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Thursday, March 07, 2019

Review: The Breakthrough

The Breakthrough is a book about the development of immunotherapy techniques in an effort to cure cancer.  The title, of course, is hype: if you read the book carefully, you'll notice that the author is careful not to promise that a cure has been found: in fact, successful therapy seems to be more the exception than the norm.

The notion behind immunotherapy is to activate the immune system against cancer. The problem, of course, is that cancers that are already susceptible to your immune system are taken care of invisibly, of course. But the cancers that survive to become dangerous tumors, however, are precisely those who've already learned to fool the immune system, which makes turning on the immune system to target those tumors a tricky proposition.

The book does a good job of covering the history of immunotherapy, and contrasts the pre-genetic approach with the current approach. One particular type of drug, known as the checkpoint inhibitor, basically takes the brakes off the immune system, telling it to operate without restraint. As you can imagine, this can lead to horrible side-effects and at least one patient had to be taken off the therapy because of those side-effects --- there's a reason nature evolved those brakes!

The other approaches include a customized approach, where the patient's T-cells are taken out of the patient, along with the tumor, and then trained to attack those tumors (the book was written by a journalist, and didn't do a good job of explaining how the process worked). These customized therapies also do not have a 100% success rate, and are expensive (on the order of $1M per course of therapy).

The book unfortunately spends more time on survivor victims than on the science, and doesn't do a good job of covering the science and mechanisms by which these new types of drugs work. Obviously, it's nice to know the history and personalities involved, but the science is very much missing, which makes it tough for me to recommend the book!

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