Facing the wall

Published in Cancer

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Like any given summer day, two years ago on a regular evening, I was web surfing after dinner to check some news. Suddenly I got an email from my collaborator Zoey. She asked me to call her immediately. We ran a lot of mouse studies together, and sometimes there was a mouse incident that she would want me to check. However, I never received her message in the evening. It's strange, I thought, but I called her anyway.

As soon as the call was connected, I heard her crying. After a few seconds, she stopped and said, "It's about Allen. Can you help him to get enrolled in a clinical trial for melanoma?" What? How was that possible? I asked her to explain.

Allen is a mouse technician in Zoey's team. He was a gentle, soft-spoken, very nice guy. During those days when I still came to the animal facility, I worked with him quite often. He always talked about his son, what the young boy liked, where they spent time together over the weekend. He was a very caring father, like many other family men. As the mice did not care about human schedules, every some time the technicians needed to come into the facility over the weekend, holidays, or under bad weather. I remembered that, in a meeting, Zoey and her colleague said that their technicians came to the facility during consecutive days of big snow, "they did not skip any dosing", she told us with gratitude and professional pride. Allen was one of the two technicians who took care of mice during those snow days.  

This wonderful person has now succumbed to the disease that our research focused on. This is a cruel irony. Zoey said that Allen was diagnosed with metastatic melanoma about two years ago. The tumors went away upon treatment with anti-PD-1 immunotherapy. Everyone thought he was cured. However, they came back furiously to get Allan sick. Very sick. She could not help but weep again.

I was very shocked. However, I thought there was hope. We knew the best melanoma experts and clinicians nation-wide, in the best cancer centers. We know the trials of new therapies are ongoing. We knew melanoma could respond to the immunotherapies. There must be some way.

I asked my boss for help. He for sure sent out an email to an oncologist in Boston whom he considered the top doctor in melanoma treatment and a good friend. He is an enthusiastic, caring, and calm person at the same time. He asked us to send him Allen's medical record. With Zoey's help, we email him the files the next day. He would evaluate it and find a clinical trial that Alan could enroll in.

I was optimistic at that point. We know so much more about melanoma, and have much more "weapons" against it, now. I still remembered that melanoma was an incurable disease when I started my research on it. I remember reading Jim Allison's first paper of anti-CTLA4 trial and could not believe my eyes- from 0 to 10% cured patients! What a miracle. I saw the survival rate increasing over years, from 10% to almost 50% nowadays.There got to be something working for Alan.

As soon as receiving Allen's medical report, the oncologist contacted the pathologists and clinical administrators to look for trials open to melanoma patients. I appreciated him very much, because I know how busy his schedule is. However, these are the characteristics of all good doctors. They always put patients in top priority, no matter how busy they are. His help gave me confidence, so I decided to call Alan to cheer him up.

I got his number from Zoey and called him. He answered in a very weak voice. I told him, Allen, there is hope. Please hold on, we will find a cure for you. He was tired and spoke with difficulty, only "OK" or "right". I spoke most of the 10 minutes myself. He said thank you to me, and I hung up. I really believed that he would get ready to fight for another round and win.

After three days, Zoey sent an email. Allen passed away. That phone call was the last time that I talked to him. 

I was so saddened and felt totally crushed.The maladies outsmarted us, and my confidence was just hubris. How could I think that we could overcome the disease without even understanding the details of Allen's condition? How could I ignore that, with every therapy we have, there are still half of the patients of metastatic melanoma who could not be saved? I kept thinking of the false hope that I could give to him. Instead, it was the desperation waiting ahead. I was wrong from the beginning.

When we tell the patient there is hope, especially those whom we are so close to, those who trust us, would it be more devastating if it is a false hope? Or would we believe that miracle could happen as long as the patients could hold on? I don't know. It was all too late for Allan, a colleague whom we care so much about. I do know that we could not let him die in vain. We have to keep working on the research he helped, keep hitting the thick stone wall between humans and the cure. Starting from making dents, to chipping inches, hammer by hammer, we will crash a hole on that wall, and eventually demolish the wall.

Before that, we will lay ourselves low to find the Achilles' heel of the Emperor of Maladies. No false hope. We could not let patients down this time.

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