Patients, Docs Remember Cancer Pioneer Judah Folkman

Meticulous Preparation

Unlike medical doctors today, who must choose early on between clinical practice and research if they hope to compete in either field, Folkman trained as a surgeon and worked in the operating room as well as the cancer laboratory until the mid-1980s. As a young surgeon, he was known for his meticulous preparation.

"He would practice operations on corpses in the hospital morgue the night before he had to perform them on patients," said Dvorak, who was an intern in pathology at the time. "Not many surgeons did that. He had to stay late at night and get up early the next morning. He showed unusual care and concern for his patients."

In 1971, 10 years after he began developing his theory, Folkman published a seminal paper in the New England Journal of Medicine. He was still decades ahead of his time. Most established cancer researchers dismissed the theory.

"No one was thinking like him at the time," said Chabner. "Ninety-nine percent of doctors believed you should attack the tumor directly."

This "cytotoxic" approach forms the basis of chemotherapy. "No one was thinking about attacking the environment of the tumor or its blood vessels," Chabner said.

Folkman doggedly pursued his idea for an additional 30 years, even when his applications for government grants were rejected. The ultimate vindication of his view did not come until 2004, when the Food and Drug Administration approved Avastin. But by then Folkman had become well known for Endostatin, an anti-angiogenic drug he developed with EntreMed, a company based in Rockville, Md.

"Endostatin Baby"

Endostatin was never approved by the FDA, but it became a huge hit with patients who took it in clinical trials. Scott Toner, 38, a risk manager at Fidelity Investments, says he is alive today only because of Folkman's drug.

When Toner was diagnosed with a rare form of pancreatic cancer on Dec. 11, 2000, he was put on Adriamycin for nearly a year. The toxic chemotherapy agent shrunk the tumor. But Toner says the treatment was killing him.

"If I took it any longer I would have destroyed my heart," Toner said.

Toner, who lives in Boston, heard Folkman speak at Beth Israel Deaconess Hospital there in late 2001. A few weeks later he entered the clinical trials for Endostatin. His tumor stopped growing and he recovered the vigor that he'd lost during chemotherapy treatments.

"You can't stay on Adriamycin for three years," Folkman explained in a 2005 interview. "Your bone marrow is burned up. But with Endostatin there are no side effects."

Toner, who was single when doctors diagnosed his cancer, said he decided to get serious about life on the new drug. He married and fathered a child while taking Endostatin.

"You can't become a parent on chemotherapy," Toner said. "You have to wear protection for your partner."

Folkman celebrated Toner's child as gleefully as the new parents. "He was very proud of our son," Toner said. "He called him the first Endostatin baby." Toner took Endostatin for almost four years. He and three other patients used up the last of the supply after the clinical trial ended and EntreMed quit making the drug.

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