Dr. Folkman's war : angiogenesis and the struggle to defeat cancer by Cooke Robert 1935-

Author:Cooke, Robert, 1935- [Cooke, Robert, 1935-]
Language: eng
Format: epub
Tags: Folkman, M. Judah, Neovascularization inhibitors, Cancer, Neoplasms, Angiogenesis Inhibitors, Antineoplastic Agents, Neovascularization, Pathologic, Research
ISBN: 0812974840
Publisher: New York : Random House
Published: 2001-06-19T19:00:00+00:00

Chapter Thirteen

THE FIRST HINT THAT SOMETHING was wrong appeared inTommy Briggs's ringers. They seemed to have become clubbed, blunt at thetips. It looked a little weird to Tommy, a sandy-haired boy who lived in Au-rora, Colorado. It was 1987; Tommy was twelve years old. His parents tookhim to the pediatrician to have him examined, but the doctor couldn't find anyobvious problems. He dismissed the condition as "idiopathic clubbing" andtold the Briggses not to worry about it.

But Tom and Judy Briggs couldn't help worrying about their son. Judywas a nurse, and she was aware that clubbing of the fingers could be associatedwith heart disease or lung ailments. Her concern deepened when Tommy be-came increasingly short of breath. When he started coughing up bloody spu-tum, she returned to the pediatrician, who started a series of referrals thateventually brought Tommy to Dr. Carl White, a pediatric pulmonary special-ist at the Children's Hospital in Denver. There he underwent a battery oftests. "Treadmill. Tubes. X rays. Skin tests. Catheterization. You name it, Ihad it," Tommy later recalled. "It was a pretty brutal thing, scary, especiallyfor me at that age."

White and the doctors he worked with agreed that the X rays showedsomething, but they weren't sure what. Finally, in August 1987, with Tommycoughing up more blood during the night, White decided he'd better take atissue biopsy from inside Tommy's lungs. He hoped to find something rela-tively innocent, perhaps a fungus infection. Instead, he found something dev-astating. Tommy had an extremely uncommon disorder called pulmonaryhemangiomatosis, essentially a big, unruly mass of capillaries growing deepinside his lungs. It soon became clear that the options were limited. Tommy

had a form of the condition that had been recorded in the medical literatureonly seven times before—all of them in autopsies.

Hemangiomas themselves are not uncommon, and usually not dangerous.They are ugly, bloodred, uncontrolled clumps of endothelial cells that canshow up anyplace, but usually appear on the body rather than inside it. Exceptin very rare cases, hemangiomas can be ignored; they'll eventually go away ontheir own. They are fairly common at birth, especially in babies born prema-turely, and rarely turn out to be of much consequence. The growths tend toexpand rapidly during the first year, then slow down, and begin to regress, fi-nally disappearing by age ten or fifteen. But in about 10 percent of cases, he-mangiomas keep growing and cause tissue damage that can be disfiguring.And in about 1 percent of these few cases, hemangiomas arise in a vital organand become life-threatening. Steroid drugs such as prednisone are effective inapproximately a third of these cases, and they help somewhat in another third.But in the remaining third the drugs prove useless, sometimes even makingthe disorder worse.

Tommy Briggs was one of the unlucky ones. Hemangiomas rarely form inthe lungs, and his was especially persistent and dangerous. The bloody masswas disrupting Tommy's airway, and it seemed to be expanding relentlessly.Steroids didn't work. Surgery was impossible. The medical literature offerednothing. Left on its own, the hemangioma would eventually smotherTommy's lungs in overgrown capillaries. By the fall,

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