Sidney Farber, Chemo Crusader

As a teenager growing up in Buffalo, Sidney Farber witnessed firsthand the power and mystery of a cruel disease. When he was 15, the 1918 flu epidemic hit the city with force, and —despite precautions that included the closing of almost all public spaces— Buffalo eventually lost more than 2,500 citizens to influenza.

As an adult, Farber would go on to dedicate the bulk of his career to battling perhaps the cruelest malady of all: cancer.

Shortly after graduating from Harvard Medical School, Farber started his pathology work at Children’s Hospital in Boston, regularly examining diseased tissue under a microscope. He was so troubled by the number of autopsies he was performing on young leukemia victims that after World War II he set his sights on finding a way to successfully treat pediatric leukemia patients.

At the time, the most effective cancer treatment was surgery or radiation therapy, options which didn’t work for blood cancers like leukemia and lymphoma —so virtually all leukemia patients were dying of the disease, most within a few weeks of diagnosis.

Farber was not deterred. It was well understood that leukemia was caused by immature white blood cells called blasts that arise in the bone marrow and crowd out healthy white blood cells, leaving patients unable to fight disease. He knew that folic acid, an essential vitamin, stimulated the growth and maturation of bone marrow; if he could somehow block folic acid and keep blasts from invading, he believed he could stop leukemia from becoming fatal.

A new drug called aminopterin then being tested had this folic-acid blocking ability. In November 1947, Farber and colleague Louis Diamond, MD, gave aminopterin to 16 children seriously ill with leukemia. Ten of them went into temporary remission, the first time that a drug tested as an anticancer agent had proved effective against the disease.

The results, reported in The New England Journal of Medicine in May 1948, were initially met with skepticism by many in the medical community. Over time, however, as Farber continued seeing positive results, more and more patient families began traveling to his Children’s Cancer Research Foundation clinic (today Dana-Farber Cancer Institute) for treatment.

And so, by the time Farber spoke at the New York Academy of Medicine dais on January 12, 1951 (later broadcast as a WNYC Lecture to the Laity), cancer care had entered the era of chemotherapy —treatment by drugs administered into the bloodstream— thanks in large part to his work. Rather than focus on his own success, however, Farber spends his talk recounting the work of other physician-scientists that have lead up to this point —from the 19^th century cellular work of Louis Pasteur and Sydney Ringer to the fortuitous discovery during World War II that a chemical related to mustard gas used in warfare (nitrogen mustard) could help thwart cancer.

“Our discussion tonight is based upon research – most of it no older than 10 years, and as recent as this moment,” he tells the crowd. “But it is only the breakthrough which has come in these last few years. What has been accomplished is based clearly upon contributions, made through the centuries and from a variety of disciplines, by individuals and institutions scattered over the world.”

Listening to the recording of Farber’s lecture, one is reminded how far cancer treatment has come since 1951. At the time, chemotherapy could temporarily slow or stop disease, but Farber notes how the vast majority of patients were still dying. “All anti-cancer effects produced by chemical compounds are temporary in man,” he says, “with effects lasting from weeks to months – and only occasionally for periods as long as six years.”

Farber does offer hope, however, that with patience and hard work these results will continue to improve. “There will be no one V-Day when the cure of cancer will be achieved,” he says. “Progress will be achieved in spurts, with great unevenness and irregularity. . . Anti-cancer compounds are being used in daily practice now, producing effects which would have aroused intense excitement a scant five or seven years ago.”

Today the progress continues, as do the achievements. Survivorship for many cancers is now often measured in decades rather than months, and Farber’s vision has become reality.