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Vincent Rajkumar Profile picture
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Jan 2 • 14 tweets • 7 min read
My picks for the Top 10 paradigm changing advances in cancer treatment in the last 100 years.

Chronological order.

1/ Methotrexate to cure Choriocarcinoma. 1953. Roy Hertz & Min Chiu Li. First cure of solid tumors with chemo. cancer.gov/research/progr…
2/ Cure of Acute lymphoblastic leukemia (ALL) with chemotherapy. 1958 Emil Frei, Emil Freireich, James Holland. @theNCI

The dawn of curative combination chemotherapy for cancer. @ASCO connection.asco.org/magazine/featu…
3/ Cure of Hodgkin’s lymphoma with combination chemotherapy by @DeVitaDoctor and colleagues. @theNCI

A landmark event. A magnificent story. If you want to know more, get this book.
4/ Cure of testicular cancer with chemotherapy. 1974. Larry Einhorn @IndianaUniv medicine.iu.edu/magazine/larry…
5/ Tamoxifen for treatment of breast cancer. 1974. V. Craig Jordan, Walpole, Richardson, Harper,

Ushered hormone therapy as treatment for cancer. (beyond the surgical approaches until then). ncbi.nlm.nih.gov/pmc/articles/P…
6/ Cure of diffuse large cell lymphoma with combination chemotherapy. 1975. @DeVitaDoctor and colleagues. @theNCI

This figure below, and the claim of cure made in the article, a classic, stood the test of time. @TheLancet thelancet.com/journals/lance…
7/ Imatinib (Gleevec) for chronic myeloid leukemia. Dramatic treatment that turned around a fatal cancer. The very essence of what targeted therapy is. 1998. Brian Druker. @nytimes nytimes.com/2009/11/03/sci…
8/ The first monoclonal antibody for the treatment of cancer: Rituximab. 1997. Ron Levy, David Maloney and colleagues. pnas.org/doi/10.1073/pn… @PNASNews
9/ Immunomodulatory drugs: Taking the most scorned drug ever (thalidomide) & making it into an effective cancer treatment. 1998. Bart Barlogie.

Thalidomide and it’s derivatives Revlimid & Pomlyst revolutionized treatment of myeloma. @nytimes nytimes.com/1999/11/18/us/…
10/ CAR-T cells. Immunotherapy using the patients’ own T cells to treat and even cure advanced cancer. 2012 Carl June. First approval 2017. @PennMedicine lancastergeneralhealth.org/health-hub-hom…
Just missed the list:

Cladribine - cure of hairy cell leukemia

ATRA for acute promyelocytic leukemia

Join and add to the list!
What have I missed?
6 of the 10 on the list cured previously incurable systemic cancer with finite duration therapy and established an aspirational vision for all cancers. Where we need to be. The others had dramatic and sustained impact on a cancer or the field overall.

They challenge us.
Great points in replies about check point inhibitors, ondansetron, allogeneic transplantation.
@carlhjune

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More from @VincentRK

Vincent Rajkumar Profile picture
Dec 29, 2022
1. The devastating impact of COVID highlighted by global excess mortality (in blue).

2. The pandemic is not over. Note the excess mortality continues.

3. Current levels may get worse because we don’t have data from China in yet.

HT @fibke
Analysis at: pandem-ic.com/global-mortali…
The reported COVID deaths underestimate global excess mortality.

The current excess mortality is mostly likely due to COVID itself, the impact COVID has had on the health of the public in the last 3 years, and the impact of COVID on healthcare delivery overall.
The reporting of COVID and COVID deaths varies across countries. In lower income countries very few COVID deaths are reported but excess mortality data tell a different story.
Read 5 tweets
Vincent Rajkumar Profile picture
Dec 24, 2022
3 years of COVID. What did we get right and wrong?

1/ At the outset, the #1 question was will the new virus cause a devastating pandemic?

Some warned us early that it would. Some minimized it.

After >650 million cases, and >6.5 million deaths, we know the answer.
2/ Can we prevent the spread of the virus?

Yes. Its hard but can be done. Many countries did this for 2-3 years through a combination of border control, masks, distancing.
3/ Can countries sustain preventive measures long term?

Unfortunately we have seen one by one countries that controlled COVID for 2-3 years eventually relax some or most of the preventive measures.

And as they did, COVID spread.
Read 15 tweets
Vincent Rajkumar Profile picture
Dec 16, 2022
10 years ago JesusSanMiguel GiampaoloMerlini and I laid out our vision for redefining myeloma. A paradigm change. @NatRevClinOncol @DianaNrco nature.com/articles/nrcli… #ASH22 Image
The revised IMWG criteria redefining myeloma and related disorders was published in 2014 in @TheLancetOncol — and is now the most cited paper in the field. thelancet.com/journals/lanon…
We also have made significant progress in early detection and therapy of smoldering multiple myeloma as outlined here. @BloodCancerJnl nature.com/articles/s4140…
Read 4 tweets
Vincent Rajkumar Profile picture
Dec 14, 2022
I just attended one of the biggest cancer meetings in the world. #ASH22 @ASH_hematology

For my followers here is a snapshot of the incredible progress happening with cancer treatment. It’s good. Thread.
1/ There is a revolution in cancer therapy that uses the power of our own immune system to fight cancer cells:

CAR-T cells
Bispecific antibodies

Both these approaches have already produced spectacular results in many cancers and we are just starting.
2/ CAR-T cells: take your own immune system cells out, engineer them to target a specific cancer, and then put them back in the body to go kill the cancer cells. A few CAR-T products have already been FDA approved. Many more to come. my.clevelandclinic.org/health/treatme… Image
Read 13 tweets
Vincent Rajkumar Profile picture
Dec 10, 2022
Updated Myeloma Treatment Algorithms presented at @IMFmyeloma @CCO_Education symposium today at #ASH22

1. Newly diagnosed transplant ineligible. Either VRd or DRd is OK. Maintenance varies by risk stratification.
2. Newly Diagnosed myeloma transplant eligible. #ASH22

Early transplant preferred. But for selected standard risk patients depending on preference, delayed is also OK. Maintenance varies by risk stratification.
3. First relapse. The approach depends on refractoriness to Len and CD38moAB. For CD38 Moab either Daratumumab or Isatuximab are OK. Depends on cost and availability. #ASH22
Read 7 tweets
Vincent Rajkumar Profile picture
Dec 8, 2022
At #ASH22 my colleague @myelomaMD will present the initial results of the ASCENT trial, aka the 2nd Cure trial to test the hypothesis whether myeloma can be cured if highly active combination therapy is given early at the smoldering myeloma stage. ash.confex.com/ash/2022/webpr… Image
Updated results from the 1st Cure trial, GEM-CESAR led by @mvmateos is also being presented at #ASH22

ash.confex.com/ash/2022/webpr…
These trials are part of a planned series of trials investigating whether the incurability of myeloma is related to the fact that we have traditionally started effective therapy only after the disease has spread and mutated to the point where it is no longer curable.
Read 9 tweets

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