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Summer Book Club: Oncology (OR:BIT) – A Cure Within

27.09.2020

With the European Society of Oncology’s (ESMO) annual conference wrapping up the science portion of their program this weekend, we at HRW were eager to continue our Hematology-Oncology story.  What better way to do this than a book review!  HRW’s very own Dana Hill (Research Manager) and Kirsty Page (Associate Director) took the time to jump headfirst into A Cure Within: Scientists Unleashing the Immune System to Kill Cancer by Neil Canavan.  This easy to digest and fascinating read sets out to be all things to all men by providing an in-depth and fascinating insight into both the science and the politics of the Immuno-Oncology (IO) journey through the medium of discreet chapters, covering the lives and achievements of many of the key players within this space.  We felt that largely Canavan succeeded in drawing us into ‘ the memoirs of IO’, leaving us hungry for more.

Ample time is spent walking through each “aha! moment” and discovery in IO right from the earliest moments beginning (starting with CTLA) that tip the balance incrementally from a criticized pseudo-science to an increasingly astonishingly impactful therapeutic approach.  Nobel prizes are handed out frequently throughout!  Canavan does an incredible job of explaining advanced principles clearly and concisely, using each chapter’s scientist in focus as building blocks to develop not only the story of the science, but the story of shared learnings, failed experiments, tragedies and successes. By the end of the book, the reader will have a very clear, fundamental understanding of all the key players (from T-cells, to dendritic cells, B cells and even to the crucial role of mice!) and pathways involved in the immune response.  The way the book is written, allows those for a passion with Oncology and a keen interest to advance their thinking further and fully grasp in a more technical sense, the chemistry and biology behind what we talk about every day.  A Cure Within conveys this in an engaging way that is likely to reignite the passions of those who have perhaps become more ‘immune’ to the potential of IO and instead inspiring them with both its history and the foundations for its potential next steps.  While Canavan caveated that the book is not intended to be educational, we think you’ll be hard-pressed to find another resource that spells out these principles in layman’s terms, all the while connecting the dots between each discovery (how rare is it that conference presentation actually spells out the new acronym they’re using).

While we’ll always love non-fiction, books focused on Oncology in particular have a bad rap for being dense, difficult to follow and not suitable or accessible for all.  A Cure Within offers an easy to read structure that engages (and left us reading well into the night) that goes beyond the science, but never leaves it too far behind, often hiding complex topics in drawings or anecdotes to help support and explain the point.  The narration, peppered with boyish like enthusiasm is an addictive hook, taking the time to dive into the stories of individuals within IO, their backgrounds, their motivations and gripping you chapter after chapter to see if a particular experiment worked, or a trial patient lived, or if a biotech company continued to fund research.  This is truly a tale of celebration and the human spirit as much as anything, highlighting the importance of these and the crucial role of determination and patience that led to many of these “a-ha” moments and will no doubt continue to do so, such as in the field of vaccines, bispecific antibodies, IDO and many more continue to push forward.

One thing that stuck out was how resilient each scientist was in terms of their passion to succeed, not only at the lab bench, but in terms of delivering tangible benefits to patients who were dying with little or no hope.  From its inception, immuno-Oncology required a gear shift in scientific thought that went against fundamental perceptions about tumor biology at the time (the immune system was thought to be unable to see a tumor and act as it is not a foreign body).  Further to that, immuno-oncology made its first strides right as imatinib was first coming to the market, reinforcing the hype that targeted therapies and personalized medicine was the way forward – no one believed that immunotherapies would work (as Canavan pointed out, IO is completely absent from The Emperor of all Maladies) . Immuno-oncology had to completely re-write the rule book, from how the immune system is understood all the way through how cancer agents are evaluated in clinical trials – and even after ‘Ipi’(ipilimumab) was able to do so, Tasuku Hojo (Chapter 4) presented the concept of anti-PD-1 to pharmaceutical companies for over one year without being able to secure partnership or funding, before relying on a venture capital firm to support the remaining research of, what is now today, nivolumab. Can you imagine?

While informative and inspirational, Canavan also managed to carve out some valued space for a ‘self-help’ book, with each chapter featuring its own “Dark Knight” – a story and piece of advice from each colleague as to how to overcome the worst of times in your career.  Patience, persistence and passion are the watchwords for most, with some perhaps taking this to the next level as many of the key players ended up married!  The core belief at the centre of each ‘character’ in the book is that IO was real, IO was exciting, IO could be amazing, how can I prove this.  Dogged perseverance and an unwillingness to let go of this determination to ‘see it through’ seemed to even speed up the science and credibility of IO, with the red tape of intellectual property barely there and with individuals committed to, for want of a better phrase, standing on the shoulders of giants to push immuno-therapy further forward.

To close, this motley crew of scientist looks like the absolute coolest (and most intelligent) group of friends and colleagues one could imagine – you know if your friends life achievements included things being the first scientist to win a Nobel Prize posthumously (Ralph Steinman). Personally, it has us a bit bummed that COVID has stood in the way of a live performance from ‘The Checkpoints’ at ASCO (the only blues band made solely of oncology immunologists that I’m aware of). And that was one of the first things to strike us as we passed through each chapter – there is an overwhelming sense of comradery that joined each of the scientists, despite what is a highly competitive field. Each chapter is not only joined through the incremental discoveries building off the past, but shared learning experience – this book is full of scenarios of scientists helping each other apply for grants and sharing cells and re-agents for experiments, in the name of progress. When Steinman was diagnosed with pancreatic cancer, there was an outpouring of support and the entire industry banded together and offered the cutting edge of IO therapies.

It’s easy to forget what a relatively short time ago it was that we first heard from IO.   Ipi (the pioneer IO) was approved just 9 years ago, to think the amount of progress made spans the course of decade is unfathomable. This year, our oncology team had the opportunity to visit a virtual ESMO, where we were left buzzing with excitement over the advancements presented for targeted therapies, and speculating if it’s come time that personalized medicine will steal some of the spotlight back from IO. But, we can say with confidence we don’t think IO is done, rather the book reignited my passion for it and our curiosity in learning what those next big building blocks could be! We highly encourage you to jump into A Cure Within if you haven’t already, or even re-read it if you see it on your bookshelf, or your Kindle library!  If the committed and passionate family of scientists whose stories we hear, can’t convince you about the merits and future opportunities for IO, we’re not quite sure what will…and you would be missing out. If you’re interested in hearing more about our oncology team, OR:BIT, reach out here!

By Kirsty Page and Dana Hill

HRW - Image of Kirsty Page

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