war ended. Yeah, but within a few years

635
00:37:41,480 --> 00:37:46,240
Speaker 1: after the war's end, chemotherapy, the era of modern chemotherapy began.

636
00:37:47,560 --> 00:37:50,160
Speaker 1: The first major clue came out of the ashes of

637
00:37:50,239 --> 00:37:54,040
Speaker 1: World War not number two, but number one. So while

638
00:37:54,239 --> 00:37:57,680
Speaker 1: just one among many atrocities committed during the Great War,

639
00:37:58,400 --> 00:38:03,320
Speaker 1: mustard gas was a nightmare brought to life. Okay, yeah,

640
00:38:03,400 --> 00:38:04,480
Speaker 1: we should do an episode on this.

641
00:38:04,600 --> 00:38:06,080
Speaker 5: I know it's been on our list for a really

642
00:38:06,160 --> 00:38:07,840
Speaker 5: long time, has Yeah.

643
00:38:08,280 --> 00:38:13,600
Speaker 1: Mustard gas is a toxic gas that leaves you asphyxiated burns.

644
00:38:14,560 --> 00:38:17,680
Speaker 1: It killed tens of thousands of soldiers and left physical

645
00:38:17,719 --> 00:38:21,960
Speaker 1: and psychological scars on many more. Physicians studying the long

646
00:38:22,040 --> 00:38:25,320
Speaker 1: term effects of mustard gas during World War One found

647
00:38:25,320 --> 00:38:27,960
Speaker 1: anemia to be a common outcome. It was like the

648
00:38:28,040 --> 00:38:32,959
Speaker 1: gas had depleted the bone marrow. I know little you know, yeah,

649
00:38:33,480 --> 00:38:35,920
Speaker 1: you know where this is going. Little hint there, little hint.

650
00:38:36,320 --> 00:38:38,680
Speaker 1: And this observation may have been lost to history in

651
00:38:38,719 --> 00:38:42,480
Speaker 1: World War One if an awful tragedy hadn't happened. During

652
00:38:42,520 --> 00:38:46,080
Speaker 1: the Second World War. In December of nineteen forty three,

653
00:38:46,640 --> 00:38:50,480
Speaker 1: German planes bombed American ships in an Italian harbor, and

654
00:38:50,560 --> 00:38:54,640
Speaker 1: one of these ships contained like seventy tons of mustard gas.

655
00:38:54,800 --> 00:38:57,280
Speaker 1: And I don't think mustard gas was really extensively used

656
00:38:57,360 --> 00:38:59,120
Speaker 1: or used at all during World War Two, but I

657
00:38:59,120 --> 00:39:01,440
Speaker 1: think it was like a it was like going just

658
00:39:01,480 --> 00:39:05,480
Speaker 1: a case. Yeah. When the ship was bombed, of course,

659
00:39:05,960 --> 00:39:09,279
Speaker 1: all that mustard gas went out into the harbor, went

660
00:39:09,320 --> 00:39:13,840
Speaker 1: into the like the surrounding town, and thousands of people

661
00:39:13,840 --> 00:39:17,319
Speaker 1: in the area were impacted. Many died, and physicians who

662
00:39:17,320 --> 00:39:21,600
Speaker 1: were working on the patients who were affected again noted

663
00:39:21,600 --> 00:39:25,640
Speaker 1: this bone marrow depletion and lymph node degradation that was

664
00:39:25,680 --> 00:39:28,680
Speaker 1: brought on by the gas. So this caught the interest

665
00:39:28,719 --> 00:39:32,000
Speaker 1: of two researchers who were studying lymphoma, and they were like,

666
00:39:32,280 --> 00:39:35,879
Speaker 1: what is going on in lymphoma where the lymph bone

667
00:39:35,880 --> 00:39:40,279
Speaker 1: marrow seemed to be affected. Is it possible that nitrogen mustards,

668
00:39:40,400 --> 00:39:43,560
Speaker 1: these compounds in nitrogen gas could be used to produce

669
00:39:43,600 --> 00:39:46,800
Speaker 1: the same effect in our patients? Could it like attack

670
00:39:46,880 --> 00:39:49,360
Speaker 1: the malignant white blood cells that are produced by the

671
00:39:49,360 --> 00:39:53,680
Speaker 1: bone marrow? Sure enough? Yeah? Wow the tumor shrink.

672
00:39:53,760 --> 00:39:54,200
Speaker 6: Wow.

673
00:39:54,360 --> 00:39:55,320
Speaker 1: Yeah.

674
00:39:55,440 --> 00:39:59,919
Speaker 5: So they were like, we'll use mustard gas to treat patients.

675
00:39:59,560 --> 00:40:03,600
Speaker 7: Basically, Okay, it wasn't precisely mustard right, right, but something similar.

676
00:40:03,680 --> 00:40:05,799
Speaker 1: Yeah, the same sort of like logic that was like,

677
00:40:05,840 --> 00:40:06,440
Speaker 1: how do we do this?

678
00:40:06,600 --> 00:40:06,839
Speaker 3: Yeah?

679
00:40:07,120 --> 00:40:13,440
Speaker 1: Yeah wow, And they had to delay their publication until

680
00:40:13,600 --> 00:40:16,520
Speaker 1: after the war ended, but when the paper finally came

681
00:40:16,520 --> 00:40:19,879
Speaker 1: out in nineteen forty six, it inspired real hope that

682
00:40:20,040 --> 00:40:22,560
Speaker 1: cancer could be treated with chemicals.

683
00:40:22,680 --> 00:40:24,759
Speaker 6: Wow, akachmemotherapy.

684
00:40:25,480 --> 00:40:28,400
Speaker 1: And this was a concept that had been introduced decades

685
00:40:28,440 --> 00:40:31,480
Speaker 1: earlier but not really demonstrated clinically. I was like, we're

686
00:40:31,520 --> 00:40:34,040
Speaker 1: going to try arsic, We're going to try all these things, right, all.

687
00:40:33,960 --> 00:40:38,399
Speaker 5: These super toxic things, but that just weren't specific enough

688
00:40:38,480 --> 00:40:39,680
Speaker 5: or weren't whatever enough.

689
00:40:40,400 --> 00:40:40,720
Speaker 3: Yeah.

690
00:40:40,760 --> 00:40:41,280
Speaker 6: Interesting.

691
00:40:41,560 --> 00:40:47,040
Speaker 1: Yeah. Unfortunately, the remissions that were induced by nitrogen gases

692
00:40:47,080 --> 00:40:50,759
Speaker 1: were short lived, but it did spur on researchers to

693
00:40:50,840 --> 00:40:53,319
Speaker 1: investigate other compounds. It was like finally, kind of like

694
00:40:53,640 --> 00:40:54,560
Speaker 1: just getting your foot in.

695
00:40:54,520 --> 00:40:57,480
Speaker 5: The door, right, Like this concept has merit. Yeah, let's

696
00:40:57,480 --> 00:40:59,640
Speaker 5: find others, find other things.

697
00:40:59,680 --> 00:41:02,399
Speaker 1: And one of the researchers who was excited about this

698
00:41:02,880 --> 00:41:05,400
Speaker 1: was has a name you might recognize, Sidney.

699
00:41:05,000 --> 00:41:12,160
Speaker 5: Farber Farber Institute, Dana Farbert Institute. Yeah, it's like where

700
00:41:12,200 --> 00:41:12,879
Speaker 5: is it in my brain?

701
00:41:12,960 --> 00:41:13,160
Speaker 3: Yeah?

702
00:41:14,160 --> 00:41:14,400
Speaker 5: I know?

703
00:41:14,560 --> 00:41:15,040
Speaker 1: It was good?

704
00:41:15,719 --> 00:41:16,600
Speaker 5: Yeah, okay.

705
00:41:16,800 --> 00:41:21,080
Speaker 1: So Farber was trained in pediatric pathology, but he found

706
00:41:21,160 --> 00:41:25,320
Speaker 1: himself intrigued by childhood leukemia, which was a devastating disease

707
00:41:25,360 --> 00:41:28,080
Speaker 1: that doctors were completely helpless to treat me at that time.

708
00:41:28,719 --> 00:41:32,920
Speaker 1: And leukemia was fairly unique among cancers then because it

709
00:41:32,920 --> 00:41:36,680
Speaker 1: could be quantified. You could count your patient's blood cells

710
00:41:36,719 --> 00:41:37,799
Speaker 1: to see how they were doing.

711
00:41:37,880 --> 00:41:40,719
Speaker 5: Oh interesting, okay, whereas we didn't have markers as much

712
00:41:40,719 --> 00:41:41,440
Speaker 5: for others.

713
00:41:41,160 --> 00:41:42,960
Speaker 1: You can't have as many markers, or it was like

714
00:41:43,040 --> 00:41:45,480
Speaker 1: more amorphous, like what does it mean to have a

715
00:41:45,560 --> 00:41:47,000
Speaker 1: growth in this tumor at that right?

716
00:41:47,120 --> 00:41:47,520
Speaker 3: Right? Right?

717
00:41:47,960 --> 00:41:51,400
Speaker 1: And so this made this made leukemia an appealing target

718
00:41:51,440 --> 00:41:53,759
Speaker 1: for Farber because it meant that you could measure how

719
00:41:53,800 --> 00:41:56,680
Speaker 1: well a certain treatment was working. If you see your

720
00:41:56,719 --> 00:41:59,239
Speaker 1: patient's cells go down drop, then maybe that's a good

721
00:41:59,239 --> 00:42:03,600
Speaker 1: exact or better right. But and so in the late

722
00:42:03,680 --> 00:42:07,520
Speaker 1: nineteen forties, Farber came across some work done by Lucy Wills.

723
00:42:07,680 --> 00:42:08,600
Speaker 1: Do you remember this name?

724
00:42:08,920 --> 00:42:10,120
Speaker 5: No, but tell me you know.

725
00:42:10,120 --> 00:42:13,880
Speaker 1: The same, because we've done an episode follate oh our

726
00:42:13,920 --> 00:42:14,880
Speaker 1: full eate episode?

727
00:42:14,800 --> 00:42:15,120
Speaker 8: Yeah?

728
00:42:15,200 --> 00:42:18,520
Speaker 1: Yes, yes, Okay. So she was the physician who discovered

729
00:42:18,560 --> 00:42:21,840
Speaker 1: that marmite, specifically the folate in marmite.

730
00:42:21,920 --> 00:42:23,040
Speaker 6: Forgot about marmite.

731
00:42:23,080 --> 00:42:27,040
Speaker 1: I know, I can never forget about marmite, but that

732
00:42:27,120 --> 00:42:30,560
Speaker 1: marmite could help treat anemia by prompting the body to

733
00:42:30,560 --> 00:42:33,560
Speaker 1: produce normal blood cells. Right, And so Farber thought that

734
00:42:33,600 --> 00:42:37,799
Speaker 1: maybe if I administer folate to my leukemia patients, that

735
00:42:37,840 --> 00:42:42,000
Speaker 1: will prompt their bone marrow to produce normal reds, normal

736
00:42:42,080 --> 00:42:46,360
Speaker 1: red blood cells. But instead it actually seemed to speed

737
00:42:46,480 --> 00:42:48,960
Speaker 1: up the leukemia process. It was not good. It was

738
00:42:48,960 --> 00:42:51,600
Speaker 1: more white blood cells. Okay, not good. And so he

739
00:42:51,680 --> 00:42:53,880
Speaker 1: was like, okay, we're going to stop this trial. What's

740
00:42:53,920 --> 00:42:56,840
Speaker 1: going on here? Maybe it's not that the like the

741
00:42:56,880 --> 00:43:00,520
Speaker 1: bone marrow doesn't seem unable to produce cells. Maybe I

742
00:43:00,560 --> 00:43:03,520
Speaker 1: just needed to get it to stop making cells completely.

743
00:43:03,840 --> 00:43:07,120
Speaker 1: And that's the problem. So instead of giving folate, which

744
00:43:07,120 --> 00:43:09,960
Speaker 1: would encourage cell production, what if I gave something that

745
00:43:10,040 --> 00:43:13,600
Speaker 1: was like anti fold that like stopped yeah, cell production.

746
00:43:13,760 --> 00:43:14,000
Speaker 6: Huh.

747
00:43:14,320 --> 00:43:17,560
Speaker 1: That's what he did, Okay, And what happened were the

748
00:43:17,600 --> 00:43:23,440
Speaker 1: first chemotherapy induced to leukemia remissions in history. Wow, which

749
00:43:24,480 --> 00:43:26,919
Speaker 1: I mean, I just like it must have been astonishing. Yeah,

750
00:43:26,920 --> 00:43:29,239
Speaker 1: to see that we've talked about this, this kind of

751
00:43:29,239 --> 00:43:33,640
Speaker 1: thing that happened before, like with the first insulin administered,

752
00:43:33,719 --> 00:43:36,960
Speaker 1: the first antibiotics administer Just like this sudden switch that

753
00:43:37,080 --> 00:43:38,920
Speaker 1: destiny is not firm.

754
00:43:39,040 --> 00:43:40,320
Speaker 6: Everything is now changed.

755
00:43:40,440 --> 00:43:44,319
Speaker 1: Yeah, yeah, Wow. And these remissions, the news of these

756
00:43:44,360 --> 00:43:47,000
Speaker 1: remissions had a similar energizing effect on the world of

757
00:43:47,040 --> 00:43:51,040
Speaker 1: cancer medicine as did those ones induced by nitrogen mustards.

758
00:43:51,400 --> 00:43:55,319
Speaker 1: There now seemed to be no doubt that chemotherapy held

759
00:43:55,400 --> 00:43:59,120
Speaker 1: the key to the cancer treatment puzzle, and in a sense,

760
00:43:59,160 --> 00:44:03,440
Speaker 1: it did. The only problem was that cancer kept changing

761
00:44:03,480 --> 00:44:04,000
Speaker 1: the locks.

