(8 of 10)
Most gratifying and surprising was the discovery that amethopterin, after years of use in acute leukemia, was effective against choriocarcinoma. Dr. Min Chiu Li, now at Sloan-Kettering, and Dr. Roy Hertz, head of NCI's hormone research, pioneered in this, starting from the fact that the female reproductive tract's cells need unusually large amounts of folic acid. Also important was the fact that women with this cancer excrete abnormally large amounts of a hormone forbiddingly named chorionic gonadotropin, and the progress or arrest of the tumor can be gauged with high accuracy by measuring the quantity of the hormone in the urine. In four years, Dr. Hertz and colleagues have treated 45 women at the Clinical Center, and ten of them now show no sign of cancer either at the original site in the uterus or in the areas to which it had spread. In more than 20 cases, the cancer was slowed for a while but then got out of control. Only one woman showed no benefit.
Extended Powers. The search for anti-cancer drugs is no U.S. monopoly. Several have been developed in Britain. From Japan has come an antibiotic, mitomycin C, with dazzling claims; U.S. researchers grant that it is potent in mice, have been baffled by failure to get good results in man. Soviet scientists are screening chemicals by the carload, and the Chinese Reds —with an eye on the propaganda value in underdoctored Asia—are sifting ancient herbal medicines.
In all, more than 100 drugs are being tested on human patients in 150 U.S. hospitals. Some are taken by mouth; others have to be injected in various ways. Some are used alone, others in conjunction with surgery or radiation. Most provocative is an ingenious technique of Drs. Oscar Creech and Edward T. Krementz, worked out at Tulane University. They isolate the blood flow through a cancerous area with tourniquets, divert it through a heart-lung machine, lace it with some alkylating agent such as nitrogen mustard. The rest of the body is protected against blood-cell destruction caused by the drug, and a far higher dose can be given. Usually, this is an extremity, but with experience the technique is being modified, by its originators and other surgeons, to attack cancers in the shoulder and even the lung or pelvis. Boston's Dr. Farber has found that actinomycin D, a derivative of one of Dr. Selman Waksman's earliest antibiotics, has both anti-cancer activity of its own and the power to increase the effectiveness of X rays. So now he uses both in a double-barreled blast against certain children's cancers.
Prevention. From all these varied approaches, Dr. Heller is confident, drug treatment will emerge as the equivalent of surgery and radiation, with its powers extended from palliation to actual cure of cancer.