Is the Cure for Cancer Inside You?

Claudia Steinman saw her husband’s BlackBerry blinking in the dark. It had gone untouched for several days, in a bowl beside his keys, the last thing on anybody’s mind. But about an hour before sunrise, she got up to get a glass of water and, while padding toward the kitchen, found an e-mail time-stamped early that morning — “Sent: Monday, Oct. 3, 2011, 5:23 a.m. Subject: Nobel Prize. Message: Dear Dr. Steinman, I have good news for you. The Nobel Assembly has today decided to award you the Nobel Prize in Physiology or Medicine for 2011.” Before she finished reading, Claudia was hollering at her daughter to wake up. “Dad got the Nobel!” she cried. Alexis, still half-asleep, told her she was crazy. Her father had been dead for three days.

Ralph Steinman in 1983. He would become his most compelling experiment.

The cell Steinman hoped would save his life looks something like a sea anemone or a ruffled shrimp dumpling.

The Nobel Foundation doesn’t allow posthumous awards, so when news of Ralph Steinman’s death reached Stockholm a few hours later, a minor intrigue ensued over whether the committee would have to rescind the prize. It would not, in fact; but while newspapers stressed the medal mishap (“Nobel jury left red-faced by death of laureate”), they spent less time on the strange story behind the gaffe. That Steinman’s eligibility was even in question, that he’d been dead for just three days instead of, say, three years, was itself a minor miracle.

In the spring of 2007, Steinman, a 64-year-old senior physician and research immunologist at Rockefeller University in New York, had come home from a ski trip with a bad case of diarrhea, and a few days later he showed up for work with yellow eyes and yellow skin — symptoms of a cancerous mass the size of a kiwi that was growing on the head of his pancreas. Soon he learned that the disease had made its way into nearby lymph nodes. Among patients with his condition, 80 percent are dead within the first year; another 90 percent die the year after that. When he told his children about the tumor over Skype, he said, “Don’t Google it.”

But for a man who had spent his life in the laboratory, who brought copies of The New England Journal of Medicine on hiking trips to Vermont and always made sure that family vacations overlapped with scientific symposia, there was only one way to react to such an awful diagnosis — as a scientist. The outlook for pancreatic cancer is so poor, and the established treatments so useless, that any patient who has the disease might as well shoot the moon with new, untested therapies. For Steinman, the prognosis offered the opportunity to run one last experiment.

In the long struggle that was to come, Steinman would try anything and everything that might extend his life, but he placed his greatest hope in a field he helped create, one based on discoveries for which he would earn his Nobel Prize. He hoped to reprogram his immune cells to defeat his cancer — to concoct a set of treatments from his body’s own ingredients, which could take over from his chemotherapy and form a customized, dynamic treatment for his disease. These would be as far from off-the-shelf as medicines can get: vaccines designed for the tumor in his gut, made from the products of his plasma, that could only ever work for him.

Steinman would be the only patient in this makeshift trial, but the personalized approach for which he would serve as both visionary and guinea pig has implications for the rest of us. It is known as cancer immunotherapy, and its offshoots have just now begun to make their way into the clinic, and treatments have been approved for tumors of the skin and of the prostate. For his last experiment, conducted with no control group, Steinman would try to make his life into a useful anecdote — a test of how the treatments he assembled might be put to work. “Once he got diagnosed with cancer, he really started talking about changing the paradigm of cancer treatment,” his daughter Alexis says. “That’s all he knew how to do. He knew how to be a scientist.”

First, Steinman needed to see his tumor. Not an M.R.I. or CT scan, but the material itself. The trouble was that most people with his cancer never have surgery. If there’s cause to think the tumor has spread — and there usually is — it may not be worth the risk of having it removed, along with the bile duct, the gallbladder, large portions of the stomach and the duodenum. Luckily for Steinman, early scans showed that his tumor was a candidate for resection. On the morning of April 3, 2007, less than two weeks after his diagnosis, he went in for the four-hour procedure at Memorial Sloan-Kettering Cancer Center, just across the avenue from his office at Rockefeller University.

