Until last weekend, Steven Rosenberg was only one of the better known surgical oncologists in the country, more recently for the fascinating research he has been doing in developing “adoptive immunotherapy” for the treatment of cancer. Thanks to the enthusiasm of Armand Hammer over the promising but very early clinical results of that research, Rosenberg came to the attention of the White House, but nothing like the scale that was generated last weekend. Now, Rosenberg probably is the most famous cancer surgeon in the universe.
Rosenberg was asked to join the team of surgeons who removed two feet of President Reagan’s right colon July 13 because of his expertise in colon cancer (It had nothing to do with the possible use of adoptive immunotherapy in any future treatment program for the President). It quickly developed at the press conference following the surgery that Rosenberg was the member of the team at whom most of the reporters’ questions were directed. The same pattern held at the press conference Monday when the fact that the tumor was malignant was made known.
The 44-year-old chief of the NCI Surgery Branch, in the Clinical Oncology Program of the Div. of Cancer Treatment, performed with cool, articulate detail the task of informing the world that for the first time in its history the sitting President of the United States had cancer (or at least the first time such was publicly known). A half hour earlier, Rosenberg had so informed Mrs. Reagan and then the President. Both took the news calmly and in good spirits, Rosenberg said.
Among the other information Rosenberg passed along in response to scores of questions from the press:
*He would not recommend any adjuvant therapy for the President because the surgery itself had a better than 50 per cent chance of being curative and because no regimen tested so far has proven effective in improving survival for colon cancer. However, he had discussed adjuvant therapy with NCI Director Vincent DeVita and would seek additional opinions on the possible use of chemotherapy.
*Neither would he recommend therapy involving monoclonal antibodies at this time because that is “highly experimental” and also because “there is no role for it given the stage of the disease.” Presumably, that also would apply to adoptive immunotherapy, although he was not asked about that procedure. Hammer had told White House Science Advisor George Keyworth about the promising results Rosenberg had observed in the first few patients who had received adoptive immunotherapy. Keyworth said if similar results could be obtained with 20 patients, he would ask the President for additional money to support large scale clinical trials. Apparently, the titillating prospect that the President himself might be the 20th such patient will not become a reality.
*He would not criticize the decisions made last year and last March, delaying colonoscopy or barium enema which might have turned up malignant tumor from four to 14 months earlier. He insisted it was “impossible” to say whether the tumor, classified as Dukes B, might have been Dukes A last year. He presented a clear, concise explanation of the differences between Dukes A, B and C.
*He defended the hemacult test as “one of the best and most practical tests for colon cancer” and although it has its problems, “is very useful.”
*He said that since the President’s diet during his 74 years “has served him well,” he would recommend that he return to it. However, he would also recommend to anyone a reduction in fat and increase in fiber.
Rosenberg, responding to a question, insisted that “no one has told me I can’t discuss any aspect of this case” with the press. LaSalle Leffall, chairman of surgery at Howard Univ. Cancer Center, a member of the National Cancer Advisory Board and former president of the American Cancer Society, touched on what may be a significant aspect of the President’s illness when he was interviewed on Cable News Network.
“Something good may come out of this,” Leffall said. “It may start many of us to thinking about this disease, and go in for examinations . There is no question in can help make people aware of it throughout the world.”
Examinations leading to diagnosis of colon cancer at Dukes A stage rather than Dukes B means five year survival of more than 90 per cent compared with more than 50 per cent.
More than a few oncologists have been shaking their heads this week, wondering what might have been in the President’s case.