When I started my fellowship in medical oncology in 2009, there were 2 inalienable truths.
First, as we assessed the weaponry we could deploy against cancer, we identified only three angles of attack: surgery, radiation, and chemotherapy. The first two were, in essence, local therapies, effective only where the scalpel or the high-energy beam was directed respectively to excise or ionize a tumor. Chemo was different because it was systemic, diffusely delivered, and the exclusive armamentarium of the medical oncologist, whose expertise lay in administering chemicals to poison malignant cells while trying to limit collateral damage to the host’s normal tissues. If the cancer signified weeds in the garden, this was akin to dispensing pesticides artfully enough to preserve the good plants. But it was hard to avoid a black thumb. Wistfully we hoped for a more discriminating way to stymie the growth of the bad actors, envious of the targeted aim of our colleagues in surgical & radiation oncology.