The Emperor of All Maladies

by Siddhartha Mukherjee

Bruce Chabner wrote in an editorial, “the world of sport was shocked by the feat of Roger Bannister. . . . On May 6, 1954, he broke the four-minute barrier in the mile. While improving upon the world record by only a few seconds, he changed the complexion of distance running in a single afternoon. . . . Track records fell like ripe apples in the late 50s and 60s. Will the same happen in the field of cancer treatment?” Chabner’s analogy was carefully chosen. Bannister’s mile remains a touchstone in the history of athletics not because Bannister set an unbreachable record—currently, the fastest mile is a good fifteen seconds under Bannister’s. For generations, four minutes was thought to represent an intrinsic physiological limit, as if muscles could inherently not be made to move any faster or lungs breathe any deeper. What Bannister proved was that such notions about intrinsic boundaries are mythical. What he broke permanently was not a limit, but the idea of limits. So it was with Gleevec. “It proves a principle.1028 It justifies an approach,” Chabner continued. “It demonstrates that highly specific, non-toxic therapy is possible.” Gleevec opened a new door for cancer therapeutics. The rational synthesis of a molecule to kill cancer cells—a drug designed to specifically inactivate an oncogene—validated Ehrlich’s fantasy of “specific affinity.” Targeted molecular therapy for cancer was possible; one only needed to hunt for it by studying the deep biology of cancer cells.