Coming face-to-face with advanced cancer

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Noah Pines
Noah Pines

Having been in the pharmaceutical business now for more than 20 years, I have seen discoveries by industry scientists work miracles. For example, they've managed to turn the tide against HIV and changed the trajectory of disease in people with cystic fibrosis. Even today, I'm watching as the defiant fortress of hepatitis C is slowly toppled, and it seems as though an effective treatment for Alzheimer's may be in the not-so-distant future.

These scientists have given us the gift of a world where many of the major diseases humans have contended with for centuries are now manageable and, in some cases, even curable. Even as the public's view of the industry varies from one hyper-focused on profits, to one challenged by voluminous safety concerns, I feel a sense of pride for the work done and of the only industry I've ever worked for.

At the same time, the past year—and particularly the past weekend—has made me realize what an enormous unmet medical need still demands our attention and passion. This weekend, I watched my 58-year old father-in law struggle to take his last few heaving breaths at a hospital north of Chicago. He was nearly a skeleton, the deep ridges of his frontal bones visible, his cheeks hollow, his waxy skin stretched thin from the peaks of the zygomatic bone down to his jaw. His eyes were lifelessly staring into infinity as he labored with each gasp, his mouth agape. It was a shocking contrast to the healthy, vibrant man whose daughter I asked to marry nearly five years ago.

Looking at him in this condition was shocking. It brought back memories of the images I saw at Hebrew school of the starved, ghost-eyed Holocaust victims discovered in the Nazi concentration camps.

When I brought our 4-month-old to the hospital room on Friday—the day before his passing—my father-in-law lit up, reaching not toward her but vaguely into the distance as though seeing a mirage after a long desert trek. He cried a well of emotions, because his body and mind were slipping from his command. It was both joyous and tearful to have given him the image of his granddaughter in the last few hours of his life.

Metastatic renal cell carcinoma (mRCC) is a disease which medical science has not yet figured out how to chronically manage, let alone disarm. It claims people at a relatively young age, especially men 50-70. My father-in-law was diagnosed with mRCC about a year ago. Six months prior, he was jubilantly attending our wedding celebration, where he gave a speech rehearsed for weeks. English is not his first language, so when he finished speaking, he received a thunderous ovation. This past weekend, I watched as friends and relatives circulated in and out of his hospital room where his lifeless, emaciated body lay still.

Over the past year, as I've witnessed this man's rapid descent from weight loss to life support, I've learned more and more about his horrid condition. According to Wikipedia, RCC is the most common type of kidney cancer in adults, responsible for approximately 80% of cases, and is known to be the most lethal of all the genitourinary tumors. In cases where the tumor is confined to the renal tissue, the five-year survival rate is 60-70%, but this is lowered considerably with metastases. That is what happened to my father-in-law—by the time he was diagnosed, the cancer already had metastasized to the liver, the lungs and the bone.

The available medicine chest offers options that only slow the speeding train for a short while; eventually, it breaks through. Therapies such as Sutent (sunitinib), Torisel (temsirolimus), Avastin (bevacizumab), Nexavar (sorafenib) and Inlyta (axitinib) have improved the outlook for RCC. Unfortunately, most of these treatments only grant two to three additional months of life.

But those additional months made the difference here. I'd like to hug the team of scientists at Pfizer Oncology who developed Inlyta, one of the drugs that prolonged my father-in-law's life long enough to meet his granddaughter, born in November.

What also struck me was a conversation I overheard between his oncologist at the hospital and one of the nurses just down the hallway. The oncologist was in a chair weeping because his own son had recently died of cancer and there was nothing that the doctor could do to save him. He felt as though, despite an entire career dedicated to medicine, he still did not have the tools to save his son.

The industry has been in the doldrums for the past few years. The patent cliff, massive layoffs, downsizing, challenges in pipeline productivity, governments not wanting to pay for new therapies, bad press and other headwinds all have us feeling down about the work we do.

But the imperative to continue fighting with relentless passion is vital. When I think about the small survival increments that these drugs confer—in this case, the increment was meaningful. I'm so appreciative for the drugs that extended my father-in-law's life just long enough to see his granddaughter. At the same time, I wish there was something that, like HIV anti-retrovirals, could neutralize or somehow tame what destroyed his kidneys, his liver, then his lungs and then finally the whole body.

So let's stay focused on why we're in this line of work. People who did not need to die so young, and their loved ones, implore us to continue engaging each day with passion and determination.
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