762
00:44:04,120 --> 00:44:05,400
Speaker 6: Yeah.

763
00:44:05,440 --> 00:44:08,520
Speaker 1: Within a few months, Farber's first patient, three year old

764
00:44:08,640 --> 00:44:13,120
Speaker 1: Robert Sandler, showed signs of recurrence. His leukemia stopped responding

765
00:44:13,120 --> 00:44:15,200
Speaker 1: to the drug, and he died in nineteen forty nine.

766
00:44:16,320 --> 00:44:20,320
Speaker 1: This pattern a new chemotherapy drug or combination of drugs

767
00:44:20,440 --> 00:44:25,239
Speaker 1: shows initial promise, recurrence happens, and then resistance develops. Is

768
00:44:25,280 --> 00:44:29,759
Speaker 1: both familiar and heartbreaking, but it also demonstrates progress, right,

769
00:44:29,840 --> 00:44:32,120
Speaker 1: like how many more months did Robert have with his

770
00:44:32,200 --> 00:44:36,640
Speaker 1: family that he wouldn't have gotten otherwise? Progress was incremental

771
00:44:36,920 --> 00:44:41,040
Speaker 1: for early chemotherapy research, but that extra time was precious,

772
00:44:42,160 --> 00:44:44,880
Speaker 1: and as the nineteen fifties melted into the nineteen sixties,

773
00:44:44,920 --> 00:44:48,880
Speaker 1: that extra time grew and grew. For certain cancers. The

774
00:44:48,920 --> 00:44:53,960
Speaker 1: first cures were reported during this period, choreo carcinomas, and

775
00:44:54,040 --> 00:44:57,000
Speaker 1: they were met with initial disbelief, like it kind of

776
00:44:57,000 --> 00:44:59,719
Speaker 1: like you know, chemotherapies which showed such initial hope, but

777
00:44:59,760 --> 00:45:02,239
Speaker 1: then and were quickly like, okay, this is not a

778
00:45:02,280 --> 00:45:05,920
Speaker 1: temporary solution. Temporary solution. Then to have these like full

779
00:45:06,040 --> 00:45:08,759
Speaker 1: cures were like this's just going to come.

780
00:45:08,680 --> 00:45:10,760
Speaker 5: Back, right, I don't want to get my hopes too high.

781
00:45:11,120 --> 00:45:16,600
Speaker 1: Yes, yeah, but those were largely the exception.

782
00:45:17,080 --> 00:45:17,239
Speaker 8: Right.

783
00:45:17,360 --> 00:45:21,200
Speaker 1: Overall results tended to be mixed. There was you know,

784
00:45:21,400 --> 00:45:25,520
Speaker 1: your you're you were given more time, That time was

785
00:45:25,560 --> 00:45:29,319
Speaker 1: not guaranteed, and it was often filled with horrible side effects, right,

786
00:45:30,120 --> 00:45:33,520
Speaker 1: and and so there were there was a lot of

787
00:45:34,280 --> 00:45:37,800
Speaker 1: kind of like this this general air, this general aura

788
00:45:37,880 --> 00:45:41,560
Speaker 1: of disappointment mixed with hope, like constantly, just like these

789
00:45:41,560 --> 00:45:44,439
Speaker 1: cycles of disappointment and hope, disappointment and hope for both

790
00:45:44,480 --> 00:45:47,799
Speaker 1: physicians and the clinical on colleges working on this, as

791
00:45:47,840 --> 00:45:52,200
Speaker 1: well as people with cancer and their families. Yeah. And

792
00:45:53,200 --> 00:45:55,920
Speaker 1: there was a sense too that like, the more aggressive

793
00:45:56,040 --> 00:46:00,560
Speaker 1: the chemo, the better. We need to push our patients'

794
00:46:01,040 --> 00:46:03,680
Speaker 1: bodies to the acts, to the absolute maximum.

795
00:46:04,480 --> 00:46:04,680
Speaker 2: War.

796
00:46:04,840 --> 00:46:07,200
Speaker 1: We're fighting a war. And this is this like this

797
00:46:07,239 --> 00:46:10,799
Speaker 1: is when the concept of maximum tolerable dose was introduced,

798
00:46:10,880 --> 00:46:13,920
Speaker 1: where it's like how much can we administer without killing

799
00:46:14,000 --> 00:46:17,080
Speaker 1: the patient? Right now? Oh God, is this idea? And

800
00:46:17,120 --> 00:46:20,560
Speaker 1: then also like chemotherapy, the same with radiation can lead

801
00:46:20,640 --> 00:46:23,600
Speaker 1: to more cancer causing effects, or can can lead to

802
00:46:23,719 --> 00:46:28,480
Speaker 1: higher cancer risk later on just because you're causing such right.

803
00:46:28,480 --> 00:46:31,560
Speaker 6: You're just damaging cells cells, Yeah, yeah, yeah.

804
00:46:33,080 --> 00:46:37,799
Speaker 1: The cancer treatment world seemed pretty singularly focused on chemotherapy

805
00:46:37,880 --> 00:46:41,520
Speaker 1: for decades. Much of the billions in cancer funding went

806
00:46:41,560 --> 00:46:45,280
Speaker 1: towards finding new combos or compounds, and this was driven

807
00:46:45,360 --> 00:46:49,720
Speaker 1: in part by Farber's partnership with activist and philanthropist Mary Lasker,

808
00:46:49,920 --> 00:46:53,480
Speaker 1: which led to a huge increase in cancer awareness as

809
00:46:53,480 --> 00:46:57,279
Speaker 1: well as funding. Together, they turned cancer into a political

810
00:46:57,360 --> 00:47:01,200
Speaker 1: and social issue, which was a much needed transformation. Their

811
00:47:01,239 --> 00:47:04,759
Speaker 1: approach was guided by the belief that with enough resources

812
00:47:04,960 --> 00:47:07,319
Speaker 1: we could brute force our way into a cure for

813
00:47:07,360 --> 00:47:13,080
Speaker 1: all cancer, and unfortunately that cure failed to materialize. Funding

814
00:47:13,120 --> 00:47:16,960
Speaker 1: for research, no matter how vast, was still a finite resource.

815
00:47:17,320 --> 00:47:21,000
Speaker 1: An incremental progress in chemotherapy was made at the cost

816
00:47:21,040 --> 00:47:26,880
Speaker 1: of investment in basic research or development of other treatment modalities. Eventually,

817
00:47:26,920 --> 00:47:30,520
Speaker 1: as chemotherapy research plateaued, other treatments emerged in the nineteen

818
00:47:30,560 --> 00:47:34,080
Speaker 1: eighties and the nineteen nineties, informed by our growing understanding

819
00:47:34,200 --> 00:47:37,640
Speaker 1: of the cellular mechanisms of cancer, which I'm excited to

820
00:47:37,680 --> 00:47:40,960
Speaker 1: hear you talk about, and today there exists a broad

821
00:47:41,200 --> 00:47:44,920
Speaker 1: array of cancer therapies that allow oncologists to design a

822
00:47:44,960 --> 00:47:48,960
Speaker 1: personalized treatment plan for their patients. We still don't have

823
00:47:49,160 --> 00:47:52,200
Speaker 1: a magic bullet for cancer for all cancer, and we

824
00:47:52,400 --> 00:47:55,719
Speaker 1: likely never will, at least it's hard to imagine that

825
00:47:55,800 --> 00:47:58,440
Speaker 1: we will based on the way that cancer works in

826
00:47:58,480 --> 00:48:03,320
Speaker 1: our bodies. But the clinical transformation that cancer has undergone

827
00:48:03,400 --> 00:48:05,719
Speaker 1: in the past century and a half. It really makes

828
00:48:05,760 --> 00:48:11,160
Speaker 1: me optimistic for the future. There is no denying that

829
00:48:11,239 --> 00:48:15,480
Speaker 1: chemotherapy was revolutionary and it remains a cornerstone of cancer

830
00:48:15,520 --> 00:48:19,279
Speaker 1: treatment today. But I have to admit that there are

831
00:48:19,360 --> 00:48:22,360
Speaker 1: parts of it history, at least, that I really struggle

832
00:48:22,400 --> 00:48:26,319
Speaker 1: with the belief that you can task force cancer while

833
00:48:26,360 --> 00:48:31,600
Speaker 1: disregarding the importance of basic research and the commercialization both

834
00:48:31,680 --> 00:48:35,440
Speaker 1: historically and today of drug development that discourages looking outside

835
00:48:35,440 --> 00:48:38,720
Speaker 1: the box that makes new treatments prohibitably expensive for people.

836
00:48:39,400 --> 00:48:41,960
Speaker 1: The concept of in network, I mean, which.

837
00:48:41,719 --> 00:48:43,520
Speaker 5: Is I know, this is like a US it's so

838
00:48:43,680 --> 00:48:46,800
Speaker 5: American thing, it's so disgusting, it is.

839
00:48:48,120 --> 00:48:48,640
Speaker 1: Inhumane.

840
00:48:48,719 --> 00:48:50,359
Speaker 6: Yes, it is, yep.

841
00:48:51,640 --> 00:48:54,160
Speaker 1: And there are parts of the story too that I

842
00:48:54,160 --> 00:48:58,239
Speaker 1: feel like are reminiscent of the quote unquote mistaken kindness,

843
00:48:58,280 --> 00:49:01,400
Speaker 1: of the age of radical surgery, where it's like, no,

844
00:49:01,560 --> 00:49:06,319
Speaker 1: we need to use the most aggressive treatment possible. There

845
00:49:06,440 --> 00:49:10,000
Speaker 1: And in the nineteen sixties and nineteen seventies, when palliative

846
00:49:10,040 --> 00:49:12,360
Speaker 1: care was kind of introduced as this concept, there was

847
00:49:12,400 --> 00:49:15,520
Speaker 1: a lot of pushback from clinical oncologists who are like,

848
00:49:15,560 --> 00:49:18,239
Speaker 1: that's giving up. We don't want to give up. We

849
00:49:18,280 --> 00:49:20,160
Speaker 1: want to fight, we want our patients to fight. We

850
00:49:20,160 --> 00:49:22,600
Speaker 1: want our we want us to fight without actually like

851
00:49:22,640 --> 00:49:25,000
Speaker 1: maybe considering talking.

852
00:49:24,640 --> 00:49:27,200
Speaker 5: With the people and finding out what's happening in your

853
00:49:27,239 --> 00:49:29,440
Speaker 5: life and what your goals are and what your hopes

854
00:49:29,480 --> 00:49:32,239
Speaker 5: and dreams are, and how this diagnosis and treatment has

855
00:49:32,280 --> 00:49:33,240
Speaker 5: affected your life.

856
00:49:33,719 --> 00:49:36,160
Speaker 1: Yeah. Yeah, I mean I think that there's a lot

857
00:49:36,160 --> 00:49:38,239
Speaker 1: of just like we talked about in the beginning part

858
00:49:38,239 --> 00:49:39,880
Speaker 1: of this episode, there's a lot of push pull on

859
00:49:39,960 --> 00:49:42,560
Speaker 1: like what it means to be a physician and a

860
00:49:42,600 --> 00:49:45,400
Speaker 1: healer and what does that look, you know, healer versus physician?

861
00:49:45,520 --> 00:49:48,040
Speaker 1: What is it? Yeah, that's a philosophical question.

862
00:49:49,160 --> 00:49:52,479
Speaker 5: Well I might talk more about it, Okay, not really,

863
00:49:52,520 --> 00:49:53,440
Speaker 5: not directly, but.

864
00:49:54,400 --> 00:49:57,680
Speaker 1: Yeah, there are also parts that sound, you know, too

865
00:49:57,880 --> 00:50:01,839
Speaker 1: much like a forward march of pro progress by prescient rebels. Right,

866
00:50:01,920 --> 00:50:04,759
Speaker 1: Like these people fought against even though their data showed

867
00:50:04,760 --> 00:50:08,160
Speaker 1: that they weren't getting anywhere, they continued to fight against it.

868
00:50:08,200 --> 00:50:10,560
Speaker 1: And I'm like that, I don't know if that's the

869
00:50:10,600 --> 00:50:13,560
Speaker 1: strength necessarily, Like they happen to be right about this,

870
00:50:13,640 --> 00:50:15,520
Speaker 1: but there are many more people in history that were

871
00:50:15,520 --> 00:50:19,000
Speaker 1: wrong right, and they weren't entirely right anyway. Yeah, and

872
00:50:19,040 --> 00:50:21,440
Speaker 1: that's just also the way that we tell science stories.

873
00:50:21,480 --> 00:50:24,360
Speaker 1: I think that's an issue with that. There's also I

874
00:50:24,400 --> 00:50:26,919
Speaker 1: think in a lot of these stories there's a lack

875
00:50:26,960 --> 00:50:31,839
Speaker 1: of accounting for the human cost and unfulfilled promises that

876
00:50:31,880 --> 00:50:36,160
Speaker 1: were brought on by all therapies during this time. I mean,

877
00:50:36,200 --> 00:50:40,680
Speaker 1: we owe so much to early patients, not just of chemotherapy,

878
00:50:40,800 --> 00:50:43,400
Speaker 1: but of surgery and radiation and every person who has

879
00:50:43,440 --> 00:50:47,000
Speaker 1: ever participated in a clinical trial ever. It's incredible.

880
00:50:47,920 --> 00:50:51,359
Speaker 5: Is it is so selfless and it is so beautiful

881
00:50:52,000 --> 00:50:54,920
Speaker 5: that someone is willing to know this might not help me,

882
00:50:55,440 --> 00:50:57,520
Speaker 5: but it will help someone else down the line.

