cancer researcher Dr. Judah Folkman

[Guest strider2004]

This researcher's name has crossed my path on several different occasions throughout my undergrad and medical career. I can't think of a bigger person in medicine right now.

 

 

www.theglobeandmail.com/s.../TPHealth/

 

By IAN BROWN

Saturday, March 13, 2004 - Page M1

 

 

Even by the standards of self-inflated Yorkville, there are a lot of Mercedes-Benzes in the driveway of Toronto's Four Seasons Hotel -- at 7:30 in the morning, no less.

 

But 150 of the city's philanthropic and medical elite have risen early this grey Monday morning to meet the man speaking in the Tudor Room, a bland white box on the hotel's third floor.

 

The race to find a cure for cancer is the most intensely competitive event in all of science these days -- the Holy Grail and the Stanley Cup and the Oscar combined. And Dr. Judah Folkman -- 70 years old, white-haired, grey-fleshed, modest as a handkerchief -- is leading the pack.

 

The room is crammed hip to lip with some of the brightest lights of the Toronto firmament. Harry Rosen, the clothing magnate, is here; so is Jack Rabinovitch, the benefactor of the Giller Prize. Over there, dark eyebrows like two caterpillars sunning on his handsome face, is Biff Mathews, lawyer and founder of Manitou Capital, an investment and money management outfit. And there's Bill Biggar, who until very recently drove Magna International's real-estate and entertainment divisions.

 

Meanwhile, Maggie Bras, the widow of cancer victim and magnate Robert Bras (pet food), is sitting at the front of the room. Ms. Bras recently handed $5-million to a new drug development program at the Princess Margaret Hospital Foundation, the host of the breakfast.

 

Across the room to her left is John Wood, scion of the Wood family fortune (toilets), who himself lost a parent and a sister to cancer and has given the drug program $300,000.

 

To widen the net and raise another $4.5-million, Mr. Wood enrolled the services of the hospital's Dr. Robert Buckman, a razzle-dazzle cancer researcher (and former member of the Cambridge Footlights) who has previously collaborated on a series of medical videos with John Cleese of Monty Python fame. Dr. Buckman, in turn, invited Dr. Folkman to speak.

 

And what are all the glittering stalwarts in the audience, the gems of the cancer establishment, doing? They're gazing at round, grey Dr. Folkman as if he was Miss April. The old doctor is dithering with a laptop in front of a PowerPoint screen filled with mind-zapping charts and four-point type and eight-syllable medical jargon, looking more like a professor at a small-town community college than the father of 21st-century cancer research. And yet the masters of the business universe are drooling over his every word.

 

This is the new game in cancer fundraising, the fundraising-for-winners breakfast. Dr. Folkman is in Toronto to raise money for the oncological theories he has been developing, mostly in obscurity, for 30 years. He is "the pope of angiogenesis," as Dr. Buckman calls him, today's best bet against cancer. He may also turn out to be a godsend in Canada, where thousands of clinical cancer-drug trials are crying out for cash.

 

"Traditional giving," says Gillian Howard, vice-president of public affairs for the University Health Network, "has been characterized by people who are older. But I think the philanthropic community needs to speak to people of the next generation -- people of the boomer generation, who have money. And to do that they have to make giving to charity more of a business proposition."

 

This is why the third floor of the Four Seasons this morning is populated by traditional philanthropists like Ms. Bras as well as baby boomer business boys such as Mr. Biggar and Mr. Mathews. If they can find it in their hearts to donate money to the 70 different cancer-drug trials under way at Princess Margaret Hospital, good. If they find it easier to do so knowing Dr. Folkman's involvement radically improves the odds of their money accomplishing something concrete -- "Who wouldn't want to be part of the cure for cancer?" as one insider puts it -- so much the better.

 

And if chatting with a handful of the world's top cancer researchers over breakfast gives them an insight into where hods of money might be made in the future, well, that is something no one is admitting to. The doctors are prohibited from having any financial stake in the new drugs they research. But for the investors and philanthropists in the room, investment ideas are bouncing around like a pack of invisible monkeys.

 

Paul Alofs, president of the Princess Margaret Hospital Foundation, is quite willing to admit it. "We would encourage our researchers and doctors who feel they have something to patent to go out and find investors," he says. He calls it "social entrepreneurship."

 

Dr. Folkman is to cancer what Elvis was to rock and roll -- although there the comparison pretty much ends. Traditional chemotherapy aims to destroy cancer cells, but kills healthy cells in the process. Anti-angiogenesis, the therapy Dr. Folkman pioneered, uses less invasive drugs (angiogenesis inhibitors) to cut off the blood supply to a tumour, which stops it from growing. Very low doses of chemotherapy can then shrink the tumours, without the hair loss, vomiting and debilitation that are standard side effects of chemotherapy. Thanks to Dr. Folkman, cancer could be transformed from a killer into a merely chronic condition like diabetes -- "cancer without disease," as Dr. Folkman calls it.

 

"Instead of blowing up every enemy office in a terrorist cell," says Dr. Buckman, the showman, "you just freeze their assets."

