Tikkun Olam through cancer research.
Mitchel L. Zoler
Is there something Jewish about cancer research?
Oncologist Mark Berger thinks so.
Dr. Berger, a Wynnewood resident and a member of Temple Beth Hillel-Beth El since 1989, designs and runs studies that are aimed at getting new cancer drugs approved by the Food and Drug Administration and onto the U.S. market.
He and his colleagues at GlaxoSmithKline, in Collegeville,
Pennsylvania scored a big success this past spring when the study that they ran for a new breast cancer drug showed that the drug delivered a substantial survival boost to selected patients. The results were so positive that the drug, lapatinib, is expected to gain FDA approval in the next few months and should be available to patients next year.
So what's Jewish about that?
Dr. Berger sees a spiritually-fulfilling and charitable element to his work; he likes to think of it as
tikkun olam, repairing the world.
When he is involved in a major success like his work with lapatinib,
he said ?it is tikkun olam in the sense that we actually can improve the
"There is an emotional component to cancer, and to caring for cancer patients," he said. Because cancer has been, for so long, a set of diseases with no cure and without good treatments
it has had more cultural overlay and religious overtones than, say, digestive or heart diseases.
?We are all more scared of cancer than other ways of dying. I think it has to do with images of patients having painful deaths, and of treatments with terrible side effects.
"In many cases you're taking care of patients who are going to die.
What is exciting about oncology is being able to help people stay as functional as they can for as long as possible.
It is helping patients reach a personal goal, such as going to a child's wedding or surviving through the next major holiday. There is a religious component to this that probably affects many physicians in the field, those who are Jewish and others as well."
After more than two decades working on cancer, Dr. Berger has the distinct impression that a disproportionately high number of oncology physicians are Jewish.
It is impossible to know if the tikkun olam angle plays a role, but Dr. Berger suspects it does.
The hopelessness that's long been part of caring for cancer patients was underscored by the results of a project that Dr. Berger worked on in the late 1990s, when he was on the staff at Wyeth. He helped design the studies that made the drug gemtuzumab ozogamicin (Mylotarg) available to patients with acute myeloid leukemia. When gemtuzumab ozogamicin was approved by the
Food and Drug Administration in 2000 it became the first new treatment for this cancer in more than 20 years.
Dr. Berger's interest in caring for patients with cancer began when he was in medical school, which led him to specialize in oncology, and continued while he completed his medical training by providing care directly to cancer patients. Following a multiyear detour when he did basic cancer research in animal models during the late
1980's and early 1990's, he started on drug development at Wyeth in 1996, and then moved to GlaxoSmithKline in 2002.
When he arrived at Glaxo, phase 2 trials with the breast-cancer drug lapatanib were finishing and Dr. Berger was given the task of shepherding the drug through the critical, next phase of clinical testing that would determine whether or not the drug was safe and effective and would reach the U.S. market. Designing such a trial required a careful balance of patient selection, recruiting subjects who were too sick to respond to conventional treatments but not so sick that a response to the investigational drug was impossible.
Lapatinib inhibits two different proteins involved in causing cancer: the epidermal growth factor receptor, and the human epidermal growth factor receptor-2 (HER-2). When either of these receptors is activated, a cell is stimulated to grow and divide. Blocking the receptors interrupts the cancer-causing process. The drug was tested in women with breast cancers that make excess levels of HER-2. About 20% of women with breast cancer have tumors that make too much HER-2.
Now that the pivotal trial is done, with lapatinib on track to produce a major advance in breast cancer treatment, Dr. Berger's new job is to try to find reliable ways to predict which women will respond to the drug and which will not.
He is also leading a program that is making lapatanib available immediately to patients who clinically match the women who are known to respond to lapatanib based on the results of the newly-completed trial.
Development of lapatinib is one more step on the path toward making cancer a manageable disease. Although curative treatments are the long-term goal, the immediate goal is to find treatments that let patients with cancer live with their disease for many years with minimal complications, the same way that patients with, for example, diabetes can receive treatments that let them live fairly normal lives, Dr. Berger said.
However, despite advances like lapatinib and gemtuzumab ozogamicin, this goal is still years away for most patients. For the foreseeable future, cancer care and the effort to develop new treatments will remain medical