Vincent T. DeVita, Jr., MD, and Elizabeth DeVita-Raeburn, The Death of Cancer, New York, Sarah Crichton Books, Farrar, Straus and Giroux, 2015.
Charlotte DeCroes Jacobs, Henry Kaplan and the Story of Hodgkin’s Disease, Stanford, Stanford General Books, An Imprint of Stanford University Press, 2010.
Review by Alan Lippman, MD
The last 40 years have brought enormous progress to the world of cancer therapy. Those of us, including myself, who were privileged to train with or to have been influenced by some of the original leaders in the field, as well as many of us with a keen interest in medical history, will appreciate the insightful biographies of two of them, Henry Kaplan and Vincent DeVita, who are regarded as modern pioneers in the establishment of successful treatment for a previously formidable and heretofore long-refractory malignancy, Hodgkin’s lymphoma. Kaplan is commonly regarded as the “father” of radiation therapy for Hodgkin’s lymphoma and DeVita as the patriarch of chemotherapy for that disorder.
Vincent T. DeVita, Jr., MD, who developed MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone), the first successful chemotherapy program for Hodgkin’s, and his co-author, science-writer and daughter Elizabeth DeVita-Raeburn, have produced a compelling narrative exploring the imagination and the struggles of a clinician who has devoted his life’s energy to engaging the “war on cancer.” And beyond the science, the book provides fascinating insights into DeVita’s personal philosophy, his relationships—and arguments—with colleagues, and his leadership—at Memorial Sloan-Kettering, the National Cancer Institute, and Yale School of Medicine—that have shaped his approaches and his attitudes along the way.
After having read The Death of Cancer, I was drawn to Henry Kaplan and the Story of Hodgkin’s Disease. Although published six years ago, this book, written by Charlotte DeCroes Jacobs, Professor of Medicine in the Division of Oncology at the Stanford University School of Medicine, is a timeless analysis of Henry Kaplan’s personal mission to cure cancer and his own contributions as a pioneer of radiation therapy in Hodgkin’s lymphoma.
Both books go well beyond the basic narrative of each man’s contribution to the early development of meaningful approaches to efforts to cure Hodgkin’s lymphoma. For DeVita, the reader is presented with the vision and determination of a scientist/clinician whose clear-thinking objectivity and persuasiveness would not infrequently clash with colleagues and institutions for whom the approaches differed from his own and that he regarded as obstacles. In the case of Kaplan, his dynamic leadership was, on occasion, frustrated by forces he regarded as too conservative for his liking. In both instances, one is reminded that true progress in medicine reflects a collaborative process in which innovative ideas must be tested and refined in an evolutionary process. This is the true measure of evidence-based knowledge that leads to significant improvements in disease management and benefits to patients.
Building on the work of Kaplan and of DeVita and the many other investigators who have followed, current management of patients with early-stage Hodgkin’s lymphoma consists of a combination of chemotherapy (usually the less toxic and better-tolerated ABVD, rather than MOPP) plus radiation therapy. For those with advanced stage disease, or limited stage with unfavorable prognostic signs, combination chemotherapy is the main treatment, with radiation therapy reserved for selected patients, as consolidation. Cure rates are high, but patients who relapse can be rescued with high-dose chemotherapy and autologous hematopoietic cell transplantation. Newer, immunologically-based therapies offer further benefit.
The major thrust in cancer treatment today lies in molecular biology and in “precision medicine,” defined by the National Institutes of Health as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” The pioneering work of men like Henry Kaplan and Vincent DeVita has served as a foundation for advances that mark the way for future success, not only for patients with Hodgkin’s lymphoma, but as a model for all cancers.