 

Unlike other cancer treatments that have grabbed the world's attention and then failed, anti-angiogenesis therapy has enjoyed some clinical success. On Feb. 26, the FDA approved the sale of Avastin, an angiogenesis inhibitor manufactured by Genentech. In company with mild chemo, Avastin can reduce colon cancer by 30 to 50 per cent, with no side effects. Colon cancer is the second-leading cause of cancer death, and kills one North American every nine minutes. Avastin is one of several new cancer drugs that have fuel-injected $40-billion into stock markets.

 

Dr. Folkman began to develop his theories of tumour behaviour as a navy surgeon in 1961. Along the way and over the years, he has made some startling findings, all of which he uses to lure his audience in:

 

Almost everyone has tiny tumours in his or her body throughout their life. But only 1 per cent of those tumours is ever "switched on" through angiogenesis, a still mysterious process that incites the growth of new blood vessels, and thus lures new blood cells to the tumours for the growth to feed on. "It's as if grapes could create their own vines," Dr. Folkman says.

 

There are 30 known angiogenesis inhibitors in an average North American body, versus 70 in its Japanese counterpart. This may be why the Japanese have lower levels of prostate and breast cancer than North Americans, at least until they start to travel here. Such findings are spawning an entire industry devoted to foods that prevent angiogenesis.

 

People afflicted by Down syndrome do not get cancerous tumours, except the testicular brand. According to Dr. Folkman, this is because the "extra" chromosome that marks Down syndrome produces additional endostatin, an angiogenesis inhibitor that occurs naturally in all animals, from humans to worms.

 

A number of well-known and even off-patent drugs are developing second lives as angiogenesis inhibitors. Thalidomide, a sedative that was banned because it caused birth defects, turns out to be a powerful angiogenesis inhibitor, especially for growths in the head and jaw, such as those that cause macular degeneration. Celebrex, the well-known arthritis drug, is being used as an angiogenesis inhibitor in clinical trials all over the United States and Europe. Both are easy to produce and increasingly inexpensive.

 

Every new inhibitor represents a potential investment. Canada is no backwater of research, either. Toronto is North America's fourth largest "bio-tech cluster." At the London Regional Cancer Centre at the University of Western Ontario, Dr. Ann Chambers is, by Dr. Folkman's assessment, the world authority on metastatic tumour migration. Dr. Robert Kerbel, a world-famous tumour biologist at the University of Toronto and Toronto's Sunnybrook and Women's College Health Sciences Centre, has been investigating low-dose "metronomic" chemotherapy -- drugs that restrict the tumor's blood supply and shrink its growth, without producing side effects.

 

Of course, Dr. Folkman is quick to point out that nearly all these therapies are still at the clinical trial stage, and are not cures for cancer. Of the 200 human cancers, only one -- medullary thyroid cancer -- produces a reliable biological warning that angiogenesis of the dormant tumour is about to begin. (The newest phase of cancer research aims to find more such "markers," from which scientists might be able to produce angiogenesis inhibitors that might work as cancer vaccines.)

 

But amid the opportunists and the doubters, the philanthropists and the cynics, there is also plenty of hope walking around the Four Seasons this overcast morning.

 

Dr. Norman Saunders, a well-known pediatrician in Toronto's north end, was diagnosed with widespread colon cancer, with multiple metastases, in June 2002. Surgery was not an option, and Dr. Saunders was told he had less than a year to live.

 

Thirteen months ago, on a break from six cycles of intravenous chemotherapy, and thoroughly convinced that his care was palliative at best, Dr. Saunders approached his old medical school pal, Sunnybrook's Dr. Kerbel. Dr. Saunders asked Dr. Kerbel to let him try a radical trial therapy: two pills a day of Celebrex, the arthritis medicine that doubles as an angiogenesis inhibitor, and one pill's worth of cyclophosphamide, a 40-year-old chemotherapy drug.

 

Dr. Saunders hasn't endured standard chemotherapy since. His tumour has shrunk to half its size; he has not lost his hair; he has resumed duties as a professor at U of T and assumed half his heavy patient load as a pediatrician. Now he's walking around the Tudor Room at the Four Seasons looking nothing like a man who has a lump of cancer in his guts.

 

"Basically," Dr. Saunders says -- and he insists that he is simply one case, and not evidence of anything more encouraging -- "the treatment has no side effects. . . . You're supposed to not live a year with what I have. So this is amazing."

 

To his and Dr. Kerbel's knowledge, he is the first colon cancer patient in Canada to have been treated with these drugs.

 

He thinks Dr. Folkman should receive the Nobel prize. Still, Dr. Saunders is a doctor, and knows the odds and risks stacked against him. "Do I think it's a cure?" he asks. "I think that would be an incredibly premature statement. I still think I'm going to die. And I still think I'm going to die fairly soon. But at least it's fair to say that -- even though I've had cancer, and treatment -- I've had a stretch of wonderful quality of life, and have been allowed to continue to contribute. That has been a complete gift."

[Guest Ian Wong]

That's pretty cool. Thanks for posting that.

 

Ian