Here's a link to the article:
Jerome Groopman, "The Transformation: Is it possible to control cancer without killing it?", The New Yorker, September 15, 2014.
It's a LONG article, but it's written by a physician, so it has some particularly interesting insights. Here are a few quotes that give a flavor of the things discussed in the article:
In discussing AG-221, a drug being developed by Agios to treat acute myeloid leukemia (AML),
The breakthrough is notable in part for the unconventional manner in which the drug attacks its target. There are many kinds of cancer, but treatments have typically combatted them in one way only: by attempting to destroy the cancerous cells. Surgery aims to remove the entire growth from the body; chemotherapy drugs are toxic to the cancer cells; radiation generates toxic molecules that break up the cancer cells’ DNA and proteins, causing their demise. A more recent approach, immunotherapy, coöpts the body’s immune system into attacking and eradicating the tumor.
The Agios drug, instead of killing the leukemic cells -- immature blood cells gone haywire --coaxes them into maturing into functioning blood cells. Cancerous cells traditionally have been viewed as a lost cause, fit only for destruction. The emerging research on AML suggests that at least some cancer cells might be redeemable: they still carry their original programming and can be pressed back onto a pathway to health.
In a discussion of how bone marrow samples look under the microscope, as it relates to studies being done of another Agios drug,
That afternoon, I examined microscope images of the bone marrow of a patient who had not been treated with the drug. As a hematologist, I often dread taking in this view. Up close, healthy marrow looks like an Impressionist painting -- a variegated landscape of cell types and colors. Leukemic marrow is a monotonous canvas of cancer cells; the images I was looking at showed hardly any normal blood cells being made. Then I examined images from a patient who had received the Agios drug. Typically, when a patient with AML is treated with high doses of chemotherapy, the marrow is emptied of all living cells; what’s left is a moonscape of fat globules and fibrous tissue. The images at Agios showed robust marrow: the leukemic cells had been forced to mature and had reverted to functioning white blood cells, red blood cells, and platelets. They were transformed.
On cancer cells in general:
In medical school, we were taught that although cancer comes in many forms, it has one immutable characteristic: it is composed of immature cells. The research on these blood cancers, however, suggests that this trait may be reversible after all, and that the cancer cells, when prompted to mature, become susceptible to therapies to which they would otherwise remain resistant.
On the concept of "cancer stem cells":
“I understand full well the attractiveness and the seduction of the cancer-stem-cell model,” William Kaelin, a cancer biologist at Harvard’s Dana-Farber Cancer Institute, told me. “But so far it hasn’t made any predictions that I wouldn’t have otherwise made. I think we already knew that cancers tended to coöpt stem-cell pathways that are important for normal stem cells. And I think we already knew that many genes that are involved with stem-cell biology were occasionally mutated in cancers.”
As I said, it's a long read, and it's also not directly related to myeloma. But there's some interesting stuff there.
