summer-2003-Part 2-live - Nieman Foundation - Harvard University

Medical Reportingof the antibody’s well-known Y shape,you’ll recall that it’s the two arms of theY that vary from one antibody to thenext. The rest of the antibody remainsthe same, no matter what the target.This experimental antibody streamlinesthe situation, discarding everything butone arm—the variable segment of theantibody that grabs the target cell.Making a Molecule Into aStoryPerhaps it was my fascination with thescience of this antibody that preventedme from thinking clearly about theemotional cost of what I was proposingto my editors at The (Toledo) Blade.The antibody, referred to as H11 by itsCanadian manufacturer, ViventiaBiotech Inc., was in Phase I clinicaltrials at the Medical College of Ohio.My proposal: Follow the patients inthis trial and see what happens. Let’suse their stories to tell the story ofcancer. What it is, how it grows, howwe fight it, and how it so often wins.Two years later, I’m amazed at mynaiveté. Think of what I was settingmyself up for—not just me, but photographerJetta Fraser, as well. I knewthe basics of the trial: The 12 enrolleeswere to be people with end-stage disease,people for whom traditional cancertherapies were failing. Althoughthe trial was open to patients with alltypes of cancers, as long as they lackedcentral nervous system metastases andmaintained reasonably good liver andkidney function, its target were thosewith no real hope. The bottom line:They should be able to survive threemonths beyond their treatment.This was—as is the case with allPhase I trials—not an experiment tosee if the new drug worked but aneffort to look for adverse reactions anddetermine a safe dose. In fact, thisscrap of antibody would carry no killingagent with it. Although preliminarytests in humans demonstrated H11 targetedtumor cells—and plans were touse it eventually in conjunction withchemotherapy—this step in the processof vetting a promising compoundincluded no lethal accompaniment.There was no reason to think H11Cissi Jackson worked to finish a wedding dress. During her illness, she continued tocreate custom-made apparel and upholstery.Jackson and her daughter Heather at the Infusion Center at the Medical College of Ohioduring one of her treatments for breast cancer.Photos by Jetta Fraser/The (Toledo) Blade.would help patients at all.I’d essentially planned to do a storyabout dying people with no real hopeof a cure acting as guinea pigs. Intellectually,I think I understood that. Emotionally,I was utterly blind. Seven ofthe 12 trial participants agreed to let ustrack their progress. The structure ofthe final stories dictated including onlyfive of them in the narrative. It focusedtightly on two, Cissi Jackson, battlingbreast cancer since 1992, and PatKrzeminski, diagnosed with advancedovarian cancer five years earlier.Cancer as a CentralCharacterFrom the start, I wanted to make cancera main character in this series. SoNieman Reports / Summer 2003 37