The Breakthrough: Immunotherapy and the Race to Cure Cancer

New York Times bestselling author Charles Graeber tells the astonishing story of the group of scientists working on a code that can enable the human immune system to fight — and perhaps even cure — cancer.

For decades, scientists have puzzled over one of medicine’s greatest mysteries: why doesn’t our immune system fight cancer the way it does other diseases? The answer is a series of tricks that cancer has developed to turn off normal immune responses — tricks that scientists have only recently discovered, and now are learning to defeat. We are in the midst of a revolution in our understanding of cancer and how to beat it.

Groundbreaking, riveting, and expertly told, The Breakthrough is the story of the game-changing and Nobel Prize-winning scientific discoveries that unleash our natural ability to recognize and defeat cancer, as told through the experiences of the patients, physicians, and immunotherapy researchers who are on the front lines. This is the incredible true story of the race to find a cure, and the definitive account of a historic moment in medical science.

Cancer treatment has long relied on “cut, burn, and poison” methods: surgery, which science journalist Graeber (The Good Nurse: A True Story of Medicine, Madness, and Murder, 2013) notes has been with us for thousands of years, coupled with the more modern radiation therapy and chemotherapy.

Immunotherapy leverages the body’s natural defense systems, made up of hundreds of millions of cells that are constantly “searching [for] and destroying the invaders that make us sick and the body cells that have become infected, mutated, or defective”—all of which describe cancer.

Immunotherapy, in short, unlocks the natural-born cancer killer within, which is no easy task, inasmuch as a hallmark of cancer is its ability to lurk within the body undetected until, at least of old, it is too late. As the author chronicles, scientists have yet to completely understand the workings of the T cell “as the serial-killing attacker of foreign cells,” but they have figured out what switches that cell on: a system of responses that are “something like how multiple keys are required to unlock a nuclear button or to open a safe deposit box.”

This helps moderate a constant danger that the immune system responses can sometimes lead to autoimmune diseases, where the cells lock onto the wrong thing; thus the “many redundancies and fail-safe feedback loops built into the immune response.” Enough has been learned that previously discarded immunotherapies are being studied to determine whether they would work “with the brakes off,” after having been paired with a “checkpoint inhibitor.”

Graeber reports that immunology researchers are promising more soon—more drugs, more fast-tracking to get therapies into hospitals, more “biomarkers to better describe cancer with molecular specificity.” Though sometimes clumsily written, the book offers hope for more effective treatments in the near future.

A readable survey of the emerging field of immunotherapy in cancer treatment.