When Folkman published a seminal paper on cancer anti-angiogenesis in the New England Journal of Medicine in 1971, the medical community was extremely skeptical. The field also ran into a lot of criticism after an infamous story on the front page of The New York Times in 1998 asserted that Folkman's research might lead to a cure for cancer, a wildly overoptimistic analysis at the time.
While it's still far from a cure, today more than 30 anti-angiogenesis drugs are in development, and the most successful of the new targeted cancer therapies, Genentech's (DNA
) Avastin, falls into this class.
Folkman remains involved in research at his lab at Children's Hospital in Boston, where he's director of the Vascular Biology Program, and trains other researchers as a professor at Harvard Medical School. But he hardly spends all his time with lab mice. A tireless worker, Folkman continues to treat patients, and his clinic gets some 50 calls a day from cancer patients and their doctors desperate for his help.
He recently talked to BusinessWeek Senior Writer Catherine Arnst in Orlando, Fla., after giving a speech at a packed forum on anti-angiogenesis at the American Society of Clinical Oncology meeting. Edited excerpts of their conversation follow:
Q: Your lab is now searching for biomarkers, proteins in the blood that are linked to the presence of particular cancers. Why is their identification important?
A: Right now, we don't know which drugs will work on which patients. When colon cancer patients are operated on, 50% are cured, and 50% will end up dying in 6 to 8 years, but we don't know who is in which group. If every three months we could test the platelets or urine for a biomarker associated with the disease, we could start patients on an anti-angiogenesis drug as soon as the biomarker starts rising, instead of waiting six years for the tumor to appear and operate again. Ideally, we would never treat the tumor. We would treat the biomarker.
Q: How hard is it to identify such biomarkers?
A: There are 20,000 different proteins in blood, and some of them are exquisitely small. It's only recently that we had the science and the technology to figure them out.
Q: How long do you think it will take to match specific biomarkers with certain cancers?
A: I can't say when. I don't predict. But I do know we won't get there at all unless people think about it.
Q: How did you first become interested in angiogenesis?
A: I was working for the Navy in 1960. At that time the Navy had launched the atomic aircraft carrier Enterprise, which was able to stay at sea with a crew of 5,000 for a year without refueling. But it had to keep coming back to port after a month, because the blood bank was outdated after a month. Admiral Rickover was outraged that a biological problem would wreck his technological wonder, so we were recruited to solve the problem.
[Folkman and the other members of the research team quickly came up with a long-term blood-storage solution, but in working on the problem he discovered that tumor cells that grew in mice did not grow in a test-tube culture.] I realized that the tumor cells needed new blood vessels to thrive. I published my experiments and their therapeutic implications in 1971 in the New England Journal of Medicine, but no on believed it.
Q: How long did it take you to win over the scientific community?
A: We were pretty much alone for 10 years, then other people started coming into the field.
Q: How do you feel now about the success of Avastin and other anti-angiogenesis drugs?
A: I'm extremely satisfied. In the past we always assumed that unless you were making the patient really sick, flooding the body with these really toxic chemotherapies, the treatment wasn't working. Before, patients were really afraid of these treatments. With these angiogenic drugs, you have none of that. All my patients comment on how much strength they have, they're all back at work.