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No Clear Link Between Cancer and 9/11 Debris, New York Health Dept. Study Finds

The study was by far the largest to date. It examined 55,700 people, including rescue and recovery workers who were present at the World Trade Center site, on barges or at the Staten Island landfill where debris was taken in the nine months after Sept. 11, 2001, as well as residents of Lower Manhattan, students, workers and passers-by exposed on the day of the terrorist attacks.

Over all, there was no increase in the cancer rate of those studied compared with the rate of the general population, researchers concluded after looking at 23 cancers from 2003 to 2008. The prevalence of three cancers — multiple myeloma, prostate and thyroid — was significantly higher, but only in rescue and recovery workers and not in the rest of the exposed population. But since the number of actual cases was small and the subjects of the study may have been screened more frequently for cancer than other people on average, the researchers noted that it was too early to draw any correlation to time spent at ground zero.

In one of many counterintuitive findings, the incidence of cancer was not higher among those who were exposed more intensely to the toxic substances than among those who were exposed less.

The lack of clear evidence of a link between cancer and the debris from Sept. 11 casts into doubt the decision by the federal government in June to add 50 different types of cancer to the list of illnesses covered by the James Zadroga 9/11 Health and Compensation Act, signed by President Obama in early 2011. That decision meant that people with other sicknesses linked more strongly to ground zero were likely to receive less money.

Dr. Thomas A. Farley, the health commissioner in New York City, said in an interview on Monday that it was too soon to take the study as a repudiation of the government’s decision.

“Cancers take 20 years to develop,” Dr. Farley said, “and we might see something different 20 years down the line.” But echoing Dr. John Howard, head of the National Institute for Occupational Safety and Health, who made the final decision on covering cancer, the commissioner added, “You don’t want to wait 20 to 30 years to get a definitive answer” to people suffering today.

On Tuesday, Dr. Howard issued a statement that said, “The W.T.C. Health Program welcomes this addition to the peer-reviewed scientific literature, and we have long encouraged the growth of such peer-reviewed research.”

Dr. Alfred I. Neugut, an oncologist and professor of epidemiology at the Mailman School of Public Health at Columbia University, said he was not surprised by the study. “I think, given the time frame and the exposures,” he said, “that there wasn’t a high likelihood that there would be an elevated risk, certainly for cancer, and to the degree that it was, it would not be for the cancers that they’re finding.”

Dr. Neugut said he sympathized with people who had cancer they attributed to the disaster, but added that their emotional response was not necessarily valid scientifically. “The 9/11 attack was a terrible thing, but it doesn’t cause everything in the world,” he said. “Cancer is a very specific outcome, and in most exposures, you have to be exposed for an extended time before you get the cancer.”

Initially, the money set aside by the law — $2.8 billion to compensate victims and $1.5 billion for monitoring and treatment costs not covered by health insurance — covered mainly respiratory illnesses. (Mental health problems were included in the treatment fund but not the compensation fund.) Studies by the city health department have found asthma and post-traumatic stress disorder to be linked to the 2001 attacks. But cancer is expected to be far more expensive to treat than other qualifying illnesses, and the economic loss caused by cancer could require more compensation, since many cancer patients cannot work, and some have died.

The study was released on Tuesday, and was to be published in the Wednesday issue of The Journal of the American Medical Association — too late to influence Dr. Howard’s decision, but perhaps not too late to influence public opinion going forward or to affect whether Congress will decide to replenish the victim compensation fund should more money be needed.

The fund has not yet begun making payments, and it is supposed to make its final payments in 2016-17. In the meantime, some police officers and other rescue and recovery workers who worked at ground zero and have cancer have been receiving enhanced pension benefits based on a 2005 state law that said they were presumed to have contracted cancer from the ground zero substances.

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