Vincent DeVita, the director of the National Cancer Institute, says that one of the major goals in drug development in the 1980s is to make chemotherapy less toxic.
"What we hope to do in the '80s is to render chemotherapy nontoxic," he said in a recent interview, "because the major problem we have with chemotherapy is it's toxic and it hurts like hell."
He said that the suffering from drugs in human experiments has not been too severe, and that what has occurred has been worth the price because of advances made in cancer treatment. He also said that patients willingly get into the experiments.
"I believe sincerely that patients want those therapies," DeVita said. "They want to go into Phase I studies. Patients do not want to go out of this world without trying in the majority of cases . . . . You stop putting cancer drugs out there and there will be an avalanche of people clamoring for drugs."
DeVita said he is very aware that some people complain that chemotherapy not only induces severe side effects, but doesn't do anything to fight cancer. He recalled a time when he was riding in a taxi in New York and the cabdriver, unaware of who DeVita was, began to rail against chemotherapy. The driver said that his mother was taking a "lousy" drug that made her sick and didn't do anything for her cancer.
"I sort of hid behind the seat as he told me about it," remembered DeVita.
He also told the joke "about the good man who dies and goes to Heaven and can't find his name in the book . . . . He finds it six months ahead, and St. Peter says, 'You're six months early. Have you been on chemotherapy?' "
In a four-hour interview, DeVita also made these comments:
"You're never going to make a cancer drug program a risk-free program . . . . But what you have to ask is, what of the greater good?
"I have no doubt that we can define and build better drugs than we have now."
"Can we find something that works for lung cancer? Well, the answer is I hope so but I don't know. So I'm optimistic, yes, because if you're not optimistic you can't start anywhere. If your starting point is to prove that something doesn't work, you're in the wrong place."
He was asked about how many people can be cured of cancer with drugs. On March 9, in testimony before a congressional subcommittee studying "orphan drugs," DeVita said that 11,000 people each year get a form of cancer for which drug cures are possible. In the interview with The Washington Post, DeVita said that there are no official statistics for drug cures. He said the 11,000 figure he gave Congress was not all-inclusive. "I always use what I have in my head and that's what I had," DeVita explained. He says that his current estimate for the cure rate is about 46,000 per year -- "give or take 10,000 on either side."
He said he reached those figures by doing his own estimates. "It's close," he said. "Arthur Upton former NCI director used to call them my back-of-the-envelope calculations."
DeVita said he gets upset when people try to point out that both the incidence rate for cancer and the overall mortality rate for cancer have been increasing steadily in the last decade.
"I don't use overall mortality rates for cancer," he said. "You won't get me to say it because I will not use it. It's ridiculous. It's putting apples and oranges and everything together. The reason I won't look at overall curves is they're dominated by lung cancer, in general, for which we have very little therapy -- it skews all the curves."
Lung cancer accounts for 117,000 deaths in the United States each year.
Speaking of the benefits of chemotherapy, DeVita said that when he began practicing as a doctor, childhood leukemia was nearly always fatal. "It was miserable to die with an untreated cancer," he said. "It's disfiguring and causes bleeding."
To see some children cured from leukemia by the late 1960s gave him great inspiration for the future, he said. And he added that, even in those cancers that cannot be cured with drugs, the drugs can help to make the patient's dying days more comfortable. "The point is that the deaths cancer patients are having now when they're on chemotherapy are in many cases better than the deaths that the patients had before chemotherapy."
DeVita said that the major accomplishment in chemotherapy in the 1960s was proving that drugs could cure cancer. The major accomplishment of the 1970s, he said, was showing that by combining drugs with surgery and radiation, more cures could be brought about. For the 1980s, in addition to reducing drug side effects, DeVita said that further combinations of existing therapies and newly discovered ones will continue to improve cancer treatment.