Submitted by Dr.Kattlove’s Cancer Blog

Judah Folkman died suddenly early this year. He was a super creative cancer researcher. His work promised a revolution in cancer treatment but it never happened.

I first encountered him when I was training in Hematology at Montefiore Hospital in the Bronx. He presented his work at one of our research seminars. He had found that he could grow cancer cells within the eyes of rabbits. But they had to be planted on the iris. That allowed blood vessels to begin growing into the tiny tumors and once that happened the tumors took off. If the cancer cells were placed in the middle of the eye chamber without attachment to any eye tissue, blood vessels didn’t develop and the cancer didn’t grow.

His theory was that the cancer needed blood vessels to supply it with nutrients and oxygen. A reasonable theory. This allowed the cancer to grow. He also reasoned that the cancer had the special ability to cause these blood vessels to develop. The corollary to this was that if you could block the blood vessel growth, you would prevent the cancer from growing.

Next, he and many others looked for the substance that caused the blood vessel growth. When they found it, they named it vascular endothelial (blood vessel lining) growth factor or VEGF. The next step was to develop a drug that would block VEGF. This would stop blood vessel growth and starve it.

Several drugs were developed. These drugs were labeled anti-angiogenesis agents, drugs that blocked blood vessel growth. This was a hot idea in the 90’s. Scientists touted these as the new wonder drugs, drugs that cancers couldn’t resist. The drugs were terrific in treating implanted cancers in mice. Unfortunately they were much less effective in humans with cancer. When used alone, they rarely shrank tumors or slowed their growth.

Finally, in 2004, one drug seemed effective. This first successful drug, called Avastin, was shown to help patients with advanced colorectal cancer and was blessed by the FDA. But no home run. The drug only worked when given with heavy-duty chemotherapy and prolonged patients’ lives by an average of 4-5 months. And of course there were side effects.

Avastin, although not a blockbuster cancer treatment, has proven very useful in medicine, by saving the vision of thousands of people. It turns out it can block the progression of macular degeneration, a cause of blindness in the elderly caused by leaky blood vessels. A small amount injected directly into the eye seems to do the trick. Go figure.

Other blood vessel blocking drugs have made it into practice, but none have had more than a small benefit. What happened? Well, although Dr. Folkman was disappointed with the lack of blockbuster effect, he pointed out, cancers are complex and had to admit that there won’t be a simple answer to treating them.
There aren’t any miracles in the wings. So take care of yourself, get screened, eat right, exercise, and try to avoid cancer in the first place.

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