883
00:50:57,600 --> 00:51:01,719
Speaker 1: Yes, yeah, Yeah, that's one of the parts that I

884
00:51:01,760 --> 00:51:05,880
Speaker 1: find inspiring. And I also find, you know, Farber's passion

885
00:51:06,160 --> 00:51:10,520
Speaker 1: and vision inspiring. There are parts that are uplifting, like

886
00:51:10,560 --> 00:51:12,880
Speaker 1: those whose lives who have that have been extended or

887
00:51:13,360 --> 00:51:17,120
Speaker 1: saved by chemotherapy, And there are parts that are thought provoking,

888
00:51:17,320 --> 00:51:20,400
Speaker 1: like where do we go from here? Yeah? Where do

889
00:51:20,480 --> 00:51:24,120
Speaker 1: we go from here? Cancer treatment, though it has dominated

890
00:51:24,160 --> 00:51:27,279
Speaker 1: the research scene for decades, is just one way to

891
00:51:27,400 --> 00:51:32,719
Speaker 1: approach this problem of multicellularity. What if we could minimize

892
00:51:32,800 --> 00:51:37,760
Speaker 1: our use of aggressive therapy or even better, avoid treatments entirely.

893
00:51:38,640 --> 00:51:41,839
Speaker 1: That's what I'll be talking about next week. How can

894
00:51:41,880 --> 00:51:45,360
Speaker 1: we incorporate screening and prevention into our picture of cancer?

895
00:51:45,520 --> 00:51:47,799
Speaker 5: Oh, I'm really excited about that.

896
00:51:48,680 --> 00:51:50,760
Speaker 1: But for now, I'll turn it over to you, Aaron,

897
00:51:50,920 --> 00:51:53,759
Speaker 1: to tell me how these different types of cancer treatment work.

898
00:51:54,080 --> 00:51:55,480
Speaker 6: Let me bring us up to speed.

899
00:51:55,680 --> 00:51:56,080
Speaker 1: Please.

900
00:52:10,680 --> 00:52:11,000
Speaker 6: Hi.

901
00:52:11,600 --> 00:52:14,560
Speaker 3: My name is doctor Longwyn and I'm an obgaan physician.

902
00:52:15,040 --> 00:52:17,359
Speaker 3: In November of twenty twenty, I felt a small lump

903
00:52:17,360 --> 00:52:19,960
Speaker 3: in my right breast. I wasn't too worried about it,

904
00:52:20,000 --> 00:52:22,040
Speaker 3: but as I was due for a mammogram, I had

905
00:52:22,040 --> 00:52:25,480
Speaker 3: my colleague ordered as a diagnostic. Within three weeks, the

906
00:52:25,480 --> 00:52:28,600
Speaker 3: mammogram quickly led to a breast biopsy, and two days

907
00:52:28,640 --> 00:52:31,920
Speaker 3: after my son's sixth birthday, my breast radiologist friend and

908
00:52:32,000 --> 00:52:34,880
Speaker 3: colleague told me I had cancer. It was in the

909
00:52:34,880 --> 00:52:37,279
Speaker 3: middle of a work day and she was so so

910
00:52:37,560 --> 00:52:40,400
Speaker 3: very kind to me. I walked to a private spot

911
00:52:40,440 --> 00:52:43,200
Speaker 3: behind the hospital and called my husband with the news.

912
00:52:43,600 --> 00:52:46,040
Speaker 3: Then I pulled myself together and finished seeing patients in

913
00:52:46,080 --> 00:52:50,160
Speaker 3: the office. I consider myself lucky. I caught it early

914
00:52:50,239 --> 00:52:53,439
Speaker 3: and had a lumpectomy a month after my diagnosis. Four

915
00:52:53,480 --> 00:52:56,279
Speaker 3: days after surgery, I walked back into my hospital. I

916
00:52:56,320 --> 00:52:59,520
Speaker 3: got my second COVID booster. A month after that, I

917
00:52:59,560 --> 00:53:01,600
Speaker 3: was back at work and continue to work when I

918
00:53:01,640 --> 00:53:05,040
Speaker 3: had my weak of radiation treatment. I will be five

919
00:53:05,120 --> 00:53:07,880
Speaker 3: years with no evidence of disease soon, and at that

920
00:53:08,040 --> 00:53:10,960
Speaker 3: time I will be able to stop taking tamoxifen. It's

921
00:53:11,000 --> 00:53:14,680
Speaker 3: been a journey. Medically induced menopause is no joke, but

922
00:53:14,760 --> 00:53:17,360
Speaker 3: I am so grateful to my friends, family, and colleagues

923
00:53:17,360 --> 00:53:20,759
Speaker 3: who have been nothing but supportive. In my field, I'm

924
00:53:20,760 --> 00:53:24,239
Speaker 3: the referring physician to the breast surgeon and oncologist. I

925
00:53:24,280 --> 00:53:26,080
Speaker 3: didn't like being on the other side of it, but

926
00:53:26,160 --> 00:53:28,919
Speaker 3: I know firsthand now that my patients are extremely well

927
00:53:28,920 --> 00:53:32,920
Speaker 3: taken care of. Thanks for letting me share my story.

928
00:53:33,080 --> 00:53:35,000
Speaker 3: I know that this may come as a surprise to

929
00:53:35,040 --> 00:53:37,400
Speaker 3: many of my long term patients who might hear this,

930
00:53:38,000 --> 00:53:41,080
Speaker 3: but I'm okay with that. Doctors are human beings too,

931
00:53:41,480 --> 00:53:45,160
Speaker 3: and cancer doesn't care. Get your mammograms, peraps, mirrors, and

932
00:53:45,200 --> 00:53:47,719
Speaker 3: colonoscopy's done. It can save your life.

933
00:53:49,760 --> 00:53:52,480
Speaker 10: Hello. My name is Jasmine and this is my experience

934
00:53:52,480 --> 00:53:55,520
Speaker 10: with cancer. To start, I'm going to tell you about

935
00:53:55,520 --> 00:53:59,160
Speaker 10: my grandfather. My grandfather was a prankster and a jokester,

936
00:53:59,560 --> 00:54:02,120
Speaker 10: locked on his grandkids in trouble for jokes he started.

937
00:54:02,960 --> 00:54:06,799
Speaker 10: He was an amateur mixologist, always trying and making something new.

938
00:54:07,360 --> 00:54:09,880
Speaker 10: He was always outside and loved to meet new people.

939
00:54:10,920 --> 00:54:13,160
Speaker 10: One of the first signs that something was wrong came

940
00:54:13,200 --> 00:54:15,960
Speaker 10: from their friends he had made. They noticed that he

941
00:54:16,080 --> 00:54:19,600
Speaker 10: was rapidly losing weight without seeming to try. This led

942
00:54:19,600 --> 00:54:22,800
Speaker 10: to a trip to the doctors. On April sixteenth, twenty

943
00:54:22,960 --> 00:54:27,400
Speaker 10: twenty four, my grandfather was diagnosed with stage four pancreatic cancer.

944
00:54:28,520 --> 00:54:31,880
Speaker 10: Shortly after this diagnosis, his children dropped everything and went

945
00:54:31,920 --> 00:54:35,399
Speaker 10: to Florida to be with him and my grandmother. One

946
00:54:35,440 --> 00:54:37,520
Speaker 10: thing we all wondered about was how this was missed

947
00:54:37,560 --> 00:54:40,160
Speaker 10: for so long. He had regular visits with the doctor

948
00:54:40,239 --> 00:54:43,080
Speaker 10: and seemed to be in good health. They quickly realized

949
00:54:43,280 --> 00:54:47,040
Speaker 10: how sneaky cancer can be. We learned that pancreatic cancer

950
00:54:47,200 --> 00:54:51,759
Speaker 10: as often misdiagnosed as diabetes, which my grandfather had. We

951
00:54:51,840 --> 00:54:55,439
Speaker 10: also learned that pancreatic cancer has a very poor prognosis,

952
00:54:55,760 --> 00:54:58,000
Speaker 10: and my grandfather was only given a couple of months

953
00:54:58,080 --> 00:55:02,600
Speaker 10: to live. In my grandfather's usual fashion, he made a

954
00:55:02,680 --> 00:55:03,719
Speaker 10: joke and fought.

955
00:55:03,440 --> 00:55:05,399
Speaker 1: Back the time.

956
00:55:05,440 --> 00:55:08,600
Speaker 10: My grandparents are coming back to their home state in Missouri.

957
00:55:09,160 --> 00:55:12,000
Speaker 10: His doctor was making plans for the next year, maybe more.

958
00:55:12,640 --> 00:55:17,200
Speaker 10: We were all astatic. Unfortunately, in July he got a

959
00:55:17,320 --> 00:55:20,239
Speaker 10: very bad infection that had him in the hospital for days.

960
00:55:20,640 --> 00:55:22,920
Speaker 10: By the time they managed to clear it, his strength

961
00:55:23,160 --> 00:55:27,279
Speaker 10: was gone. He was never able to resume his treatments.

962
00:55:27,800 --> 00:55:31,520
Speaker 10: On November ninth, twenty twenty four, early in the morning,

963
00:55:31,880 --> 00:55:35,319
Speaker 10: surrounded by family and his loving wife, he passed away.

964
00:55:36,840 --> 00:55:39,600
Speaker 10: One thing that sucks with cancer is to memories. It steals.

965
00:55:40,440 --> 00:55:42,920
Speaker 10: Seeing my grandfather as a shadow of his former self

966
00:55:43,800 --> 00:55:47,640
Speaker 10: hurt beyond belief. He was also only half a year

967
00:55:47,680 --> 00:55:51,000
Speaker 10: away from my wedding because of cancer. I never got

968
00:55:51,080 --> 00:55:54,240
Speaker 10: to show my grandfather and my wedding dress. Because of cancer,

969
00:55:54,680 --> 00:55:57,520
Speaker 10: he never got to meet his third great grandchild, he

970
00:55:57,640 --> 00:56:00,880
Speaker 10: was born two weeks later. This soul journey husband a

971
00:56:00,960 --> 00:56:06,239
Speaker 10: roller coaster from despair to hope to say goodbye one

972
00:56:06,320 --> 00:56:09,839
Speaker 10: last time. I can only hope to see you again

973
00:56:09,920 --> 00:56:15,480
Speaker 10: one day. Thank you for listening to my story.

974
00:56:37,400 --> 00:56:39,879
Speaker 5: I don't think I'm going to tell you how these work. Necessarily,

975
00:56:40,080 --> 00:56:43,680
Speaker 5: that's fine in detail, but what I do want to

976
00:56:43,719 --> 00:56:46,359
Speaker 5: do I mean in part because it would be way

977
00:56:46,400 --> 00:56:49,640
Speaker 5: too much to try and deep dive on Oh, I know,

978
00:56:49,840 --> 00:56:51,160
Speaker 5: like all of this.

979
00:56:51,280 --> 00:56:52,320
Speaker 1: Give me the broad strokes.

980
00:56:52,400 --> 00:56:55,080
Speaker 5: I will, thanks, And I want to kind of walk

981
00:56:55,160 --> 00:56:59,319
Speaker 5: us through some context on like how we use the

982
00:56:59,320 --> 00:57:02,480
Speaker 5: tools that you walked us through, because those are still

983
00:57:02,520 --> 00:57:06,719
Speaker 5: the three, how do we use them today? How is

984
00:57:06,760 --> 00:57:09,000
Speaker 5: that different than how we use them historically? And then

985
00:57:09,160 --> 00:57:12,040
Speaker 5: what are some of the biggest new technologies that have

986
00:57:12,200 --> 00:57:15,759
Speaker 5: now become a mainstay and a like integral part of

987
00:57:15,800 --> 00:57:18,240
Speaker 5: our cancer treatment. But they're new within the last like

988
00:57:18,320 --> 00:57:21,360
Speaker 5: ten fifteen years, and yet now they are like the

989
00:57:21,400 --> 00:57:26,560
Speaker 5: standard of care. So that's what we're gonna do. Okay, okay, great.

990
00:57:27,280 --> 00:57:30,040
Speaker 5: So I talked in the very first episode of the

991
00:57:30,120 --> 00:57:33,680
Speaker 5: series about how we stage cancers, and the staging of

992
00:57:33,800 --> 00:57:37,080
Speaker 5: cancers is a really important part of this initial process

993
00:57:37,160 --> 00:57:40,000
Speaker 5: in deciding how that treatment is going to progress and

994
00:57:40,040 --> 00:57:43,440
Speaker 5: what treatments are going to be recommended. Knowing where this

995
00:57:43,520 --> 00:57:45,960
Speaker 5: cancer came from, what kind of tissue, how far it

996
00:57:46,000 --> 00:57:49,160
Speaker 5: has spread, all of this has to be taken into

997
00:57:49,200 --> 00:57:52,120
Speaker 5: consideration to plan your particular cancer treatment.

998
00:57:52,240 --> 00:57:52,479
Speaker 1: Camera.

999
00:57:52,680 --> 00:57:55,240
Speaker 5: Yeah, so I'm going to go through the three that

1000
00:57:55,320 --> 00:57:57,920
Speaker 5: you had gone through I think I have them in

1001
00:57:57,960 --> 00:58:01,440
Speaker 5: a different order of this, and then we'll move on

1002
00:58:01,480 --> 00:58:07,000
Speaker 5: to like immunotherapies and some of the newer things. So surgery, surgery,

1003
00:58:07,120 --> 00:58:11,240
Speaker 5: surgery is very often still a part of cancer treatment.

1004
00:58:12,320 --> 00:58:14,600
Speaker 5: It is totally going to depend on the tumor if

1005
00:58:14,640 --> 00:58:17,480
Speaker 5: there is a tumor at all. Obviously, for blood cancers

1006
00:58:17,920 --> 00:58:20,360
Speaker 5: not going to have a surgery, sue. It's going to

1007
00:58:20,400 --> 00:58:24,040
Speaker 5: depend on where exactly that's located, how far it has spread.

