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False dawn

And Carla? She’s fine. Five years after Mukherjee confirmed her first remission, he drives to her house, bringing her flowers and good news. Her latest bone-marrow biopsy is negative. Oncologists are sparing with the word, but she has his permission to count herself as cured: five years in total remission is as good as good news gets.

Basic cancer science, Mukherjee believes, has revealed not another false dawn but a light at the end of the historical tunnel. We now see a way out of the “cell-kill paradigm” and toward the development and deployment of highly targeted, nontoxic chemical therapies based on genetic science. The much touted anti-leukemia drug Gleevec here appears as the hero of modern, genetics-based cancer therapy, a “rationally designed” drug specifically directed against a known cancer gene. In development since the late eighties, Gleevec has been stunningly successful against a form of blood cancer called chronic myeloid leukemia (C.M.L.), achieving such deep remissions that oncologists talk of a “pre-Gleevec era” and a “post-Gleevec era,” and tell patients that they can look forward to “their functional life span”—on the condition that they take Gleevec “for the rest of their lives.” C.M.L. is just one, not very common, type of cancer, but, as one oncologist said, “It proves a principle. It justifies an approach.”