On Combination Chemotherapy: Hope through Death

The following is an essay limited to 500 words and answering the prompt, "What new medical intervention in the last 50 years had the greatest impact on pediatric medicine?": 

Leukemia is form of liquid death.  First described in 1845 after a patient died from a “suppuration of blood”, any such ghostly white appearance of the humors portended certain death. Slowly, doctors learned the true depravity of the disease: it was the blood, the ‘life of the flesh’, which attacked the body.

In the early 1960s, leukemia remained uniformly fatal.  Surgery had made progress against solid tumors and radiation oncologists had treated lymphomas, but both were impotent against the amorphous liquid cancer.  In humanity’s great battle against cancer, leukemia was the victor.  However, the first glimmer of hope arose from the ashes of one of humanity’s greatest battles, World War I.   As nitrogen mustard gas crept across the killing fields of Europe, researchers noticed it depleted the leukocytes of its victims. Thus began intensive research into chemotherapeutic agents, poisons that could kill cancer faster than they could kill the body.  Researchers discovered many types of chemotherapy, but none with enough killing power to completely eradicate leukemic cells.  After decades of research and war, doctors won several fights, but leukemia consistently won the battle and claimed its victim. 

Doctors Emil Frei and Emil Freireich of  the National Cancer Institute realized no single chemotherapeutic agent possessed enough power to eradicate the leukemic cells from the body.   So the duo proposed a clinical trial of a four drug combined regimen: vincristine, amethopterin, mercaptopurine, and prednisone.  VAMP, as it would come to be called, was a wildly controversial idea.  No one had administered so many poisons to a person before.  Even worse, the trial was for children, leukemia’s favorite target. Despite the opposition, Drs. Frei and Freireich maintained that the body had to be pushed to its limit, to the door of death itself, to push leukemia into the abyss.

In 1962 the trial commenced and the infusions started.  As the drugs dripped slowly into the children’s veins, their little bodies began to shrivel.  Leukocyte counts plummeted, as did the body’s ability to fight infections.  Some children experienced days of fever-induced delirium, others spent nights retching in the bathroom.  Drs. Frei and Freireich could only sit at the bedside, hold a hand, and wait.  Slowly, the miraculous began to happen.  The shriveled bodies plumped up, their energy returned, their infections subsided.  Laughter soon bounced off the walls of the oncology unit as the trial participants became children again.  Even more awe-inspiring, the cancer cells were gone from the blood and the first true remissions had been achieved!

The VAMP trials proved that cure was possible, and the work of Drs. Frei and Freireich inspired generations of doctors to continue research on combination chemotherapy.  The results of this effort are stunning: from 100% mortality 50 years ago, a child’s chance of surviving leukemia in certain circumstances is now greater than 95%.  From its dark beginnings as a weapon of war to its ascendant triumph as a lifesaving cure, the story of combination chemotherapy is a beautiful reminder that even in the darkest times, hope lives.