Book Review: Dr. Folkman’s War

Saturday, May 18, 2002


Read “Dr. Folkman’s War: Angiogenesis and the Struggle to Defeat Cancer” by Robert Cooke. Dr. Judah Folkman while working in a navy lab in 1961 noticed that strangely, tumors do not grow unless they manage to recruit blood capillaries to provide them with a lot of blood to nourish their growth. After a period of 40 years this intriguing observation has blossomed into a multibillion-dollar industry in the biomedical arena racing towards possible cure for cancer. Since Folkman happened to be Chief of Pediatrics Surgery in the Boston Children’s Hospital (rather than a cancer researcher), the established cancer research fraternity refused to seriously look at his proposals/research/results and consistently scoffed him off until the 90’s..!

As you may know, the standard treatment for cancer is removing the tumor by surgery and/or killing the cancerous cells either by chemotherapy or by radiation. So the establishment has been all along focused on fine-tuning the Maximum Tolerable Dosage (MTD) of toxins or radiation that can be administered to kill the cancer cells while avoiding the killing of patient in the process (since a large number of non-cancerous cells also get killed in this shotgun approach). The Angiogenesis approach is to simply cutoff the needed blood supply to the cancer cells so that they can never grow beyond microscopic levels. People with microscopic cancerous tumors can live a long and peaceful life. Since this type of cancer management does not affect any normal cells, it is has very little or no side effect..!

Another well-known problem in cancer treatment is the appearance of secondary tumors once the primary tumor is surgically removed. As long as the primary tumor is in the system you don’t see too many secondaries in most of the patients. The traditional treatment is just to hope that the intervention is timely and pray that the cancer has not spread to other parts of the body yet. But in many cases once the primary tumor is removed, a whole slew of secondaries appear all over the body. Folkman’s team hypothesized that the primary tumor, in addition to releasing a chemical to invite and recruit blood capillaries, must also be releasing some other factor that keeps the secondaries at bay and limits their growth. Again cancer establishment threw out this idea asking what the hell does a pediatric surgeon know about the pathology of cancer cells that oncologists don’t already know. One of the main problems Folkman faced was that these factors are so small in quantity that no one could quickly separate them to demonstrate their effect. But in the last few years they have. Book details all the trails and tribulations Folkman went through to get funding for his research, establishment of his labs, all the fights he had to put up to fend of bad publicity, etc. What is nice is that it is not a biography of Folkman but a chronicle of the development of Angiogenesis as an accepted, recognized field of study solely developed and pushed into the lime light by Folkman.

He is portrayed as a very affable researcher, grooming his research associates well, constantly giving them credit for what they have contributed, free spirited researcher deeply committed to his work, willing to talk to anyone who is interested, etc. This seems to be quite true since every report/documentary I have seen mentions these aspects of his nature. The factors his team has isolated called angiostatin and endostatin are in clinical trials at this point in time. There are several more in the labs now since the U.S. Govt., NSF, American Cancer Society, etc. recognize this approach’s potential in treating, managing cancer. Pretty interesting. You can see a PBS documentary on this topic at http://www.pbs.org/wgbh/nova/cancer/program.html

While working on these issues, he has developed a polymer that is porous enough to releases chemicals stored on one side to the other at extremely slow rates. Since neither he nor Harvard wanted to patent anything (as they felt it is against the spirit of academic research), the idea was put into public domain and has been used very effectively in the Norplant contraceptive..! (If you don’t know about Norplant, read up on the web. It is a very neat application of this polymer.) BTW, Harvard no longer has that “not-patenting-anything-ever” policy. How sad. :-(

Updates on November 26, 2011
Dr. Folkaman passed away in 2008. Avastin, which is a drug developed based on Angiogenesis theory received its first approval in 2004 for combination use with standard chemotherapy for metastatic colon cancer. While at one point it was also approved for breast cancer by the FDA, the approval was revoked on 18 November 2011.