Reviewed January 31, 2002.
Random House, 2001.  366 pages.

It’s not often that I stay up until the wee hours of the morning reading a nonfiction book.  (With fiction, that’s another story!)  This book fascinated me.

It tells the story of Dr. Judah Folkman, a surgeon at Children’s Hospital in Boston and a tenured professor at Harvard University.  As early as the Sixties, he developed a theory that cancer needs to grow blood vessels in order to grow, and therefore must release some substance that promotes blood vessel growth.  He called this angiogenesis.  If a substance could be found that would inhibit blood vessel growth (antiangiogenesis), it should also inhibit the growth of tumors.

Dr. Folkman and his research assistants worked on this theory for decades.  For almost all of that time, he was treated as if the idea were crazy.  His papers were not accepted for publication.  It was a completely different way of looking at cancer, and he wasn’t even an oncologist.  Others attributed the blood vessel growth that he observed to simple inflammation.

In 1987, these ideas first saved the life of a patient, Tommy Briggs, a twelve-year-old with a hemangioma (a mass of blood vessel cells) growing on his lungs.  This is a rare condition, and at the time was almost always fatal.  Tommy’s doctor talked to Dr. Folkman about his ideas on antiangiogenesis.  They tried out an already-approved drug on him that seemed to slow blood vessel growth.  It worked.  Tommy survived.  More hemiagioma patients were sent to Children’s Hospital.  In 1992, 40 percent of those patients died, but by 1998, not a single patient at Children’s Hospital died of a hemiangioma.

It turned out that this angiogenesis research had applications in many areas.  Blindness caused by the growth of blood vessels could be prevented.  They are developing a treatment to prevent blindness in diabetics, as well as stopping macular degeneration, a major cause of blindness in the elderly.

Angiogenesis (as opposed to antiangiogenesis) turned out to have applications helping heart disease.  Angiogenesis agents could help a patient grow new blood vessels, rather than going through multiple bypass surgery.  Initial tests look promising.

Then, of course, there’s cancer.  As of the writing of the book (It came out a year ago.), new drugs were only beginning to be tested.  Even with very small doses used to test for toxicity, even on patients for whom nothing else had worked, results look promising.  Researchers even started questioning whether antiangiogenesis properties might be why standard chemotherapy treatments work.  The old method of trying to poison the tumor without poisoning the patient too badly might not be the best way to use those chemicals after all.  Did I mention that antiangiogenesis agents have few side effects?  Is it possible that in another decade or so, the awful side effects of chemotherapy may be a thing of the past?

So, this was an exciting book.  The methods are brand new and are not thoroughly tested yet.  However, instead of being the pariah he once was, Dr. Folkman’s ideas have gotten the medical world’s attention.  All the major drug companies now are working on some form of antiangiogenesis agents.  It seems that it’s only a matter of time before they find new substances that are safe and effective against different types of cancer.  Exciting!