1008
00:58:24,480 --> 00:58:28,200
Speaker 5: But for a very large proportion of cancers, a surgery

1009
00:58:28,280 --> 00:58:32,040
Speaker 5: that removes that entire tumor and aims to remove a

1010
00:58:32,240 --> 00:58:37,720
Speaker 5: margin of healthy tissue. And that's what when we hear

1011
00:58:38,000 --> 00:58:40,600
Speaker 5: in your pathology report you get it says, oh, it had.

1012
00:58:40,440 --> 00:58:41,680
Speaker 6: Clear margin margins.

1013
00:58:42,040 --> 00:58:44,880
Speaker 5: That means that all of the surrounding tissue did not

1014
00:58:45,040 --> 00:58:48,400
Speaker 5: have cancerous tissue. So if it didn't have clear margins,

1015
00:58:48,400 --> 00:58:50,480
Speaker 5: it means that tumor is all the way to the

1016
00:58:50,600 --> 00:58:52,360
Speaker 5: edge of the tissue that we got, which means we

1017
00:58:52,360 --> 00:58:55,360
Speaker 5: think we might have had everything behind. If it's all

1018
00:58:55,360 --> 00:58:57,320
Speaker 5: the way to the margins. If you have clean margins,

1019
00:58:57,360 --> 00:58:59,000
Speaker 5: it means we didn't leave anything behind.

1020
00:58:59,120 --> 00:59:01,640
Speaker 1: So what would it say if your report did not say,

1021
00:59:01,680 --> 00:59:03,000
Speaker 1: clean margins, what would it say.

1022
00:59:03,080 --> 00:59:05,720
Speaker 5: It might say that it like there was cancer's tissue

1023
00:59:05,720 --> 00:59:08,560
Speaker 5: to the periphery or including the margins or something like that.

1024
00:59:08,680 --> 00:59:10,520
Speaker 6: Okay, so that would be not good, got it?

1025
00:59:12,160 --> 00:59:14,840
Speaker 5: And so yeah, that is the point, and so that

1026
00:59:14,960 --> 00:59:18,280
Speaker 5: is the goal of any kind of surgery usually is

1027
00:59:18,320 --> 00:59:21,200
Speaker 5: to remove all of the tumor and then some portion

1028
00:59:21,320 --> 00:59:24,760
Speaker 5: of healthy, non cancerous tissue all the way around the tumor.

1029
00:59:25,640 --> 00:59:27,840
Speaker 5: How exactly we're going to do that, what kinds of

1030
00:59:27,840 --> 00:59:30,080
Speaker 5: surgery is going to happen, how much tissue that's going

1031
00:59:30,120 --> 00:59:32,880
Speaker 5: to be all depends on the cancer. And there's probably

1032
00:59:32,920 --> 00:59:34,880
Speaker 5: a lot that I could have gotten into on the

1033
00:59:35,040 --> 00:59:41,600
Speaker 5: incredible surgical advancement so many there are so many incredible

1034
00:59:41,600 --> 00:59:44,200
Speaker 5: surgical techniques that have been developed in the last few

1035
00:59:44,360 --> 00:59:48,440
Speaker 5: years decades, both in terms of understanding how much tissue

1036
00:59:48,480 --> 00:59:50,400
Speaker 5: needs to be removed. Do we need to do radical

1037
00:59:50,440 --> 00:59:54,720
Speaker 5: mastectomies very often not like you said, lumpectomies often have

1038
00:59:54,880 --> 00:59:59,440
Speaker 5: similar morbidity and well better morbidity and similar survival and

1039
00:59:59,480 --> 01:00:03,240
Speaker 5: recurrence rates. But also there's been so much advancement in

1040
01:00:03,280 --> 01:00:07,160
Speaker 5: things like minimally invasive surgeries, in the use of robotic

1041
01:00:07,280 --> 01:00:11,360
Speaker 5: surgery surgery, which has allowed for surgery to be a

1042
01:00:11,480 --> 01:00:14,720
Speaker 5: part of cancer treatment where before it couldn't be. If

1043
01:00:14,720 --> 01:00:16,640
Speaker 5: you think of trying to do surgery in a place

1044
01:00:16,680 --> 01:00:19,640
Speaker 5: that's very small and has a lot of really important

1045
01:00:19,680 --> 01:00:22,600
Speaker 5: anatomical structures, like in our head and neck, a lot

1046
01:00:22,600 --> 01:00:25,880
Speaker 5: of time surgery wasn't an option in those areas because

1047
01:00:25,920 --> 01:00:28,280
Speaker 5: they're so small, because there's so much important tissue there.

1048
01:00:28,400 --> 01:00:31,920
Speaker 5: But now, with the advancement of minimally invasive and robotic techniques,

1049
01:00:32,160 --> 01:00:34,520
Speaker 5: you might be able to have a surgery which could

1050
01:00:34,600 --> 01:00:39,120
Speaker 5: significantly improve your outcomes. So there have been incredible That's

1051
01:00:39,120 --> 01:00:42,240
Speaker 5: all I'm going to say about surgery. It's like, sorry,

1052
01:00:42,240 --> 01:00:44,120
Speaker 5: I'm not doing it justice to all of you surgeons

1053
01:00:44,120 --> 01:00:45,600
Speaker 5: out there, but you do incredible work.

1054
01:00:45,680 --> 01:00:47,400
Speaker 1: Oh my gosh, I mean it is. It is like

1055
01:00:47,520 --> 01:00:50,400
Speaker 1: it was reading that quote from nineteen thirty seven where

1056
01:00:50,400 --> 01:00:53,560
Speaker 1: it's like we have the most technologically advanced surgery and

1057
01:00:53,640 --> 01:00:56,439
Speaker 1: I'm like you did then you have no idea idea

1058
01:00:56,520 --> 01:00:57,760
Speaker 1: what's coming well, and like.

1059
01:00:57,720 --> 01:01:01,560
Speaker 5: The advancements in plastic surgery and like you know, reconstructions

1060
01:01:01,560 --> 01:01:05,640
Speaker 5: and things like, it's it's amazing and incredible. So like

1061
01:01:05,840 --> 01:01:08,840
Speaker 5: shout out to surgeons everywhere. I feel like I probably

1062
01:01:08,840 --> 01:01:14,200
Speaker 5: don't shout the whoop woop to you, uh, and so

1063
01:01:14,240 --> 01:01:16,560
Speaker 5: that so surgery is a really important part of many,

1064
01:01:16,720 --> 01:01:20,200
Speaker 5: many types of cancer treatment. Yes, chemotherapy is the other

1065
01:01:20,400 --> 01:01:24,080
Speaker 5: big time mainstay, and chemotherapy comes in a lot of

1066
01:01:24,120 --> 01:01:28,480
Speaker 5: different varieties these days. But the way that they all

1067
01:01:29,160 --> 01:01:34,200
Speaker 5: work mechanistically is that they kill cancer cells, and they

1068
01:01:34,280 --> 01:01:40,160
Speaker 5: do this by being cytotoxic broadly, meaning toxic two cells broadly.

1069
01:01:40,920 --> 01:01:44,480
Speaker 5: The goal with all chemotherapies is that they are targeting

1070
01:01:44,680 --> 01:01:49,240
Speaker 5: mostly rapidly dividing cells, right, because we know from our

1071
01:01:49,280 --> 01:01:53,280
Speaker 5: cancer biology and like basic science research, that cancer cells

1072
01:01:53,360 --> 01:01:57,440
Speaker 5: are continuously dividing. That's one of their big hallmarks. And

1073
01:01:57,520 --> 01:02:01,480
Speaker 5: so by targeting these rapidly dividing cells, we are mostly

1074
01:02:01,840 --> 01:02:06,280
Speaker 5: targeting cancer cells. So some of these chemotherapies might work

1075
01:02:06,320 --> 01:02:10,440
Speaker 5: by disrupting DNA replication, right. Some of them might work

1076
01:02:10,480 --> 01:02:14,240
Speaker 5: by disrupting what's called microtubule formation, which is like how

1077
01:02:14,400 --> 01:02:17,800
Speaker 5: your cells have to arrange the DNA as they divide,

1078
01:02:18,360 --> 01:02:21,320
Speaker 5: So some might target that, some of them might There's

1079
01:02:21,360 --> 01:02:24,560
Speaker 5: lots of different specific ways that each chemotherapy drug might

1080
01:02:24,560 --> 01:02:28,000
Speaker 5: interact with those rapidly dividing cells, but across the board

1081
01:02:28,080 --> 01:02:32,080
Speaker 5: that's what they're targeting, which means that while they target

1082
01:02:32,120 --> 01:02:37,760
Speaker 5: cancer cells, they are also affecting all of our rapidly

1083
01:02:37,800 --> 01:02:42,120
Speaker 5: dividing cells, like our hair follicles, like our GI tract,

1084
01:02:42,280 --> 01:02:45,840
Speaker 5: like our bone marrow, like our skin cells, and so

1085
01:02:45,920 --> 01:02:50,080
Speaker 5: that can cause a really really wide range of very

1086
01:02:50,120 --> 01:02:53,720
Speaker 5: significant side effects. We can see things like mylosuppression, which

1087
01:02:53,760 --> 01:02:55,960
Speaker 5: is what we saw in those first chemotherapy drugs you

1088
01:02:56,000 --> 01:02:58,280
Speaker 5: were talking about, which means your bone marrow is suppressed,

1089
01:02:59,240 --> 01:03:01,920
Speaker 5: which might be a good thing in certain treatments, but

1090
01:03:01,960 --> 01:03:04,720
Speaker 5: also might be a very negative side effect where you

1091
01:03:04,760 --> 01:03:07,960
Speaker 5: have significant anemia and now you have no immune system

1092
01:03:08,040 --> 01:03:11,160
Speaker 5: to fight off other opportunistic infections and things like that.

1093
01:03:11,920 --> 01:03:16,240
Speaker 5: They all cause things like fatigue and weakness. They're going

1094
01:03:16,280 --> 01:03:19,480
Speaker 5: to have a lot of gastrointestinal side effects, nausea, vomiting,

1095
01:03:19,520 --> 01:03:22,760
Speaker 5: potentially diarrhea, all kinds of things, your hair falling out.

1096
01:03:23,520 --> 01:03:26,200
Speaker 5: This is a common side effect of many, many different

1097
01:03:26,280 --> 01:03:31,000
Speaker 5: chemotherapy treatments. There's also a lot that can affect certain

1098
01:03:31,480 --> 01:03:34,400
Speaker 5: cells in our body, like, for example, our heart cells,

1099
01:03:34,920 --> 01:03:38,200
Speaker 5: because they accumulate in some of our tissues, and so

1100
01:03:38,240 --> 01:03:40,400
Speaker 5: you have to be very careful with the dosage that

1101
01:03:40,440 --> 01:03:44,480
Speaker 5: you're given across your entire lifetime, yep. And so all

1102
01:03:44,520 --> 01:03:47,040
Speaker 5: of this again has to be taken into consideration in

1103
01:03:47,720 --> 01:03:49,680
Speaker 5: your specific cancer yep.

1104
01:03:49,840 --> 01:03:50,080
Speaker 6: Right.

1105
01:03:51,120 --> 01:03:53,160
Speaker 5: One of the things that I think is probably new

1106
01:03:53,200 --> 01:03:56,240
Speaker 5: and different in how we use chemotherapy today compared to

1107
01:03:56,320 --> 01:03:58,200
Speaker 5: how we maybe used to use it in the past,

1108
01:03:58,760 --> 01:04:02,960
Speaker 5: is that there is of a very distinct decision on

1109
01:04:03,200 --> 01:04:06,880
Speaker 5: when to use chemotherapy, and so we might use different

1110
01:04:06,880 --> 01:04:10,280
Speaker 5: types of chemotherapy with different intentions at different points in

1111
01:04:10,360 --> 01:04:16,360
Speaker 5: someone's cancer journey. So we sometimes might use chemotherapy before surgery,

1112
01:04:17,080 --> 01:04:21,000
Speaker 5: and this is called neoadjuvant or sometimes pery operative, depending

1113
01:04:21,000 --> 01:04:24,040
Speaker 5: on the exact timing of when you give that. But

1114
01:04:24,080 --> 01:04:27,160
Speaker 5: the goal might be to shrink that tumor before we

1115
01:04:27,240 --> 01:04:29,600
Speaker 5: go in to try and remove it with surgery, right right.

1116
01:04:30,600 --> 01:04:35,000
Speaker 5: Other times we might use it after surgery, so adjuvant chemotherapy,

1117
01:04:35,040 --> 01:04:37,400
Speaker 5: and that means like, in addition to this surgery you're

1118
01:04:37,680 --> 01:04:40,040
Speaker 5: removal of most of the cancer tissues, We're going to

1119
01:04:40,120 --> 01:04:42,680
Speaker 5: also do chemotherapy to kind of kill anything that might

1120
01:04:42,720 --> 01:04:46,120
Speaker 5: be left behind or anything that's more broadly systemic or

1121
01:04:46,160 --> 01:04:48,760
Speaker 5: something like that. And these are not mutually exclusive. You

1122
01:04:48,840 --> 01:04:51,440
Speaker 5: might have one regimen for before and one regimen for

1123
01:04:51,480 --> 01:04:56,320
Speaker 5: after surgery, and you're using these in combination, so that's chemotherapy.

1124
01:04:57,360 --> 01:05:00,439
Speaker 5: Then we still have radiation, and I think it's very

1125
01:05:00,480 --> 01:05:05,160
Speaker 5: interesting to think about how I mean it's both old

1126
01:05:05,160 --> 01:05:05,760
Speaker 5: and not old.

