Chapter 8: The Runaway Cell: New Ways to Address the Killer That Is Cancer

**Chap­ter 8: The Run­away Cell — New Ways to Address the Killer That Is Can­cer**

In the late 1960s, Steve Rosen­berg encoun­tered a patient, James DeAn­ge­lo, who mirac­u­lous­ly sur­vived a metasta­t­ic stom­ach can­cer with­out treat­ment, lead­ing Rosen­berg to hypoth­e­size the immune sys­tem’s role in fight­ing can­cer. Despite Rosen­berg’s ini­tial fail­ures in can­cer research, his deter­mi­na­tion laid the ground­work for mod­ern immunother­a­py. The nar­ra­tive shifts to the author’s per­spec­tive, explain­ing his deci­sion to pur­sue sur­gi­cal oncol­o­gy inspired by Rosen­berg’s work. The his­to­ry of can­cer research and the lim­it­ed progress in cur­ing can­cer are dis­cussed, despite sig­nif­i­cant invest­ment and the dis­cov­ery of the genet­ic com­plex­i­ty of tumors.

The chap­ter empha­sizes can­cer as a dis­ease of aging, high­light­ing the preva­lence and dead­ly nature of metasta­t­ic can­cer, which remains a chal­lenge due to late detec­tion and the com­plex­i­ty of treat­ment. The impor­tance of ear­ly detec­tion, advance­ments in immune-based ther­a­pies, and the meta­bol­ic prop­er­ties of can­cer cells are dis­cussed as crit­i­cal areas for future break­throughs in can­cer treat­ment.

His­tor­i­cal attempts at tack­ling can­cer through the immune sys­tem are exam­ined, from William Coley’s bac­te­r­i­al inoc­u­la­tions to Rosen­berg’s exper­i­ments with interleukin‑2 and the devel­op­ment of CAR‑T cells and check­point inhibitors, lead­ing to recent suc­cess­es in immunother­a­py. Despite the promise of immunother­a­py, it helps only a small per­cent­age of patients, prompt­ing the need for broad­er and more effec­tive treat­ment strate­gies.

The author advo­cates for bet­ter screen­ing to improve ear­ly can­cer detec­tion. He crit­i­cal­ly exam­ines cur­rent screen­ing prac­tices for var­i­ous can­cers, empha­siz­ing the need for more aggres­sive screen­ing strate­gies and the poten­tial of liq­uid biop­sies to rev­o­lu­tion­ize ear­ly can­cer detec­tion by iden­ti­fy­ing cell-free DNA asso­ci­at­ed with tumors.

The chap­ter con­cludes with a reflec­tion on the endur­ing chal­lenge of can­cer pre­ven­tion and treat­ment. While rec­og­niz­ing the lim­i­ta­tions of cur­rent strate­gies, the author remains hope­ful about the prospects of immunother­a­py, ear­ly detec­tion, and the evolv­ing under­stand­ing of can­cer’s meta­bol­ic and genet­ic prop­er­ties, envi­sion­ing a future where can­cer can be effec­tive­ly man­aged or even cured.