Can We Learn from Our Patients?

Neil P. Ruzic. Racing to a Cure: A Cancer Victim Refuses Chemotherapy and Finds Tomorrow's Cures in Today's Scientific Laboratories. Urbana: Univ. of Illinois Press, 2003. Pp. 448. $24.95.

As health care professionals, and particularly as physicians, we should always strive to learn from the patients we seek to treat. Racing to a Cure, the story of a cancer patient, presents just such an opportunity. This book was written by Neil Ruzic, a patient who in 1998 suddenly learned he had mantle cell lymphoma, a rare and particularly deadly form of non-Hodgkin's lymphoma. After an initial phase of shock, fear, anger, and sadness, the author, at the age of 68, set out to tackle this new problem in much the same fashion as he had faced challenges in the past. As a scientist, inventor, journalist, and science publisher, Ruzic had developed a particular style and discipline in his approach to life's problems. Determined to learn as much as he can about cancer and about mantle cell lymphoma in particular, he read books and journal articles and sought the best advice about his treatment options.

The author provides a great service in the way he writes his story. It is an informative work that can be read and understood by all without an extensive background in medicine. The book reveals a great deal about cancer and about some of the recent discoveries in the field of oncology, and also introduces readers to the many interesting physicians and scientists the author encountered on his journey. It is heartening to read how the author's quest for information and healing positively influences many others who are fighting the same cancer as he.

Mantle cell lymphoma behaves much like indolent or low-grade lymphoma, but with intermittent episodes of fierce and accelerated growth that many times overwhelms its victims. Mantle cell's bizarre behavior has confused many physicians and pathologists in the past, to the extent that there is still some debate about the proper classification of this cancer. Mantle cell lymphoma does not appear to fit any of the classical patterns of lymphoma behavior, and only recently have scientists learned that this lymphoma is the result of a unique chromosomal abnormality, t (11;14) (q13; q32), which approximates the bcl-1 oncogene at the 11q13 locus of the immunoglobulin heavy chain at 14q32. This translocation leads to over-expression of cyclin D1, which regulates the transition from the G₁ to the S phase of the cell cycle. When the author understands the significance of this information, he immediately requests that samples of his tumor tissue (from a recent splenectomy and abdominal lymph node resection) be sent to the best genetic laboratories in the country for proper diagnosis. He discovers that he indeed has the genetic translocation that characterizes mantle cell lymphoma, but not the subtype that over-expresses cyclin D1. He also learns that current aggressive multi-drug chemotherapy treatments are not particularly effective in this disease: the side effects are devastating, and the therapy offers little survival benefit.

Faced with this news, the author does not give up. Instead, he continues to familiarize himself with the literature concerning the latest basic and clinical trials on mantle cell lymphoma. In particular, he investigates some clinical trials on new agents called biologics (radioactively labeled and unlabeled monoclonal antibodies, vaccines, etc.) that are being conducted at some of the top medical centers in the United States in patients who had failed to respond to chemotherapy. Armed with this information, Ruzic sets out to obtain the advice of some of the best-known medical oncologists. He immediately encounters two types of physicians: those who will only consider one type of treatment (i.e., the multi-drug chemotherapy known as Hyper...