STEVE INSKEEP, HOST:
An idea for cancer treatment that helped Jimmy Carter is older than he is. The former president is 91. He announced recently that his advanced melanoma had been successfully treated. He credited an immunotherapy drug which does not directly kill cancer cells, instead boosting the patient's immune system to do the job. It is cutting-edge cancer treatment, although the idea behind it dates back more than a century. NPR's Rebecca Davis reports.
REBECCA DAVIS, BYLINE: In the late summer of 1890, surgeon William Coley prepared to examine a new patient. What he didn't know at the time was this young woman would change his life and the future of cancer research.
DAVID B. LEVINE: Her name was Elizabeth Dashiell, known as Bessie Dashiell.
DAVIS: Dr. David B. Levine is director of archives at the Hospital for Special Surgery in New York. He says 17-year-old Bessie had injured her hand. It seemed like a simple bump, but it kept getting worse and worse.
LEVINE: She had a lot of pain and nobody could diagnose what the problem was.
DAVIS: At first Dr. Coley thought Bessie must have an infection. But when he took a biopsy...
LEVINE: It turned out to be this cancer - a very malignant cancer, very advanced cancer.
DAVIS: A kind of cancer called sarcoma. Stephen Hall, author of "A Commotion In The Blood," says there wasn't very much Dr. Coley could do for Bessie.
STEPHEN HALL: You have to remember this is prior to radiation therapy, prior to chemotherapy. And he didn't typically treat cancer patients. He was a general surgeon.
DAVIS: So Dr. Coley did the only thing he could. He amputated.
HALL: Right arm just below the elbow.
DAVIS: Hoping, says David Levine, to stop the spread of the cancer.
LEVINE: Within a month, she had widespread metastasis of her cancer to her lungs, her liver and all over her body.
DAVIS: There was nothing to do but wait for the end. When the time came, Dr. Coley stayed by Bessie's side.
LEVINE: On Jan. 23, 1891, she died.
DAVIS: It was an ugly death and a painful one. Stephen Hall says it made a huge impression on Coley.
HALL: He's still a young surgeon. He's in his 20s. He sees this seemingly healthy young woman come in, and within the course of several months, her body is completely overtaken by this malignant disease. It really shocked him.
DAVIS: And it spurred him into action. There wasn't a lot known about cancer at the time, so Coley started digging through dozens upon dozens of old hospital records, looking for something that would help him understand this cruel and aggressive disease. Stephen Hall.
HALL: As a student, he had read Darwin. And one of the lessons he took away from Darwin was always pay attention to exceptions to the rule. When there's a biological exception to a rule, ask yourself why this has happened.
DAVIS: Coley discovered one of these biological exceptions. It was the case of a German immigrant named Fred Stein. Stein had been a cancer patient at the hospital eight years earlier. Doctors had removed a cancerous growth - a sarcoma - from his neck. But the tumor kept coming back. And then Stein contracted a serious bacterial infection of the skin. David Levine says his days were numbered.
LEVINE: Only Stein didn't die. His infection subsided. And along with that, his mass, which was large, disappeared. And he was discharged from New York Hospital.
DAVIS: Coley wondered if all these years later Stein could still be alive. It was the winter of 1891 when William Coley the surgeon became William Coley the detective. He headed for the tenements of the Lower East Side of Manhattan, knocking on door after door, asking for a man named Fred Stein with a distinctive scar across his neck. After several weeks of searching, Coley found him alive and cancer-free. But why? Why did Fred Stein's cancer go away and stay away after getting a bacterial infection?
LEVINE: Coley speculated that the strep infection could reverse cancer.
DAVIS: And if that were the case then what would happen if he tried to reproduce that effect on purpose, if he deliberately injected cancer patients with a bacteria? Coley decided to test his idea on the most seriously ill patients. He started with an Italian immigrant named Zola, a man who had, just like Bessie Dashiell, was suffering from sarcoma with life-threatening tumors riddling his throat. Coley armed himself with a good supply of the strep bacteria and his experiment began. Stephen Hall.
HALL: This process went on for months. You know, he would create little cuts and rub the bacteria in it. And there'd be a slight response but not really too much.
DAVIS: And then Coley got his hands on a much stronger strain of the bacteria. And this time, Zola got violently ill. The infection could easily have killed him.
HALL: But Coley then describes this tumor - in this case I think they described it as the size of an orange - almost within 24 hours beginning to decrease in size, sort of liquefy and kind of disintegrate. This was the phenomenon that seemed to occur very rarely, but nonetheless, when you saw it you were utterly astonished.
DAVIS: Zola completely recovered. And Coley knew he was onto something. He kept experimenting and refining his use of bacteria. Eventually, he named the treatment Coley's toxins. It was an exciting time. Coley was having tremendous success. And he was celebrated in America and abroad. But Bradley Coley Jr., William Coley's grandson, says the American medical establishment at the time was skeptical.
BRADLEY COLEY JR: It was a hard sell, especially when nobody knew how it worked, including my grandfather, by the way.
DAVIS: Because the immune system was still a mystery and the results couldn't be replicated with any consistency. Then, in the early 1900s, along came radiation. And this would be the treatment medicine embraced. William Coley remained committed to his toxins, but they were largely overshadowed.
COLEY: When he died, all interest in it stopped.
DAVIS: And quite possibly, that's where Coley's legacy could have ended, except for this - after his death in 1936, his daughter, Helen Coley Nauts, started looking through hundreds and hundreds of her father's cases. And she found he had had some extraordinary rates of success using Coley's toxins to make certain cancers go away. But she couldn't get anyone interested in studying her father's work, so she decided to do it herself. In 1953, with a modest grant, she started up the Cancer Research Institute, an organization that helped create a whole new field dedicated to understanding the immune system and its relationship to cancer, a dedication that has been key in making immunotherapy the promising treatment it is today. Rebecca Davis, NPR News.
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