A Pause on the Threshold of 1965: The Balance Sheet of Cancer Medicine

A Pause on the Threshold of 1965: The Balance Sheet of Cancer Medicine

What was in hand in 1965?

Those who follow the series know the columns. Surgery: Wertheim's radical hysterectomy (Day 93) and Patey's modified mastectomy, aimed at "cutting less" (Day 104). Radiotherapy: the entry of X-rays and radium into use (Days 92 and 94) and the cost becoming visible (Day 95). Hormones: Beatson's oophorectomy (Day 91), Lacassagne's experiments (Day 105) and Huggins's prostate work (Day 112). Drugs: from Ehrlich's "magic bullet" idea (Day 96) to the first nitrogen mustard patient (Day 115), Farber's children's ward (Day 122), Min Chiu Li's choriocarcinoma work (Day 132) and the combination-therapy stories of recent weeks (Days 141 and 142). The fifth column is causes: Doll and Hill's finding on cigarettes (Day 125), the 1964 Surgeon General's report (Day 139), viruses (Days 97 and 140) and, as told yesterday, the institution that would count causes across countries (Day 143).

This list is a list of capabilities, not a list of successes. Two separate questions must not be confused: a treatment producing a response in a disease is one thing; most patients surviving that disease is another. In 1965 the second was, with a few exceptions, more the exception than the rule. To show this disease by disease I look at two subjects: Hodgkin disease and Wilms tumour in children.

A trial on the threshold: Hodgkin disease

According to a review article, before combination chemotherapy Hodgkin lymphoma was mostly a disease that could not be treated and that led to loss of life; some patients with early-stage disease were cured by radiotherapy (no figures or dates are given). At the NCI in 1964, Vincent DeVita and colleagues began testing a four-drug regimen for advanced Hodgkin disease: mechlorethamine, Oncovin (vincristine), procarbazine and prednisone. According to OncLive, its name was suggested by his NCI superior Emil Frei III: MOPP. Of the first 43 patients, 36 reached complete remission within six months (36/43, about 84 percent), and results were first reported in 1967. The full publication came in 1970 (DeVita, Serpick, Carbone; Annals of Internal Medicine). As one review relays, in the 20-year follow-up of a 188-patient series that included the first 43 (Longo and colleagues, 1986), the complete response rate was 84 percent and the proportion disease-free for more than ten years was 66 percent.

Note the timing. The regimen was already being tried in 1965; but what was known in 1965 was the remissions in the first patients. The ten-year disease-free figure was published in 1986. So the balance sheet of 1965 is one in which the later evidence had not yet been written.

Two children's series from the same period

In Wilms tumour, two studies from the same period draw a different picture. In Ledlie and colleagues' national series (1962-1966) the contribution of actinomycin D was very small. In the study by Jenkin, Jeffs, Stephens and Sonley published in the Canadian Medical Association Journal on 17 July 1976, five-year relapse-free survival in children treated in 1963-1968 was 49 percent and overall survival 70 percent; in 49 unselected children treated in 1969-1974 these were 78 and 81 percent. The authors attribute the improvement to adjuvant actinomycin D and vincristine. The absolute difference: 29 points in relapse-free survival and 11 points in overall survival; the relative difference about 59 percent and 16 percent (the calculations are mine).

These two studies cannot be compared directly: one is a national register with three-year survival, the other a treatment series with five-year survival; and the periods and treatments also differ. My reading is this: in the "treatable" picture of 1965 there was a gap between the promising results of centre series and what happened across a country, and only later controlled trials narrowed it. I mark this inference as interpretation, not evidence.

Radium, chemotherapy and the first council in Istanbul

According to Kösebay and Göker's article on the history of gynaecologic oncology in Turkey, the first radium purchase was made in 1926 with the contribution of the Istanbul Municipality, and the results were presented at the 1929 National Turkish Medical Congress. The same article reports that in 1965 Dr. İmer Adalı joined the Oncology Institute in Istanbul and, together with Dr. Metin Aran, brought chemotherapy to Turkey. In 1968 an oncology council of gynaecologists, pathologists, medical oncologists and radiation oncologists was formed at Hacettepe; in 1972 a medical oncology branch within internal medicine was opened at Hacettepe under Prof. Dr. Dinçer Fırat and two cobalt-60 units were acquired. So Turkey's balance sheet in 1965 was not a reflection of the world balance sheet of the same year but a story just beginning: radium was already there, chemotherapy was just entering, and the multidisciplinary council came three years later. All of this comes from a single secondary source, and I used the part I read through a summarizing tool, not the whole article.

This article is Day 144 of the "365 Days of Cancer History" series and presents the state of cancer medicine on the threshold of 1965 as a historical reading. It is historical-popular content, not a diagnosis or treatment recommendation. For treatment decisions consult your physician. Sources are verified; details that rest on a single secondary source, only an abstract or a text that could not be read are marked in the fact-check notes.