1127
01:05:05,800 --> 01:05:07,560
Speaker 6: I guess radiation.

1128
01:05:07,440 --> 01:05:10,439
Speaker 1: It's old in the history of cancer therapy, but it's

1129
01:05:10,440 --> 01:05:12,000
Speaker 1: not old in a history.

1130
01:05:11,720 --> 01:05:12,480
Speaker 6: Of med science.

1131
01:05:12,640 --> 01:05:16,880
Speaker 5: Yeah, but even radiation therapy has come a very very

1132
01:05:16,920 --> 01:05:17,360
Speaker 5: long way.

1133
01:05:17,600 --> 01:05:21,880
Speaker 1: So targeted, yeah, instead of just like let's have X

1134
01:05:21,960 --> 01:05:24,400
Speaker 1: rays entire shoe store.

1135
01:05:24,600 --> 01:05:26,200
Speaker 6: Yeah, oh gosh.

1136
01:05:26,360 --> 01:05:29,640
Speaker 5: But especially with advancements I think in things like interventional

1137
01:05:29,720 --> 01:05:34,000
Speaker 5: radiology another shout out to interventional radiologist. Everywhere we can

1138
01:05:34,080 --> 01:05:38,840
Speaker 5: deliver radiation now to much more targeted areas. And sometimes

1139
01:05:38,840 --> 01:05:42,920
Speaker 5: this might still be external radiation. And so there's different

1140
01:05:42,920 --> 01:05:46,200
Speaker 5: techniques that you know, have different names. There's like stereotactic

1141
01:05:46,440 --> 01:05:48,520
Speaker 5: and sometimes it's called radiosurgery, even though a lot of

1142
01:05:48,560 --> 01:05:52,280
Speaker 5: times there's no surgery involved, there's no cutting open of anything.

1143
01:05:53,280 --> 01:05:56,560
Speaker 5: I don't know. Sometimes it's called radiotherapy, sometimes it's called

1144
01:05:56,640 --> 01:05:57,320
Speaker 5: radio surgery.

1145
01:05:57,760 --> 01:05:59,920
Speaker 1: What does surgery mean as a term? What's the room?

1146
01:06:00,480 --> 01:06:01,360
Speaker 6: And that's a you question.

1147
01:06:03,760 --> 01:06:06,480
Speaker 5: But these kinds of techniques in general that use external

1148
01:06:06,560 --> 01:06:11,640
Speaker 5: radiation usually use now very advanced imaging, so MRIs or

1149
01:06:11,640 --> 01:06:16,280
Speaker 5: ct scance or something in combination with radiation to deliver

1150
01:06:16,400 --> 01:06:20,360
Speaker 5: that radiation to very specific areas of your body. And

1151
01:06:20,400 --> 01:06:22,920
Speaker 5: that's to minimize the effect on all of your surrounding

1152
01:06:22,920 --> 01:06:26,920
Speaker 5: healthy tissues. And so sometimes what we'll see, and I

1153
01:06:26,960 --> 01:06:29,640
Speaker 5: think people who maybe have been familiar with someone who's

1154
01:06:29,640 --> 01:06:32,000
Speaker 5: had like a head and neck cancer or something like that,

1155
01:06:32,120 --> 01:06:34,680
Speaker 5: or a brain cancer, you might have to have made

1156
01:06:34,760 --> 01:06:39,320
Speaker 5: these very specialized masks that hold your head in a

1157
01:06:39,480 --> 01:06:43,800
Speaker 5: very very specific position and that's made only for you

1158
01:06:44,360 --> 01:06:47,280
Speaker 5: so that that radiation can be delivered to one specific

1159
01:06:47,320 --> 01:06:50,680
Speaker 5: area to target only that tumor and none of the

1160
01:06:50,680 --> 01:06:51,720
Speaker 5: surrounding tissue.

1161
01:06:51,880 --> 01:06:54,240
Speaker 1: Also, you should look up radio liken therapy because it's

1162
01:06:54,560 --> 01:06:55,400
Speaker 1: very exciting.

1163
01:06:55,560 --> 01:06:55,880
Speaker 6: Love it.

1164
01:06:56,520 --> 01:07:00,320
Speaker 5: And so how we deliver that, whether it's external or weather.

1165
01:07:00,440 --> 01:07:04,280
Speaker 5: There's something called break etherrapy, which is where you have

1166
01:07:04,480 --> 01:07:07,720
Speaker 5: radioactive material. So rather than external like beam radiation, you

1167
01:07:07,800 --> 01:07:10,760
Speaker 5: have radioactive material that's either put on something like a

1168
01:07:10,800 --> 01:07:14,000
Speaker 5: wire or a little seed they call it, and that

1169
01:07:14,120 --> 01:07:17,320
Speaker 5: might be placed inside or very close to a tumor.

1170
01:07:17,720 --> 01:07:19,920
Speaker 5: It might be left there for the long term, it

1171
01:07:20,000 --> 01:07:23,640
Speaker 5: might be there only during the course of a procedure. Again,

1172
01:07:23,680 --> 01:07:26,520
Speaker 5: this is where things like interventional radiology can really play

1173
01:07:26,560 --> 01:07:29,800
Speaker 5: a huge role in targeting tumors that are even deep

1174
01:07:29,840 --> 01:07:33,400
Speaker 5: inside the body, which is incredible. And we have other

1175
01:07:33,480 --> 01:07:36,920
Speaker 5: techniques now besides just radiation that I think kind of

1176
01:07:37,000 --> 01:07:40,880
Speaker 5: fall into this kind of procedural category where we might

1177
01:07:41,040 --> 01:07:48,000
Speaker 5: use heat or electricity or even ice freezing in one

1178
01:07:48,000 --> 01:07:54,280
Speaker 5: of theodomia episodisodes. Yeah, so we can do that cryotherapy

1179
01:07:54,520 --> 01:07:56,880
Speaker 5: directly to tumors. They use this for things like liver

1180
01:07:57,120 --> 01:08:02,440
Speaker 5: some liver cancers or liver tumors and things like that. Why, Okay,

1181
01:08:02,480 --> 01:08:05,320
Speaker 5: it's easy to access, that's one of the paysons. Yeah,

1182
01:08:05,360 --> 01:08:07,680
Speaker 5: and livers have really good blood supply, so then like

1183
01:08:07,720 --> 01:08:10,240
Speaker 5: the surrounding tissue is still going to have good blood supply,

1184
01:08:10,320 --> 01:08:12,960
Speaker 5: I think is part of it. It's also just a

1185
01:08:13,040 --> 01:08:15,320
Speaker 5: very commonplace that you get tumors, so yeah, things like that.

1186
01:08:15,880 --> 01:08:18,120
Speaker 5: So we've come a really long way in our use

1187
01:08:18,160 --> 01:08:22,360
Speaker 5: of radiation, and radiation still has very significant side effects,

1188
01:08:23,360 --> 01:08:26,120
Speaker 5: especially we use it a lot in you know, either

1189
01:08:26,160 --> 01:08:30,120
Speaker 5: anal or rectal cancers, and like the after effects of

1190
01:08:30,200 --> 01:08:34,800
Speaker 5: radiation on the surrounding tissue can be very severe in

1191
01:08:34,880 --> 01:08:38,599
Speaker 5: the long term. So it's still not, by any means

1192
01:08:38,840 --> 01:08:40,639
Speaker 5: a perfect system.

1193
01:08:41,200 --> 01:08:44,439
Speaker 1: No, I think. I think this is something that, like

1194
01:08:44,560 --> 01:08:47,760
Speaker 1: chemotherapy in general, comes up as a what will what

1195
01:08:47,840 --> 01:08:50,519
Speaker 1: will we look back on in the future and go.

1196
01:08:51,120 --> 01:08:53,360
Speaker 5: Whoa, whoa, this is what we did.

1197
01:08:53,280 --> 01:08:55,559
Speaker 1: This is what we did. I mean, and again, like,

1198
01:08:56,160 --> 01:08:58,720
Speaker 1: this is the like people are. It's not like people

1199
01:08:58,760 --> 01:09:01,679
Speaker 1: are working on this as a torture device. No, people

1200
01:09:01,760 --> 01:09:04,360
Speaker 1: physicians worked on this because they wanted to help their patients,

1201
01:09:04,479 --> 01:09:07,800
Speaker 1: save patients anticipated in this because they wanted to have

1202
01:09:07,880 --> 01:09:10,360
Speaker 1: their own lives extended or the lives of other future

1203
01:09:10,400 --> 01:09:11,120
Speaker 1: cancer patients.

1204
01:09:11,160 --> 01:09:14,160
Speaker 6: Like it's yeah, yeah, it's it is.

1205
01:09:14,200 --> 01:09:18,040
Speaker 1: But I agree, I know, I know, it's really it's complicated.

1206
01:09:17,600 --> 01:09:18,200
Speaker 6: It really is.

1207
01:09:18,880 --> 01:09:21,040
Speaker 5: So those are the kind of big three that we

1208
01:09:21,080 --> 01:09:24,479
Speaker 5: still use today. But there's a lot more ways now

1209
01:09:24,560 --> 01:09:29,080
Speaker 5: that we have to help treat and prevent recurrence of

1210
01:09:29,640 --> 01:09:35,280
Speaker 5: cancers going forward. So yeah, I mentioned therapy. Well let's

1211
01:09:35,320 --> 01:09:39,080
Speaker 5: get there. Okay, one short thing before we go, immunotherapy.

1212
01:09:39,280 --> 01:09:39,960
Speaker 5: Here we go.

1213
01:09:40,160 --> 01:09:40,479
Speaker 6: Ready.

1214
01:09:41,520 --> 01:09:43,680
Speaker 5: The only thing I wanted to mention aside from immunotherapy

1215
01:09:43,760 --> 01:09:45,800
Speaker 5: before I dig deep into that is that for some

1216
01:09:45,920 --> 01:09:49,559
Speaker 5: cancers we test for and I mentioned this in I

1217
01:09:49,560 --> 01:09:52,120
Speaker 5: think the last episode, for some cancers we might test

1218
01:09:52,120 --> 01:09:55,200
Speaker 5: for things like hormone receptors. So we know for some

1219
01:09:55,320 --> 01:09:58,000
Speaker 5: prostate cancers, for some breast cancers, these might be very

1220
01:09:58,040 --> 01:10:01,360
Speaker 5: hormone sensitive. And so for some people, part of their

1221
01:10:01,400 --> 01:10:05,640
Speaker 5: treatment might include hormone blockers, and this might be to

1222
01:10:05,920 --> 01:10:09,520
Speaker 5: halt the growth and also to prevent recurrence of cancers,

1223
01:10:09,840 --> 01:10:11,240
Speaker 5: you know, kind of maybe towards the end of a

1224
01:10:11,320 --> 01:10:13,960
Speaker 5: therapy or in some cases, like throughout the entire course

1225
01:10:14,000 --> 01:10:17,400
Speaker 5: of their cancer treatment. And so that's a very relatively

1226
01:10:17,520 --> 01:10:19,639
Speaker 5: I mean, hormones have been around forever, but I mean.

1227
01:10:19,760 --> 01:10:22,640
Speaker 1: The kind of the conceptual design of hormone therapy has

1228
01:10:22,680 --> 01:10:25,639
Speaker 1: been around since probably like the nineteen thirty something like that,

1229
01:10:25,720 --> 01:10:30,040
Speaker 1: when hormones were like becoming a thing. Yeah, the height

1230
01:10:30,120 --> 01:10:33,840
Speaker 1: of endocrinology, or at least like the beginning excitement around it. Yeah,

1231
01:10:34,000 --> 01:10:36,599
Speaker 1: but I don't think, like, I'm actually not sure when

1232
01:10:36,640 --> 01:10:39,160
Speaker 1: it became more of a routine or standard of care

1233
01:10:39,280 --> 01:10:40,680
Speaker 1: for certain cancers.

1234
01:10:40,320 --> 01:10:43,040
Speaker 5: Probably depends on when they figured out that these cancers

1235
01:10:43,040 --> 01:10:47,000
Speaker 5: were sensitive to hormones for their growth but you are

1236
01:10:47,080 --> 01:10:48,960
Speaker 5: right that I think that one of the biggest ways

1237
01:10:48,960 --> 01:10:51,760
Speaker 5: that we've changed in how we target cancers today is

1238
01:10:51,800 --> 01:10:54,960
Speaker 5: the advent of immunotherapy. So I want to talk a

1239
01:10:55,000 --> 01:10:57,120
Speaker 5: little bit about what that means because it's a very

1240
01:10:57,160 --> 01:11:00,920
Speaker 5: broad category, and depending I think on who you talk to,

1241
01:11:01,080 --> 01:11:04,040
Speaker 5: they might be more generous in what counts as immunotherapy,

1242
01:11:04,080 --> 01:11:05,800
Speaker 5: and I'm going to be very generous in what we

1243
01:11:05,880 --> 01:11:09,080
Speaker 5: count as immunotherapy, okay, And that means anything that is

1244
01:11:09,160 --> 01:11:13,240
Speaker 5: targeting the immune system with the goal of using the

1245
01:11:13,439 --> 01:11:17,000
Speaker 5: immune system to help target our cancers.

1246
01:11:17,040 --> 01:11:19,240
Speaker 1: Like, hey, he's over there, right.

1247
01:11:19,320 --> 01:11:23,799
Speaker 5: And so that might be in a relatively passive way.

