The First Cell

Starred review from August 19, 2019
Raza, a Columbia University professor of medicine and practicing oncologist, offers a passionate account of how humans grapple with the scourge of cancer. She masterfully explains how her research science work intersects with her job treating dying patients on a daily basis: “Nowhere is the science of medicine replaced by the art of caring as in the final days of a terminal illness.” She also explains why using animal models to search for new cancer treatments is unlikely to work, as cancer is so variable and dependent on the specific environment in which it grows. Meanwhile, most new cancer drugs, if they work at all, add months to life and are accompanied by severe costs, both financial and physiological. Her message is as simple as it is paradigm-shifting: rather than trying to kill every last cancer cell, medicine needs to focus on finding the first occurring cancer cells. Progress is being made on this front, she shows, but only a small percentage of available research dollars are being spent on it. Showing that compassion is just as important for cancer patients as the drugs administered to them, Raza’s deeply personal work brings understanding and empathy to the fore in a way that a purely scientific explication never could. Agent: John Brockman, Brockman Inc.

September 1, 2019
A welcome argument that we are overdue for a change in the paradigm for treating cancer. Raza (Medicine/Columbia Univ.) decries the "protocol of surgery, chemotherapy, and radiation--the slash-poison-burn approach to treating cancer" that has remained unchanged for decades." She points out the billions spent on research to find and target a single mutated gene or a faulty signaling pathway at a time when a seasoned tumor has evolved into a chaotic mass of malignant cells reproducing in multiple clones with varying genetic and cellular derangements. In this approach, researchers study human tumors as static entities in tissue culture or injected into mice whose immune systems and microenvironments are in no way comparable to the cancers seen in mostly elderly patients. Consequently, it's not surprising that candidate cancer drugs fare dismally in human trials and that the few that offer some hope extend the life of patients by only weeks--and at great cost. The author does not ignore the recent success with immunotherapy, but she notes that the therapy remains limited and comes with its own risks and side effects. What she wants instead is research to address prevention and the initiation of the cancer process--find and eliminate the first faulty cells. Her approach may be inspired in part by her own research on a pre-cancer syndrome that can develop into acute myeloid leukemia. She describes her efforts in that area as well as new research aimed at finding blood or tissue biomarkers of those first cancer cells. Her explanation of the science and her brief history of cancer research would be enough to recommend this volume to general readers, but it is in the case histories of cancer patients she has treated, including her late husband's, where Raza's eloquence is on full display. With elegant literary references and a compassion that deeply personalizes her interactions with patients and families, she engages readers in a commitment to finding a better way. Intelligence, empathy, and optimism inform the argument for new research on cancer that could obviate the suffering prevalent today.

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Starred review from October 1, 2019

Richard Nixon declared the "War on Cancer" in 1971. Since then, survival rates have improved, thanks to early detection and smoking cessation. However, according to Raza (oncology, Columbia Univ.), our treatment methods have not changed. We still rely on surgery, chemotherapy, and radiation. Genetic therapy and other technological approaches that sounded promising have not resulted in benefits for most patients. Researchers have uncovered many secrets of cancer cell biology, but their findings have not led to improved therapies. Along with touching on end-of-life issues in cancer care, Raza proposes that our approach to cancer research should be turned on its head. Current research focuses on developing drugs that will kill the last cancer cell, using cell culture and mouse models. The failure rate for drugs manufactured in this manner is 95 percent. Of the five percent, one such drug extends the life of pancreatic cancer patients by 12 days at a cost of $26,000. Rather, according to Raza, we should fund research into early screening that locates the first cancer cell and kill it at the source, with lower costs and fewer side effects. VERDICT This memorable work will be of interest to anyone who has been impacted by cancer, both patients and family and friends.--Rachel Owens, Daytona State Coll. Lib., FL

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