Another daunting problem that we face is that it’s not just the cancer cell, it doesn’t exist in isolation. It exists in the soil, in a microenvironment, which is feeding it. Again, I’d like to show you what that is.
Multiple mutations can come one after another and then the bone marrow microenvironment is playing a role here. So once again, you have the cancer cell, it expands itself and becomes this clone and gives birth to certain sub-clones, daughter cells. Now, each of these are producing growth factors and cytokines, which are affecting the microenvironment, which keeps changing with time as well.
So how are we going to study this bone marrow microenvironment, which changes with each subsequent new clone of cells? The next slide may not be ideal for those who are faint of heart, but this is how we do a bone marrow. And when we actually put in our syringe and pull out the bone marrow, the liquid that you’re getting only has the seed in it. The soil, or the microenvironment cells, are contained in this bottom picture, which is the bone marrow biopsy. So in other words, what I’m saying is we have to study everything. We have to study the cancer cells, as well as their microenvironment.
Three decades ago, when I decided to dedicate my life to the study of this illness, I also decided to start saving cells on my patients. I started when I was 28 years old, which was 100 years ago and now, we have a tissue repository, which has over 50,000 samples, which were collected over three decades. It’s not just one of the richest, but it’s definitely the oldest in the country. And why is that important? Because it gives us the luxury of having that perspective.
Why did one patient take 14 years to go from pre-leukemia to acute leukemia, whereas another one took three months to do so? What molecular genetic events characterized their unique diseases? So, we really have to give up studying mouse models. We really have to start studying humans. We have to take advantage of what we have, especially historically available. Art is I. Van Gogh would stand and paint the starry nights by himself, but science is we. We all have to work together: patients, oncologists, basic researchers, computational scientists, institutions, academia, funding agencies, philanthropies. We all must band together to work.
And where is the will? Everyone thinks that so much money is being spent on cancer research. That is not exactly true. So, just take a look at this. This is how we spend money. $4 billion are spent on cancer research. $358 billion are spent on shoes alone. That’s got to change. We really need to invest money in research. There is probably no one in this room whose life has not been touched in one way or another by a cancer.
So to end, I would just like to read a short paragraph written by this little girl whose picture you see here.
“My father died of leukemia. Now it is 10 years since death parted us. I recall that last morning, as he laid dying. At 7 a.m., Mom came into my room and said that dad wanted to see me. I ran into his room with the sinking, instinctive certainty of an 8-year-old that all was not well, only to find him sitting up in bed, smiling and stretching his wasted arms out to hug me. We spent the next several hours with me alternately reading to him, jumping on his bed, running away with his walker, having a serious discussion with him about Madagascar frogs, and every few minutes, taking his temperature with the thermometer that I loved to play with. Each time, he would oblige me by smiling sweetly. Finally, a family friend came and took me out to the park. This was the last time I would see my father. He died less than two hours later. It was only after several years that Mom told me how Dad had woken up at five that morning, bleeding from multiple sites, and being the oncologist that he was, and director of the Cancer Center, calmly informed my mother that he was going to die that day. After she cleaned him up and changed his dressings around the port, all he wanted to do in those last hours was to spend time with the family. Even as he got more and more short of breath and his lungs filled up with blood, Dad calmed himself in those last hours by watching me play, listening to me chatter on, reading and discussing biologic facts about my pet frogs. The perfect example of “amor fati”, love of fate. Dad truly lived up to this concept of amor fati, defined by Nietzsche as ‘the meaning of life is to do well what must be done.’ And the one thing he definitely did well was to die with dignity.”
Ladies and gentlemen, that young girl is my daughter and that is my husband.