1248
01:11:23,960 --> 01:11:27,280
Speaker 5: Passive doesn't quite work, but that's correct, actually, and that

1249
01:11:27,360 --> 01:11:31,559
Speaker 5: might be something like monoclonal antibodies. So monoclonal antibodies are

1250
01:11:31,640 --> 01:11:33,800
Speaker 5: things that we use very commonly now for a lot

1251
01:11:33,880 --> 01:11:37,040
Speaker 5: of different types of cancers. And these are antibodies that

1252
01:11:37,080 --> 01:11:41,640
Speaker 5: we give to a person that target specific cell receptors

1253
01:11:41,680 --> 01:11:47,040
Speaker 5: on their particular cancer in order to help our immune

1254
01:11:47,040 --> 01:11:49,240
Speaker 5: system recognize them. The reason I say passive is because

1255
01:11:49,280 --> 01:11:51,879
Speaker 5: it's like the antibodies are doing the flagging.

1256
01:11:52,040 --> 01:11:54,280
Speaker 1: Yeah, you're not telling the immune system is not like

1257
01:11:54,360 --> 01:11:56,360
Speaker 1: you're not going, come on, come on, come on, do this.

1258
01:11:56,320 --> 01:11:57,559
Speaker 6: It's like it's just.

1259
01:11:57,520 --> 01:12:02,960
Speaker 5: Putting these flags on yeah them. So that's an amazing

1260
01:12:03,520 --> 01:12:06,960
Speaker 5: way that we have found for a lot of different

1261
01:12:07,000 --> 01:12:10,200
Speaker 5: types of cancers. We have monoclone antibodies for breast cancers,

1262
01:12:10,320 --> 01:12:14,040
Speaker 5: for chematologic cancers, for a lot of different for blood cancers,

1263
01:12:14,120 --> 01:12:17,040
Speaker 5: for a lot of different types of cancers. But even

1264
01:12:17,240 --> 01:12:20,000
Speaker 5: you could think of a bone marrow transplant as a

1265
01:12:20,040 --> 01:12:23,840
Speaker 5: type of immunotherapy. A bone marrow transplant is wiping out

1266
01:12:23,960 --> 01:12:28,320
Speaker 5: the cancero bone marrow and replacing it with a new

1267
01:12:28,600 --> 01:12:32,759
Speaker 5: bone marrow. That is immunotherapy. All of this is leveraging

1268
01:12:32,800 --> 01:12:37,639
Speaker 5: our body's own immune system. Because cancers are incredibly good

1269
01:12:37,960 --> 01:12:42,559
Speaker 5: at evading this, they can manipulate a lot of our

1270
01:12:42,640 --> 01:12:45,960
Speaker 5: typical defenses. So the aim of a lot of the

1271
01:12:46,120 --> 01:12:50,960
Speaker 5: newest forms of immunotherapy is to reactivate a lot of

1272
01:12:51,000 --> 01:12:55,200
Speaker 5: the immune responses that are turned off or altered in

1273
01:12:55,280 --> 01:13:00,160
Speaker 5: some way or another during cancer. For some cancers can

1274
01:13:00,200 --> 01:13:05,160
Speaker 5: identify very specific receptors, for example, like her too New,

1275
01:13:05,160 --> 01:13:06,600
Speaker 5: which a lot of people may have heard of in

1276
01:13:06,640 --> 01:13:08,760
Speaker 5: breast cancer. It's not only in breast cancer, it's also

1277
01:13:08,800 --> 01:13:12,080
Speaker 5: in gastric cancers and things. But that's a specific receptor

1278
01:13:12,360 --> 01:13:15,240
Speaker 5: that is present on some cancers that we have an

1279
01:13:15,280 --> 01:13:18,200
Speaker 5: antibody that can target, and that can boost our immune

1280
01:13:18,240 --> 01:13:20,519
Speaker 5: systems response to targeting that cancer.

1281
01:13:20,640 --> 01:13:21,640
Speaker 6: Yeah.

1282
01:13:21,880 --> 01:13:25,439
Speaker 5: So by identifying those kinds of receptors that we might

1283
01:13:25,479 --> 01:13:28,439
Speaker 5: be able to target, we can help our own immune

1284
01:13:28,439 --> 01:13:32,200
Speaker 5: system recognize those cells as being damaged or as being

1285
01:13:32,320 --> 01:13:38,640
Speaker 5: cancerous and eliminating those cells. So monoclonal antibodies are one.

1286
01:13:38,800 --> 01:13:43,000
Speaker 5: There's another type of immunotherapy that is very very common

1287
01:13:43,040 --> 01:13:45,479
Speaker 5: now that's really quite new, like in the last I

1288
01:13:45,520 --> 01:13:48,559
Speaker 5: think probably ten or fifteen years, and these are called

1289
01:13:48,680 --> 01:13:54,160
Speaker 5: checkpoint inhibitors. Yes, yes, and these basically help to again

1290
01:13:54,280 --> 01:13:58,799
Speaker 5: turn back on a mechanism that cancer cells usually turn off.

1291
01:14:00,040 --> 01:14:04,360
Speaker 5: Ancer cells turn off this ability for our normal T

1292
01:14:04,560 --> 01:14:09,439
Speaker 5: cells to recognize cancer as cancer. So checkpoint inhibitors turn

1293
01:14:09,520 --> 01:14:11,680
Speaker 5: that back on and make our T cells go, oh

1294
01:14:11,680 --> 01:14:14,559
Speaker 5: wait a second, wait I see this, and you're not right?

1295
01:14:14,840 --> 01:14:16,360
Speaker 1: Yeah, how could I have missed this?

1296
01:14:16,640 --> 01:14:17,080
Speaker 6: Exactly?

1297
01:14:17,320 --> 01:14:20,240
Speaker 5: Exactly, And so those are very incredible. And we have

1298
01:14:20,320 --> 01:14:24,400
Speaker 5: a number of different checkpoint inhibitors that target different checkpoints,

1299
01:14:24,600 --> 01:14:27,200
Speaker 5: as it were, because different ones might be turned on

1300
01:14:27,280 --> 01:14:32,080
Speaker 5: and off in different types of cancers. Another very very exciting,

1301
01:14:32,520 --> 01:14:36,120
Speaker 5: super new kind of area of immunotherapy that has shown

1302
01:14:36,200 --> 01:14:39,200
Speaker 5: a special promise and has the most like approved treatments

1303
01:14:39,280 --> 01:14:43,559
Speaker 5: for blood cancers like leukemia's and lymphomas and myelomas is

1304
01:14:43,600 --> 01:14:45,559
Speaker 5: something called car T cell therapy.

1305
01:14:45,800 --> 01:14:47,200
Speaker 1: I know car T cell therapy.

1306
01:14:48,200 --> 01:14:50,720
Speaker 5: This is very exciting, too detailed for me to like

1307
01:14:50,760 --> 01:14:56,240
Speaker 5: go dig deep on, but it basically involves engineering your

1308
01:14:56,320 --> 01:15:00,000
Speaker 5: own T cells, So taking out immune cells from your body,

1309
01:15:00,120 --> 01:15:04,360
Speaker 5: led cells from your own body, adding things to them,

1310
01:15:04,760 --> 01:15:08,559
Speaker 5: putting them back in your body with these specific types

1311
01:15:08,560 --> 01:15:12,040
Speaker 5: of receptors on them that target your specific cancer.

1312
01:15:12,320 --> 01:15:16,559
Speaker 1: Basically saying, let's engineer these cells to become, you know,

1313
01:15:16,640 --> 01:15:18,080
Speaker 1: cancer detectors.

1314
01:15:17,600 --> 01:15:20,400
Speaker 5: Cancer detectors in a way that they aren't right now.

1315
01:15:20,760 --> 01:15:23,040
Speaker 5: And what's really fascinating is that they've been able to

1316
01:15:23,080 --> 01:15:25,000
Speaker 5: do this. And again I've got some papers if you

1317
01:15:25,000 --> 01:15:26,840
Speaker 5: want to dig really deep on the mechanisms here, because

1318
01:15:26,880 --> 01:15:29,760
Speaker 5: it is really fascinating. But they're able to do this

1319
01:15:29,840 --> 01:15:34,040
Speaker 5: in a way that also helps sort of jump over

1320
01:15:34,200 --> 01:15:37,000
Speaker 5: several hoops that our immune system usually has to jump through,

1321
01:15:37,680 --> 01:15:40,639
Speaker 5: so that you don't have to convince everyone in your

1322
01:15:40,640 --> 01:15:42,559
Speaker 5: immune system to get on board through.

1323
01:15:42,439 --> 01:15:45,400
Speaker 1: That red tape exactly get right to the cancer.

1324
01:15:45,040 --> 01:15:46,280
Speaker 6: Just get right to the cancer.

1325
01:15:46,560 --> 01:15:48,880
Speaker 5: So that's very incredible, and there's a lot of interest

1326
01:15:48,920 --> 01:15:51,120
Speaker 5: in being able to use these type of therapy for

1327
01:15:51,280 --> 01:15:54,760
Speaker 5: solid tumors as well. So far as far as I know,

1328
01:15:54,800 --> 01:15:56,559
Speaker 5: we don't have any therapies that are cart you sell

1329
01:15:56,640 --> 01:15:59,080
Speaker 5: for those yet, but I do think that that's one

1330
01:15:59,080 --> 01:16:00,000
Speaker 5: of the big ones on the horizon.

1331
01:16:00,080 --> 01:16:01,040
Speaker 6: And I could be wrong about that.

1332
01:16:01,080 --> 01:16:03,479
Speaker 5: I might have just missed some super new research, but

1333
01:16:04,439 --> 01:16:08,599
Speaker 5: it's very like immunotherapy in general broadly, and all of

1334
01:16:08,600 --> 01:16:11,280
Speaker 5: these specific types of immunotherapy, and I'm sure I'm missing

1335
01:16:11,360 --> 01:16:17,280
Speaker 5: some really are incredible in that they recognize this knowledge

1336
01:16:17,280 --> 01:16:20,479
Speaker 5: of basic cell biology and the basic cancer biology of

1337
01:16:20,560 --> 01:16:23,400
Speaker 5: how they are evading our immune system and are looking

1338
01:16:23,439 --> 01:16:27,400
Speaker 5: for ways to use our own immune system get it

1339
01:16:27,479 --> 01:16:29,559
Speaker 5: back online the way that it ought to be right.

1340
01:16:30,040 --> 01:16:32,160
Speaker 5: So I think that that's really incredible, and they show

1341
01:16:32,240 --> 01:16:33,520
Speaker 5: so much promise.

1342
01:16:33,360 --> 01:16:37,000
Speaker 1: Well, and I think it's just like thinking about the

1343
01:16:37,960 --> 01:16:41,639
Speaker 1: millennia of evolution, thinking about like last week's episode, and

1344
01:16:41,760 --> 01:16:47,280
Speaker 1: how cancer cells have to overcome have to evolve so

1345
01:16:47,320 --> 01:16:49,880
Speaker 1: many different mutations, so many different ways to then evade

1346
01:16:49,880 --> 01:16:52,160
Speaker 1: the immune system, proliferate all these different things. Yeah, our

1347
01:16:52,160 --> 01:16:56,360
Speaker 1: immune system does an incredible job of usually preventing that

1348
01:16:56,360 --> 01:16:58,479
Speaker 1: from happening in the first place, exactly. And so if

1349
01:16:58,520 --> 01:17:00,040
Speaker 1: we can just like be like, you know what, we

1350
01:17:00,240 --> 01:17:04,920
Speaker 1: have a really great cancer detector and cancer eliminator here,

1351
01:17:05,520 --> 01:17:06,240
Speaker 1: Let's just give it.

1352
01:17:06,160 --> 01:17:07,880
Speaker 5: A little bit of a boost, right, Let's leverage what

1353
01:17:07,920 --> 01:17:12,320
Speaker 5: we've already got in a way. And sometimes, very often

1354
01:17:12,520 --> 01:17:16,680
Speaker 5: these immunotherapies might be used in combination with chemotherapy and

1355
01:17:16,720 --> 01:17:20,839
Speaker 5: they might actually help to improve chemotherapy outcomes or mitigate

1356
01:17:20,880 --> 01:17:24,160
Speaker 5: some of the resistance that we see to chemotherapy. So,

1357
01:17:24,320 --> 01:17:29,799
Speaker 5: as one example, if a chemotherapy drug is inducing DNA damage,

1358
01:17:29,840 --> 01:17:32,080
Speaker 5: and that's the main thing that it's doing, is damaging

1359
01:17:32,120 --> 01:17:35,240
Speaker 5: the DNA, but the tumor cells that are there have

1360
01:17:35,320 --> 01:17:40,160
Speaker 5: these mechanisms that resist our immune system's ability to detect

1361
01:17:40,280 --> 01:17:43,439
Speaker 5: damaged DNA, where the tumor itself is like it doesn't

1362
01:17:43,439 --> 01:17:45,920
Speaker 5: matter how much you damage me, I'm still going to proliferate.

1363
01:17:47,000 --> 01:17:50,360
Speaker 5: Then immunotherapy might be able to help make those damage

1364
01:17:50,360 --> 01:17:51,040
Speaker 5: cells more.

1365
01:17:50,960 --> 01:17:52,880
Speaker 6: Visible to the immune system.

1366
01:17:53,240 --> 01:17:55,000
Speaker 5: So they kind of can work in tandem and in

1367
01:17:55,000 --> 01:17:59,599
Speaker 5: conjunction like that, which I think is pretty incredible. There

1368
01:17:59,680 --> 01:18:04,120
Speaker 5: are a number of papers from less than twenty years ago, ten,

1369
01:18:04,240 --> 01:18:06,760
Speaker 5: fifteen years ago, twenty eleven, and twenty sixteen. I found

1370
01:18:06,760 --> 01:18:11,120
Speaker 5: a few that are all about immunotherapy that say, this

1371
01:18:11,200 --> 01:18:14,280
Speaker 5: is the beginning of the end of cancer. We've done it.

1372
01:18:14,640 --> 01:18:17,000
Speaker 5: We've done it, and.

1373
01:18:16,920 --> 01:18:19,599
Speaker 1: It's not that, sorry, haven't we learned this lesson?

