In the war against cancer, there are no cheap victories. Every year the disease in its various forms kills four million people worldwide, 462,000 of them in the U.S. No one is more aware of those numbers than Dr. Steven A. Rosenberg, 45, chief of surgery at the National Cancer Institute (NCI) in Bethesda, Md. “My work,” he explains, “is filled with moments of intense frustration—and moments of intense joy.”
Rosenberg heads a 25-member NCI clinical team that has labored seven years on an experimental immunotherapy project, working first with laboratory animals, then on human patients. The first human trials were discouraging: 66 patients showed no response during preliminary studies to develop a medical procedure. But last January, after Rosenberg had introduced some crucial changes in the treatment, a surgical resident rushed excitedly into his office holding X rays of a 41-year-old man whose colon cancer had spread to his lungs. “I think you’ll be interested in these,” said the researcher. Indeed Rosenberg was. Comparing the before-and-after treatment photos, he saw that two of the patient’s five lung tumors had become smaller; the other three had disappeared.
“I didn’t say ‘Eureka!’ ” recalls Rosenberg, “because strange things can happen to one patient that can’t be repeated. But I thought we might well be on to something.” Two weeks later the hunch was confirmed when a 29-year-old woman, who had had advanced skin cancer that had spread throughout her body, came in for an after-treatment checkup. Rosenberg found her tumors dramatically reduced, and two months later she was “absolutely disease-free.”
Has science, at long last, found the “miracle bullet” to stop cancer? “This is only a promising first step in a new approach to treating cancer,” cautions Rosenberg. “It’s not a cancer cure in 1985, but it is a breakthrough in that it marks the first successful approach to using the body’s own immune system to reject a cancer.”
Essentially the treatment involves giving patients massive doses of interleukin-2 (IL-2), a genetically engineered protein that activates the body’s white blood cells to fight cancer. During the one-month therapy, a patient is connected to a cell-separation machine that isolates part of the body’s white cells, which are mixed with IL-2. The activated cells then are returned to the blood stream along with added doses of IL-2, enhancing the ability of such “killer cells” to seek and destroy tumors.
Immunotherapy has severe side effects, including fever, chills, hallucinations and diarrhea. Fluid retention, moreover, can cause a patient to gain 30 pounds in three weeks and can lead to serious lung, kidney and liver disorders. Happily the side effects seem to disappear once treatment ends.
In an initial study group of 25 critically ill cancer victims, the NCI team reported tumors shrank 50 percent or more in 11 patients suffering from advanced stages of various cancers. On the negative side, Rosenberg notes, “Fourteen patients had no response at all and will die of their cancer.” Another patient who was part of a later study group died after immunotherapy, in part because of the treatment itself. Still, to clinical researchers who applaud new drugs with considerably lower success rates, the NCI figures are promising. As Rosenberg points out, patients in the immunotherapy program “are people who have failed all other treatments. They came to us with no hope and suddenly they have hope.”
Yet he is equally concerned that the new treatment, hailed as the first major cancer breakthrough in 30 years, is raising hopes too high too soon. “We can treat only eight people a month,” Rosenberg explains, and NCI currently is not adding any new patients to its lengthy waiting list. The estimated cost per patient is $30,000 (though those at the federally funded NCI are cared for free of charge). Even if other medical centers verify the Cancer Institute’s findings, Rosenberg says, “it will be at least two to four years” before immunotherapy for cancer will be available on any sizable scale.
The public first took note of Rosenberg in July when, as cancer specialist on the medical team, he announced, “The President has cancer,” then explained in layman’s terms the nature of Ronald Reagan’s illness. Rosenberg today treasures an autographed photo of the Reagans, but he protests, “What I did for the President is no different from what I do all the time.”
Born in the Bronx, the youngest of three children of Jewish immigrants from Poland who owned a luncheonette, Rosenberg “cannot remember a day when I didn’t want to be a doctor.” In high school he read medical textbooks brought home by older brother Jerry, then in med school and now a surgeon and professor at Detroit’s Wayne State University. Steve earned his M.D. from Johns Hopkins and a Ph.D. in biophysics from Harvard. During his residency at Boston’s Peter Bent Brigham Hospital, he dated the chief nurse, and in 1968 married her. Recalls Alice O’Connell Rosenberg, “He had an excitement about medicine the way kids get excited about new toys.”
Rosenberg joined NCI in 1970 as a clinical associate in immunology. Just four years later, at 33, he was named chief of surgery, a post in which he oversees an 80-member surgical department in addition to the immunotherapy team. This year he shared a $100,000 Armand Hammer Cancer Prize with a researcher in Japan. In Bethesda, he puts in 12-hour workdays. “The hardest part is to confront the tragedy and pain induced by cancer,” he says, “and then go home and laugh with the kids.” Around the Rosenberg dinner table, Alice and their three daughters, ages 4 through 14, share daily in Daddy’s latest advance or setback. (“We were thrilled when the first mouse got better,” Alice says.) After dessert they often peer through an eight-inch lens telescope. (“We’re just waiting for a clear shot at Halley’s comet,” says Rosenberg.)
But work calls him incessantly. “We’re struggling hard to overcome the obstacles and have a long way to go,” he reflects. “I know this is just a first step—but maybe….” And then his face breaks into a broad grin.