Although we’ve had sad string of bad news on the forums from many of the users recently, I need to add a link to an obituary as part of a tribute to Judah Folkman, who died this past week of a heart attack at age 74 (obituary here).  He was one of my medical school professors, but before he became the illustrious Dr. Folkman, he persevered for years of working in the field of cancer research before making his lasting impact (bio here).  In the end, he made a huge difference in cancer management by recognizing the importance of a tumor’s blood supply, and through work in the field of angiogenesis, we now have drugs like avastin, sutent, and nexavar that have already been shown to significantly improve survival, in addition to a long list of drugs that block tumor blood supply that are still in clinical trials but that may become useful tools in the future.

   The idea of angiogenesis is that among the central, most important features of a cancer is a sustained blood supply:

(Click on image to enlarge)

 Cancer cells divide faster than normal cells, but they can only develop a tiny nodule of about 1-3 mm before they become limited in their ability to receive adequate nutrients and eliminate waste by passive diffusion.  In order to grow beyond that size, a nodule needs to develop a blood supply, which it does by producing pro-angiogenic (blood vessel-inducing) proteins like vascular endothelial growth factor, or VEGF:

   While this may seem very understandable and reasonable now, when Dr. Folkman first presented the idea that tumors could be inhibited by blocking their blood supply, he was laughed off the stage by his colleagues.  It took many years of shrugging off the derision of the research establishment before his work began to bear fruit.  Fast forward 25 years, and avastin is now shown to improve outcomes in lung cancer, as well as colon cancer, breast cancer, and others.  Anti-angiogenesis is now a cornerstone of cancer treatment, although we are still on the steep part of our learning curve.  These agents were only entering into clinical use 5 years ago.

  So Judah Folkman’s death at 74 reminds me that the agents that appear to have blazed onto the scene didn’t really come out of nowhere.  The really important ideas often go back many years, and the truly visionary work runs the risk of being ignored or ridiculed early on.  The entire cancer community, physicians and patients, owe a debt of gratitude to Dr. Folkman for his perseverence.