1374
01:18:19,800 --> 01:18:20,120
Speaker 6: I know.

1375
01:18:20,680 --> 01:18:25,200
Speaker 5: It's not that the hype isn't warranted, because again, immunotherapistess

1376
01:18:25,200 --> 01:18:28,519
Speaker 5: have shown and have made incredible bounds. They have made

1377
01:18:28,520 --> 01:18:31,360
Speaker 5: it so that some cancers that used to have absolutely

1378
01:18:31,400 --> 01:18:34,960
Speaker 5: no treatment can now be put completely into remission, if

1379
01:18:35,000 --> 01:18:38,920
Speaker 5: not cured in some cases, because of immunotherapies. So it's

1380
01:18:38,920 --> 01:18:42,000
Speaker 5: not that the hype isn't warranted. But for every promising

1381
01:18:42,080 --> 01:18:46,320
Speaker 5: aspect of these therapies, there are also side effects. There

1382
01:18:46,360 --> 01:18:51,439
Speaker 5: are also unforeseen consequences, and very often the reality that

1383
01:18:51,479 --> 01:18:54,200
Speaker 5: we see is that the successes in early or pre

1384
01:18:54,240 --> 01:18:59,720
Speaker 5: clinical trials don't always replicate on a big scale, and

1385
01:19:00,120 --> 01:19:04,880
Speaker 5: cancers still evolve and adapt even to our best immunotherapy efforts.

1386
01:19:05,680 --> 01:19:08,320
Speaker 5: Not everybody is going to respond to them. Not everyone

1387
01:19:08,400 --> 01:19:11,360
Speaker 5: is going to respond in exactly the same way. And

1388
01:19:11,439 --> 01:19:14,759
Speaker 5: so it really is that in all of the papers

1389
01:19:14,800 --> 01:19:17,479
Speaker 5: now about like what is the future of oncology, in

1390
01:19:17,520 --> 01:19:20,360
Speaker 5: the future of you know, cancer treatment, it is this

1391
01:19:20,479 --> 01:19:24,599
Speaker 5: idea that you had said, Aaron, of personalized or precision medicine,

1392
01:19:24,680 --> 01:19:28,360
Speaker 5: precision medicine and for cancer therapy. What that means is

1393
01:19:28,400 --> 01:19:32,920
Speaker 5: that no to cancer treatments might be exactly the same.

1394
01:19:33,240 --> 01:19:37,240
Speaker 5: We have to find a combination of medicines, of immunotherapy,

1395
01:19:37,520 --> 01:19:42,559
Speaker 5: of chemotherapy, hormone therapy, surgery and radiation and whatever we

1396
01:19:42,600 --> 01:19:46,480
Speaker 5: come up with in the future to treat your specific

1397
01:19:46,800 --> 01:19:50,679
Speaker 5: cancer and adapt that treatment to your cancer as it goes.

1398
01:19:50,880 --> 01:19:52,919
Speaker 6: Yeah, and you mentioned Aaron.

1399
01:19:52,720 --> 01:19:57,400
Speaker 5: This idea of adaptive therapy, and there's a lot of

1400
01:19:57,439 --> 01:20:00,759
Speaker 5: really strong preclinical evidence for this idea of adaptive therapy

1401
01:20:00,800 --> 01:20:04,839
Speaker 5: basically not aiming for cure but just sort of keeping

1402
01:20:04,920 --> 01:20:09,759
Speaker 5: things as they are. And it's not something that's used widely.

1403
01:20:09,880 --> 01:20:12,680
Speaker 5: It's mostly all in clinical or pre clinical research at

1404
01:20:12,680 --> 01:20:17,120
Speaker 5: this point. But I think that this concept is so

1405
01:20:17,400 --> 01:20:23,360
Speaker 5: fascinating but requires a complete paradigm shift in how we

1406
01:20:23,400 --> 01:20:27,960
Speaker 5: think about cancer, how we are measuring success in cancer treatments,

1407
01:20:28,720 --> 01:20:35,000
Speaker 5: and how we conceptualize cancer. Period one percent, right, absolutely,

1408
01:20:35,040 --> 01:20:38,080
Speaker 5: And I think that this is a really important framework because,

1409
01:20:38,160 --> 01:20:40,439
Speaker 5: like we've said so many times by this point, like

1410
01:20:41,320 --> 01:20:47,920
Speaker 5: some cancers we can cure, most cancers we cannot. But

1411
01:20:48,160 --> 01:20:51,760
Speaker 5: often when we go into an oncologist office, that is

1412
01:20:51,800 --> 01:20:57,760
Speaker 5: still the hope. And it is not necessarily clear that

1413
01:20:57,960 --> 01:21:02,360
Speaker 5: a therapy the goal might not even be curative treatment,

1414
01:21:02,920 --> 01:21:06,920
Speaker 5: but whether that goal is communicated clearly to the people

1415
01:21:07,040 --> 01:21:10,599
Speaker 5: undergoing it and their families may or may not actually happen.

1416
01:21:11,520 --> 01:21:15,400
Speaker 5: And you know, we do have palliative care and palliative

1417
01:21:15,439 --> 01:21:18,639
Speaker 5: therapies that are often used, and I have so much

1418
01:21:18,760 --> 01:21:22,400
Speaker 5: love for palliative care and pallative care physitions, but I

1419
01:21:22,439 --> 01:21:25,840
Speaker 5: think that they are seen as a last resort for many.

1420
01:21:26,000 --> 01:21:31,320
Speaker 5: They are seen as giving up. There's often kind of clashes, unfortunately,

1421
01:21:31,439 --> 01:21:35,720
Speaker 5: between oncologists and palliative care physicians in what their goals are.

1422
01:21:36,560 --> 01:21:39,600
Speaker 5: Whether the goal is you know, reducing the cancer, or

1423
01:21:39,640 --> 01:21:44,200
Speaker 5: whether the goal is the patient's goals and their families

1424
01:21:44,240 --> 01:21:46,720
Speaker 5: goals and what you want out of your life and.

1425
01:21:46,680 --> 01:21:47,240
Speaker 6: Things like that.

1426
01:21:47,920 --> 01:21:51,840
Speaker 5: And so I think that these ideas of using therapies

1427
01:21:51,920 --> 01:21:54,760
Speaker 5: with different goals in mind, it has to come a

1428
01:21:54,800 --> 01:21:57,120
Speaker 5: really long way before we're kind of there.

1429
01:21:57,439 --> 01:22:00,160
Speaker 1: It does, and I think that like part of the

1430
01:22:00,160 --> 01:22:04,240
Speaker 1: the challenge with it is the way that cancer treatments.

1431
01:22:04,520 --> 01:22:07,000
Speaker 1: And again i'll throw Nixon under the bus, I don't

1432
01:22:07,040 --> 01:22:10,160
Speaker 1: really care. Yeah, but this idea of like war on cancer,

1433
01:22:10,200 --> 01:22:12,320
Speaker 1: we throw enough money at this problem, we will come

1434
01:22:12,400 --> 01:22:14,920
Speaker 1: up with a solution, and then that fail to deliver

1435
01:22:15,240 --> 01:22:18,360
Speaker 1: on that promise, on that all of these money spent.

1436
01:22:18,520 --> 01:22:20,960
Speaker 1: That money was not ill spent at all. No, the

1437
01:22:21,080 --> 01:22:23,960
Speaker 1: problem was the messaging in the first place, and saying

1438
01:22:24,240 --> 01:22:26,920
Speaker 1: there is going to be this thing, and so then

1439
01:22:26,960 --> 01:22:31,040
Speaker 1: when that thing doesn't materialize, there's disappointment and there's a

1440
01:22:31,040 --> 01:22:33,960
Speaker 1: loss of faith really sometimes in the scientific and medical

1441
01:22:33,960 --> 01:22:38,200
Speaker 1: community because what was promise has not been delivered without

1442
01:22:38,240 --> 01:22:41,840
Speaker 1: seeing what actually has been delivered, which is incredible. And

1443
01:22:41,880 --> 01:22:47,400
Speaker 1: so this reframing of cancer as this unavoidable consequence of multicellularity,

1444
01:22:47,479 --> 01:22:50,760
Speaker 1: or this consequence of multicellularity maybe not entirely unavoidable, but

1445
01:22:51,880 --> 01:22:54,960
Speaker 1: this thing that maybe is cure the goal? What is

1446
01:22:55,000 --> 01:22:56,960
Speaker 1: the right goal? How do we measure success? All of

1447
01:22:57,000 --> 01:23:01,320
Speaker 1: these different things are not have not really had a

1448
01:23:01,360 --> 01:23:03,519
Speaker 1: seat at the table when it comes to the war

1449
01:23:03,600 --> 01:23:06,880
Speaker 1: on cancer exactly, and so I think that has been

1450
01:23:06,960 --> 01:23:10,360
Speaker 1: that has contributed so much as well to the fear

1451
01:23:10,479 --> 01:23:11,200
Speaker 1: surrounding it.

1452
01:23:11,400 --> 01:23:11,639
Speaker 3: Yeah.

1453
01:23:11,880 --> 01:23:13,920
Speaker 5: Yeah, I think one of our listeners actually wrote in,

1454
01:23:14,000 --> 01:23:17,400
Speaker 5: and I really love the way that he framed this idea,

1455
01:23:17,880 --> 01:23:20,840
Speaker 5: because he was saying that all of these analogies saying

1456
01:23:20,880 --> 01:23:23,519
Speaker 5: that we have to fight cancer, that it's this battle.

1457
01:23:23,960 --> 01:23:26,800
Speaker 5: This imagery implies that if you've lost, it's because you

1458
01:23:26,840 --> 01:23:27,880
Speaker 5: didn't fight hard enough.

1459
01:23:28,000 --> 01:23:30,799
Speaker 1: Are winners and losers, and you didn't fight exactly.

1460
01:23:31,040 --> 01:23:33,680
Speaker 5: And so I'm going to quote him and thank you

1461
01:23:33,720 --> 01:23:36,759
Speaker 5: so much for sending this email. He said, quote, cancer

1462
01:23:36,800 --> 01:23:39,120
Speaker 5: is not something that you fight, it's something you endure.

1463
01:23:39,680 --> 01:23:41,760
Speaker 5: And I think that that's just so powerful because it's

1464
01:23:41,800 --> 01:23:45,559
Speaker 5: true for so so many people. You know, despite how

1465
01:23:45,680 --> 01:23:48,080
Speaker 5: much progress we have made, and I don't want to

1466
01:23:48,200 --> 01:23:51,439
Speaker 5: understate how much progress we have made, right, there are

1467
01:23:51,560 --> 01:23:58,560
Speaker 5: also still huge disparities in cancer treatment on so many different.

1468
01:23:58,360 --> 01:24:00,719
Speaker 1: Levels, so much levels.

1469
01:24:00,760 --> 01:24:03,719
Speaker 5: On one level, not all cancers get the same amount

1470
01:24:03,800 --> 01:24:07,760
Speaker 5: of research funding, so not all cancers are as well understood.

1471
01:24:08,479 --> 01:24:12,320
Speaker 5: So we have these new paradigm shifting treatments like car

1472
01:24:12,439 --> 01:24:16,000
Speaker 5: T cell therapy for some cancers, and others, we have

1473
01:24:16,360 --> 01:24:21,240
Speaker 5: nothing new under the sun. And for cancers where new

1474
01:24:21,400 --> 01:24:24,599
Speaker 5: or exciting or very promising treatments still exist, these are

1475
01:24:24,680 --> 01:24:29,320
Speaker 5: not universally available by any means. So where you live

1476
01:24:29,439 --> 01:24:33,280
Speaker 5: in the world, where you live in this country in

1477
01:24:33,320 --> 01:24:35,960
Speaker 5: the United States, whether you live in a big city

1478
01:24:36,080 --> 01:24:39,839
Speaker 5: like Boston where you have your pick of cancer treatment centers,

1479
01:24:40,320 --> 01:24:42,680
Speaker 5: or if you live in a state that has no

1480
01:24:42,880 --> 01:24:48,200
Speaker 5: access to clinical oncology or in academic medical center in

1481
01:24:48,240 --> 01:24:52,760
Speaker 5: this country, what insurance provider you have, and whether or

1482
01:24:52,840 --> 01:24:55,760
Speaker 5: not they are willing to cover any of your treatments

1483
01:24:56,000 --> 01:25:00,280
Speaker 5: or what is recommended. Your race, your education, life level,

1484
01:25:00,479 --> 01:25:05,760
Speaker 5: your socioeconomic status. All of these things affect your access

1485
01:25:05,880 --> 01:25:09,760
Speaker 5: to treatment and have affected the outcomes that we see

1486
01:25:10,080 --> 01:25:14,280
Speaker 5: in cancer treatments and cancer mortality. And this has led

1487
01:25:14,280 --> 01:25:18,800
Speaker 5: to really huge disparities in especially cancer mortality, but as

1488
01:25:18,840 --> 01:25:22,799
Speaker 5: well as like diagnosis, which contributes to mortality exactly exactly.

1489
01:25:22,880 --> 01:25:25,120
Speaker 5: We'll talk more about that next week. But what we

1490
01:25:25,120 --> 01:25:28,800
Speaker 5: see in the US is that black Americans and Americans

1491
01:25:28,800 --> 01:25:32,759
Speaker 5: who live in rural areas, and Americans with lower education

1492
01:25:32,920 --> 01:25:36,439
Speaker 5: levels or lower socioeconomic status, which often go hand in hand,

1493
01:25:36,880 --> 01:25:42,400
Speaker 5: have significantly higher mortality rates across almost all cancers. And

1494
01:25:42,439 --> 01:25:44,519
Speaker 5: we'll talk in a lot more detail about that later.

