Review: Emperor of all maladies, part 7: treatment timeline

Treatment

• 440 BC From Herodotus writings, we have first record of attempted lumpectomy for breast cancer
• late 1890s (exact date not given) 1^st hysterectomy FOR breast cancer performed in Scotland
• 1890s Halstead pioneers the mastectomy
• 1896 1^st use of radiation therapy
• 1898 Halstead jumps up to radical mastectomies
• 1904 1^st radical prostatectomy performed by Halstead’s pupil
• 1907 Halstead publishes data showing radical mastectomy only works in early stage breast cancer, but ignores his own findings and continues the procedure on anyone, dooming women to mutilation for almost half a century more
• 1924-1928 Geoffrey Keynes tests using a lumpectomy (a name given to his conservative surgery by colleagues as a term of derision) and radiation therapy in combination in breast cancer patients—proves as effective and less devastating to patients as Halstead’s increasingly radical mastectomies; was ignored by oncology for decades due to idol-worshiping of surgeons
• 1930s radiation shown effective at reducing lymphomas
• 1933 1^st lung removal
• 1942 1^st human trial using mustard gas as chemotherapy
• 1947 Farber makes the first attempts at chemotherapy in children with ALL
• 1950s In Halstead tradition, surgeons push toward “ultra-radical” mastectomies, whereby the remove almost ¼ of the torso
• 1956 1^st metastatic solid tumor case cured by chemotherapy
• 1957 1^st randomized control trial to show that using multiple chemotherapy drugs simultaneously increases the effectiveness in leukemia (previously proved in mice by Skipper)
• 1958 1^st use of extended field radiation therapy
• 1958 1^st combination of chemotherapy and radiation for treatment in a patient with Wilms’ tumor (a cancer of the kidney)
• 1961 1^st full trial of using 4 chemotherapies (the VAMP trial) for children’s leukemia begins; initially seems a disaster as it almost kills the children in a few days
• 1962 Due to initial scare, VAMP only has 6 subjects after one year, but they finally pulled through and seemed to be in remission; the trial continues
• 1963 1^st VAMP subjects come back with leukemia cells in the spinal fluid
• 1964 1^st trial begins that will lead to a chemotherapy cure for advanced stage Hodgkin lymphoma, and it uses mustard gas as one of its drugs
• 1967 radical mastectomy as gold standard for breast cancer treatment is finally challenged culturally, despite evidence from Halstead and Keynes half a century earlier
• 1975 adjuvant chemotherapy shown to reduce breast cancer relapses 30-50%
• 1981 Tamoxifen shown to reduce relapse in estrogen receptor positive breast cancer by 50%
• 1993 Gleevec, a targeted hormone therapy for CML (a rare leukemia) shown very effective in pilot tests. The pharmeceutical company the researcher worked for, Novartis, didn’t approve full trials until 1998, because it was not a money making drug.
• 2003 Herceptin increased survival in women who had Her-2 positive cancer by 33%