The worldwide cancer research community this week mourned the death of Judah Folkman, a medical visionary whose breakthrough ideas were ignored in the 1960s and '70s, but have since become the blueprint for revolutionary 21st-century cancer therapies.
His pioneering theory, known as angiogenesis, holds that tumors must create their own blood vessels in order to grow. Treatments based on cutting off cancer's blood supply have supplanted chemotherapy and made the disease a treatable chronic condition for many patients.
By the time Folkman died of a heart attack at 74 on Monday — changing planes on the way to a medical conference in Vancouver — his theory had become the basis for treating a variety of cancers. More than 1,000 laboratories around the world are hard at work building on his ideas, according to the Children's Hospital in Boston Web site, where Folkman did his own research. Colleagues spoke of him with reverence rare for such a competitive field of research.
"I don't think he slept," said Dr. Harold Dvorak, 70, professor of pathology at Harvard Medical School, who got to know Folkman as an intern at Massachusetts General Hospital when Folkman became chief surgical resident there in 1963.
"People came to his lab or called him every day. He had a very large lab. He traveled constantly to conferences. I'm not surprised that he died in an airport."
Folkman is widely considered the grandfather of a new generation of therapies — most notably Avastin, a multibillion-dollar drug made by Genentech — that arrest cancer by neutralizing chemicals that tumors secrete to stimulate blood vessel growth. Such drugs cut off the supply of blood and nutrients to a tumor, halting its growth and sometimes shrinking it. This approach can often turn some previously lethal forms of cancer into manageable chronic conditions.
But the theory that made him an icon in the cancer world was hardly an instant success. When he first advanced the new ideas in the 1960s and 1970s, established scientists ignored or even ridiculed his ideas
"His thinking was ahead of the evidence for much of his career," said Bruce Chabner, 67, clinical director of the Massachusetts General Hospital Cancer Center. Chabner was a student at Harvard Medical School when he became friends with Folkman, who was then a surgical resident. "He believed in the long-term correctness of his theory even when he didn't have the data to prove it. And he had such great passion for cancer research, both publicly and privately, that he had the ability to get a few people to hang in there with him."
Folkman was doing research in the Navy in 1961 when he had his first insight into tumor growth. He noticed that all of the tumors he implanted in human organ tissue grew to exactly the same size. As he explained on the PBS TV show "Nova" in 2001, he expected the size of tumors to be distributed in the bell-shaped curve that occurs throughout biology. When he saw no bell curve, he hypothesized that a common limitation was halting tumor growth. Eventually, he identified the inability to form blood vessels as that common limiting factor.