A trailblazing oncologist who took on childhood leukemia by introducing combination chemotherapy — in which anticancer drugs are given simultaneously rather than singly — retired in September after 50 years at MD Anderson.
Yet Emil J Freireich, M.D., 88, who achieved legendary status as a pioneer in the early history of oncology triumphs, still comes to work every day, attending meetings and participating in the center’s medical education program.
Retirement is “just a suggestion,” Freireich says. “I’m too motivated to lounge around the house like a dried-up old geezer.”
Freireich’s motivation to stop cancer was born back in 1955 when he was hired at the fledgling National Cancer Institute (NCI) in Bethesda, Maryland. Built “way out in the country” on the campus of the National Institutes of Health, the center was the first full-time, patient-oriented clinical research center in the world. It was there that Freireich would alter the course of childhood leukemia for millions of patients in the years to come.
Stop the bleeding
On his first day at the institute, Freireich was assigned to care for children in the leukemia ward — a job no one else wanted.
“Leukemia at that time was a horrible illness — a death sentence,” he says. “Most children lived only eight weeks after being diagnosed. Ninety-nine percent died within a year.”
His first order of business was to halt the nonstop bleeding that is the hallmark of the disease.
“Leukemia prevents blood from clotting,” he explains. “Children bled to death. The leukemia ward looked like a slaughterhouse. Blood covered the pillowcases, the floor, the walls … it was horrific.”
Early chemotherapy drugs were available, but patients bled to death before they could undergo treatment.
Freireich firmly believed his patients’ bleeding was caused by insufficient platelets — tiny blood cells that help the body form blood clots. Recent research revealed that the platelets of World War II atom bomb victims had been wiped out by radiation, and that those victims died from hemorrhaging. The connection was indisputable, Freireich believed. Yet the medical community dismissed his idea.
To prove them wrong, Freireich mixed platelets from his own blood with blood from leukemic children. Without fail, the bleeding stopped.
Further studies confirmed not only that Freireich had been right all along, but also his belief that platelets were useless unless they were obtained from fresh blood.
“Platelets in donated blood last only 48 hours,” he explains. “Because blood bank protocol demanded that the oldest blood be used first, the children all along had been getting blood that was too dated to contain platelets.”
With these discoveries, bleeding as a cause of death was essentially eliminated.
With the bleeding problem solved, Freireich turned his attention to curing childhood leukemia. Another difficult-to-treat disease, tuberculosis, recently had been cured. He believed the TB treatment approach might work for leukemia as well.
“We knew that three drugs controlled tuberculosis, but you had to administer them all at once. If given separately, they didn’t work,” he says. “I had an inkling the same method would work for leukemia.”
So Freireich began combining chemo drugs instead of giving them one at a time.
First he administered two of the highly toxic drugs, then three. With each addition, children became seriously ill, and some were brought to the brink of death. When he upped the ante to four drugs in a 1961 trial, an outcry arose from the medical establishment.
“They said I was unethical and inhumane and would kill the children. Instead, 90 percent of them went into remission immediately. It was magical.”
Once children were in remission, Freireich continued their four-drug regimen for a full year to kill any residual cancer cells. That exact strategy, called early intensification, is still used today, and the cure rate for childhood leukemia is 92%.
In 1965, Freirech and his NCI friend and colleague Tom Frei, M.D., were recruited by MD Anderson to launch a chemotherapy program. Until then, the cancer center had treated patients with surgery and radiation. The two doctors formed the Department of Developmental Therapeutics and hired brilliant young scientists who developed drug combinations that cured various cancers based on the same methods used to treat childhood leukemia. Today, nearly all successful chemotherapy regimens use this approach of administering multiple drugs simultaneously.
Curing cancer isn’t synonymous with eradicating cancer, Emil J Freireich points out.
Our bodies contain 70 trillion cells, and when one of them misbehaves, you can get cancer. With that many cells, he says, mathematically, there’s great potential for error.