1495
01:25:45,760 --> 01:25:49,000
Speaker 5: So I think it's true what you said already, Aaron,

1496
01:25:49,120 --> 01:25:51,719
Speaker 5: and what actually Lindsay Fitzharris said in our book Club

1497
01:25:51,760 --> 01:25:54,559
Speaker 5: episode that like, are we going to look back on

1498
01:25:54,640 --> 01:25:57,600
Speaker 5: cancer treatments how we do it today in thirty or

1499
01:25:57,600 --> 01:26:00,960
Speaker 5: fifty years and say, WHOA, I can't believe that we

1500
01:26:01,000 --> 01:26:04,920
Speaker 5: did these things. And at the same time, the way

1501
01:26:04,920 --> 01:26:08,120
Speaker 5: that we treat cancer today is drastically different than how

1502
01:26:08,160 --> 01:26:12,160
Speaker 5: we treated it ten, even twenty, even five years ago

1503
01:26:12,240 --> 01:26:16,600
Speaker 5: for some cancers. So it's really, it's really really incredible

1504
01:26:16,720 --> 01:26:20,559
Speaker 5: how much progress has been made. And this has been

1505
01:26:20,600 --> 01:26:24,479
Speaker 5: made because of funding for basic research. This has been

1506
01:26:24,479 --> 01:26:28,599
Speaker 5: made because of funding for clinical trials, and right now

1507
01:26:29,920 --> 01:26:34,160
Speaker 5: that funding has been cut in the US hugely, hugely,

1508
01:26:35,000 --> 01:26:38,280
Speaker 5: nearly four billion dollars so far in cuts to the

1509
01:26:38,360 --> 01:26:42,120
Speaker 5: National Institutes of Health and NSF, including over seven hundred

1510
01:26:42,160 --> 01:26:45,400
Speaker 5: and ninety million dollars from the National Cancer Institute alone.

1511
01:26:46,520 --> 01:26:49,439
Speaker 5: And what is so scary is that the therapies that

1512
01:26:49,479 --> 01:26:53,879
Speaker 5: we have today came from research that was done five, ten, fifteen,

1513
01:26:53,880 --> 01:26:54,599
Speaker 5: twenty years ago.

1514
01:26:54,760 --> 01:26:56,960
Speaker 1: There's a time lag to all of this.

1515
01:26:57,120 --> 01:27:00,800
Speaker 5: So we will not know the impacts of all of

1516
01:27:00,840 --> 01:27:04,400
Speaker 5: the cuts that we have seen to basic research and

1517
01:27:04,640 --> 01:27:08,160
Speaker 5: clinical research that has happened this year and last year,

1518
01:27:08,960 --> 01:27:11,840
Speaker 5: for the next five or ten years, but there will

1519
01:27:11,880 --> 01:27:13,080
Speaker 5: be impacts.

1520
01:27:12,680 --> 01:27:16,599
Speaker 1: It's investment, Like, there is no other way to look

1521
01:27:16,640 --> 01:27:21,400
Speaker 1: at this. Funding for basic research, funding for clinical trials,

1522
01:27:21,840 --> 01:27:26,160
Speaker 1: funding for any kind of scientific medical research is investment,

1523
01:27:26,200 --> 01:27:29,160
Speaker 1: investment in our future. And the fact that that's being cut,

1524
01:27:29,400 --> 01:27:32,519
Speaker 1: I mean, yeah, what more can we say that hasn't

1525
01:27:32,520 --> 01:27:35,800
Speaker 1: been said. It's shortsighted, It is ridiculous. It shows a

1526
01:27:36,360 --> 01:27:39,240
Speaker 1: complete lack of understanding of the way that the world

1527
01:27:39,280 --> 01:27:43,760
Speaker 1: works and how each individual person has benefited directly from

1528
01:27:43,880 --> 01:27:44,639
Speaker 1: basic research.

1529
01:27:44,720 --> 01:27:48,000
Speaker 5: Yes, so a huge thank you to everyone who has

1530
01:27:48,040 --> 01:27:52,719
Speaker 5: ever participated in clinical trials, in any kind of research trials,

1531
01:27:52,760 --> 01:27:54,920
Speaker 5: all of you who are working on research, who are

1532
01:27:54,960 --> 01:28:00,160
Speaker 5: doing that research like it. It cannot be overstated how

1533
01:28:00,200 --> 01:28:01,840
Speaker 5: impactful that is and will be.

1534
01:28:03,120 --> 01:28:04,760
Speaker 6: And thank you. That's all.

1535
01:28:05,520 --> 01:28:07,240
Speaker 1: Yeah. I had a little note here too that was

1536
01:28:07,280 --> 01:28:10,639
Speaker 1: like thinking about the history of treatment and how far

1537
01:28:10,720 --> 01:28:14,360
Speaker 1: we've come, and how many people have been involved in that,

1538
01:28:14,560 --> 01:28:17,040
Speaker 1: in the fundraising for it and the raising awareness of it,

1539
01:28:17,080 --> 01:28:19,679
Speaker 1: in the participating in clinical trials, and the being willing

1540
01:28:19,720 --> 01:28:22,759
Speaker 1: to organize a clinical trial. Everyone who has been support

1541
01:28:22,840 --> 01:28:25,640
Speaker 1: staff the pis everything takes.

1542
01:28:25,479 --> 01:28:30,320
Speaker 5: So many people. Yes, and it is so valuable. And

1543
01:28:30,880 --> 01:28:33,519
Speaker 5: hopefully this will change and it will continue to be

1544
01:28:33,640 --> 01:28:36,720
Speaker 5: valued as it is in other countries and things like that.

1545
01:28:37,080 --> 01:28:39,760
Speaker 5: But I have a lot of interesting articles. If people

1546
01:28:39,760 --> 01:28:41,680
Speaker 5: want to read more about what we anticipate, some of

1547
01:28:41,720 --> 01:28:47,280
Speaker 5: those impacts might be Yes, so that's cancer treatment today, answer.

1548
01:28:47,120 --> 01:28:50,559
Speaker 1: Treatment A survey of the existing treatments.

1549
01:28:50,640 --> 01:28:56,240
Speaker 6: Yes, that was great, thanks, Yeah, sources.

1550
01:28:55,960 --> 01:28:58,720
Speaker 5: Yeah, yeah, people want to read more. I want a

1551
01:28:58,720 --> 01:28:59,519
Speaker 5: lot more, a lot.

1552
01:29:01,080 --> 01:29:05,120
Speaker 1: Yes, let's see again. I'll shout out The Emperor of

1553
01:29:05,120 --> 01:29:09,320
Speaker 1: All Maladies. Great story about the by Siddartha Mukherjee. Great

1554
01:29:09,320 --> 01:29:12,639
Speaker 1: story about the history of different cancer therapies, but especially

1555
01:29:12,720 --> 01:29:16,920
Speaker 1: chemotherapy is the main focus there to learn more about

1556
01:29:16,960 --> 01:29:22,639
Speaker 1: the history of surgery Wild and post in well, Okay,

1557
01:29:22,680 --> 01:29:25,760
Speaker 1: wild at All from twenty fifteen called the title The

1558
01:29:25,760 --> 01:29:30,800
Speaker 1: Evolution of Cancer Surgery in Future Perspective by Hater from

1559
01:29:30,960 --> 01:29:33,559
Speaker 1: nineteen ninety eight. The Clinic as Laboratory The case of

1560
01:29:33,640 --> 01:29:37,400
Speaker 1: Radiation Therapy nineteen eighteen ninety six to nineteen twenty Really

1561
01:29:37,400 --> 01:29:41,800
Speaker 1: interesting about this transitional shift between evidence supported research and

1562
01:29:41,840 --> 01:29:44,840
Speaker 1: how that kind of flew in the face of experience

1563
01:29:44,960 --> 01:29:50,719
Speaker 1: supportive decisions. Then by Galmarini at all from twenty twelve,

1564
01:29:50,840 --> 01:29:54,559
Speaker 1: cancer Chemotherapy a Critical Analysis of its sixty years of history.

1565
01:29:54,600 --> 01:29:58,559
Speaker 5: Okay, I have quite a lot of papers for this one,

1566
01:29:58,600 --> 01:30:01,799
Speaker 5: including a lot of fis on different types of cancer.

1567
01:30:01,840 --> 01:30:04,559
Speaker 5: So if you're interested in like breast cancer treatments today,

1568
01:30:04,640 --> 01:30:06,880
Speaker 5: colon cancer treatments today, I have a lot of papers

1569
01:30:06,880 --> 01:30:09,360
Speaker 5: that you could look at those details, but some broader

1570
01:30:09,400 --> 01:30:11,680
Speaker 5: ones I mentioned. There was one from twenty eleven by

1571
01:30:11,720 --> 01:30:15,559
Speaker 5: Melman at all in Nature called Cancer Immunotherapy Comes of Age,

1572
01:30:15,560 --> 01:30:18,720
Speaker 5: which is really interesting read. I have one on car

1573
01:30:18,800 --> 01:30:21,760
Speaker 5: T cell therapy from Patel at all twenty twenty five

1574
01:30:21,840 --> 01:30:24,519
Speaker 5: that's called from Concept to Cure the Evolution of car

1575
01:30:24,600 --> 01:30:26,760
Speaker 5: T cell Therapy that goes into a lot more detail

1576
01:30:26,800 --> 01:30:29,280
Speaker 5: on what exactly that is. I have a couple other

1577
01:30:29,320 --> 01:30:32,280
Speaker 5: papers on adaptive therapy and things, but I also just

1578
01:30:32,320 --> 01:30:34,120
Speaker 5: want to give a shout out to to These are

1579
01:30:34,120 --> 01:30:36,600
Speaker 5: not peer reviewed. These are articles that were written by

1580
01:30:36,720 --> 01:30:40,840
Speaker 5: Nature staff members, but they're about kind of trying to

1581
01:30:40,920 --> 01:30:44,120
Speaker 5: forecast what some of the impacts of these funding cuts

1582
01:30:44,200 --> 01:30:46,840
Speaker 5: might be. Because we can't know right now, and so

1583
01:30:46,880 --> 01:30:48,880
Speaker 5: these are kind of interesting papers that you could take

1584
01:30:48,920 --> 01:30:50,800
Speaker 5: a look at. They're just sort of articles. They're not, again,

1585
01:30:50,880 --> 01:30:54,800
Speaker 5: not peer reviewed, but they're interesting. And again I got

1586
01:30:54,840 --> 01:30:56,840
Speaker 5: a long list here, so go to our website. This

1587
01:30:56,880 --> 01:30:59,760
Speaker 5: podcast would kill you dot com to see all of

1588
01:30:59,760 --> 01:31:02,400
Speaker 5: this is from this episode and every single one of

1589
01:31:02,439 --> 01:31:02,840
Speaker 5: them one.

1590
01:31:03,000 --> 01:31:09,080
Speaker 1: So we've read so many papers. Thank you again so

1591
01:31:09,240 --> 01:31:11,519
Speaker 1: much to the providers of our first hand accounts. Yeah,

1592
01:31:11,520 --> 01:31:12,920
Speaker 1: it means the world, it really does.

1593
01:31:12,960 --> 01:31:13,280
Speaker 6: Thank you.

1594
01:31:14,000 --> 01:31:17,120
Speaker 5: Also, thank you to John and Brett, our respective husbands,

1595
01:31:18,160 --> 01:31:20,720
Speaker 5: for all of your help and letting us talk your

1596
01:31:20,720 --> 01:31:22,360
Speaker 5: ear off about this. I also want to shout out

1597
01:31:22,360 --> 01:31:25,160
Speaker 5: my friend Julia, who is a palliative care physician and

1598
01:31:26,200 --> 01:31:27,760
Speaker 5: she let me talk in her ear for a long

1599
01:31:27,800 --> 01:31:30,880
Speaker 5: time about my feelings about all of this. So thank

1600
01:31:30,920 --> 01:31:31,559
Speaker 5: you Julia.

1601
01:31:31,640 --> 01:31:35,280
Speaker 1: Thank you, Juliah. Thank you to Bloodmobile, who provides the

1602
01:31:35,360 --> 01:31:38,120
Speaker 1: music for each episode, this episode and all of our episodes. Wow,

1603
01:31:38,120 --> 01:31:39,240
Speaker 1: I haven't said that in a while.

1604
01:31:39,000 --> 01:31:41,960
Speaker 6: In that way since a week from week today.

1605
01:31:42,479 --> 01:31:44,760
Speaker 5: Thank you to everyone in the exactly right studios but

1606
01:31:44,880 --> 01:31:48,240
Speaker 5: we're recording this today. Thank you to Tom and Leanna

1607
01:31:48,360 --> 01:31:55,360
Speaker 5: and Pete and everyone who's here today, Jessica and Corey everyone.

1608
01:31:55,720 --> 01:31:58,800
Speaker 1: Yes, thank you, thank you, and thank you to you listeners.

1609
01:31:59,040 --> 01:32:02,599
Speaker 1: You make us, make you make this happen. You thank

1610
01:32:02,640 --> 01:32:05,800
Speaker 1: you for listening, participating in this podcast in some way.

1611
01:32:05,920 --> 01:32:06,760
Speaker 6: We really appreciate it.

1612
01:32:06,880 --> 01:32:09,080
Speaker 1: How do we not do this better at this point?

1613
01:32:09,240 --> 01:32:10,599
Speaker 6: Listen, We're trying.

1614
01:32:10,680 --> 01:32:14,599
Speaker 1: We're trying. Thank you. Patrons. Also, your support means everything. Yes,

1615
01:32:14,680 --> 01:32:18,320
Speaker 1: thank you, thank you. Until next time, wash your hands.

1616
01:32:18,520 --> 01:32:19,439
Speaker 6: Stealthy Animals

1617
01:32:25,160 --> 01:32:25,200
Speaker 3: A