Charles Graeber’s latest book The Breakthrough on Immunotherapy.
More than 1.7 million people are diagnosed with cancer each year in the United States. Of those diagnoses, half will respond to traditional treatments such as surgery, chemotherapy or radiation. The other half won’t. For decades, that “other half” has claimed millions of lives and confounded doctors and scientists. But now, as bestselling author Charles Graeber details in his latest book The Breakthrough, there’s new hope for cancer patients thanks to cutting-edge immunotherapy.
Graeber began researching immunotherapy long before the treatment became a buzzword at medical conferences and cancer wards around the country. In fact, when he was trying to get his book published, one skeptical publisher scoffed: “If this immunotherapy was such a big deal, wouldn’t we have heard about it already?” But Graeber was on to something, and the month before his book hit the shelves, the immunotherapy scientists profiled in The Breakthrough received the Nobel Prize in Medicine.
Based primarily in New York City, Graeber also routinely writes from his family’s summer home on Nantucket. He will be returning to the island this month as a featured author at the Nantucket Book Festival. As a preview to their discussion on stage at the Book Festival, N Magazine’s Robert Cocuzzo spoke with Graeber about immunotherapy, the future of cancer and how he came to understand this new frontier in medical science.
N MAGAZINE: When did you realize you wanted to write about cancer?
GRAEBER: I definitely didn’t want to write about cancer, never, no way, not interested. Nor did I want to read about it. My take was I’ll deal with cancer when I have to. The treatment options had been the same for a generation pretty much, in some cases the same for a hundred years: Cut, poison or burn. You had to be hopeful, but ultimately it was depressing. If I wasn’t going to cure cancer, and didn’t at that moment have it, all I wanted to know were the options for my friends and family members who had been diagnosed.
GRAEBER: It’s important for potential readers to know that I wouldn’t just be writing about cancer, no matter what. I’m writing about a turning point in history, about people, discoveries, rule breakers, survivors, a hopeful new chapter in human history. And I’m writing about ideas, faith, belief, science and about the fact that we didn’t understand cancer, or our own bodies. We believed and science taught that the immune system couldn’t see or kill cancer. We had to poison cancer, bomb cancer, cut it out. We had to treat it like a monster. We couldn’t treat it like any other disease, because unlike every other disease, our immune systems couldn’t see it or kill it. That was the belief. That was dogma. And all that turns out to be dead wrong.
N MAGAZINE: How so?
GRAEBER: Turns out, cancer has been tricking our immune system, using a sort of secret handshake to tell it, “Hey, don’t attack me, I’m one of you.” We didn’t know that before, but now we do. Now, we can block the secret handshake and let the immune system treat cancer like the common cold, or any other disease.
N MAGAZINE: There are many startling takeaways in The Breakthrough. What was one discovery that struck you most during your research?
GRAEBER: The basic idea that cancer is a mutating problem—that cancer dances. And we’ve been throwing drugs at it, which kill the cancer, or most of it. But what the drugs don’t kill always dances away—changing, mutating and ultimately coming roaring back. Drugs don’t dance. Chemo, radiation—they don’t dance. We were never going to cure cancer that way, not completely. But we have a built-in system designed to dance with disease. It wasn’t designed in a lab recently, but over the course of 500 million years of brutal trial and error. That’s the immune system. Finally, we have a mutating solution to a mutating problem. That’s the only kind that will work. Cancer has evolved to trick the things that kill it, to avoid the immune system. Now that we know those tricks exist, we can block them, look for more tricks. This is the new age we live in. And most folks don’t know about it because it’s that new.
N MAGAZINE: If you were diagnosed with an aggressive form of cancer, what would be the first three things you would do in light of all you’ve learned in researching The Breakthrough?
GRAEBER: The doctors I speak to tell me that if they can’t cure their patient today, plan B is to keep them around long enough to take advantage of the newest immunotherapy advances as they arrive. So the first thing is hope. If your doctor tells you there’s nothing they can do, you should seek other opinions. Most doctors were trained before the immunotherapy breakthrough, when immunotherapy was widely considered impossible. So find an anchor of realistic hope—I wrote The Breakthrough to be that. I’d also make sure I was in a comprehensive cancer center, a place where you have options. Teaching hospitals, university affiliates, those attached in some way to the National Cancer Institute. You want to have every option and an understanding of clinical trials, if it comes to that. And I’d start asking about clinical trials. That’s not guinea pig stuff anymore; that’s where the good new options are, and there are no placebo arms in those trials.
GRAEBER: What we’re seeing right now is that combinations of treatments work better than any one alone. Pretty much everything works much better when you take the brakes off the immune system. One way to think of this is like vaccines. Most of us have a general idea of how they work: You introduce a weak or dead version of the disease to the immune system so it can build up a ready army against it and recognize and defeat that disease quickly if it shows up for real. Bits of those weak or dead versions of the disease get distributed like wanted posters all throughout the body. So if you blow up a tumor cell with radiation or chemo, or starve it out with targeted poisons, that dead cancer cell is now in the body as a sort of wanted poster, too. It works like a vaccine works, metaphorically, teaching the rest of the immune system what the enemy looks like.
Meanwhile, immunotherapies allow the immune system to actually see those wanted posters, to muster into an army against them, to recognize the living version of that cancer enemy and to block that cancer’s tricks for hiding itself or shutting the T cells down. That’s how it’s working best, so far. The difference is, you don’t need to rely on the poisons as much—hoping to kill the cancer while you almost kill the patient. It’s likely that there will be a much-reduced role for those specialties, and in fact, they won’t be siloed, as they are now, but rather packaged as a cancer solution.
N MAGAZINE: Some cancer patients who have experienced miraculous cures talk about the mind-body connection. Do you think it’s possible to activate one’s immune system in fighting cancer through the power of one’s mind?
GRAEBER: There absolutely is a mind-body connection. I believe it helps—just as depression and illness seem related and self-perpetuating. Just as grief is being looked at as a measurable immunosuppressant. But I don’t know to what extent it’s possible to “activate” a T cell against a specific antigen. I believe there are general factors related to this mind-body connection that we’ll better understand in the future. The immune system is us, but so is cancer. Which side are you trying to control and activate? I believe there are aspects important to immunity that are very much related to aspects of the mind. If the immunotherapy breakthrough has taught us anything, however, it’s that a phenomenon that is observed should not be discounted just because the science behind it is not truly understood. How can some yogis control their own heartbeat? It’s not magic. The world is interesting and we’ve barely scratched the surface of that fascinating truth.