A Lifesaving Legacy

Two years ago, a patient of mine received some terrible news. Her cancer had spread to her liver, and it had spread so extensively that she was given only a few months to live. Her doctor prescribed a new drug, Avastin. Instead of directly killing the tumor cells, this drug was designed to disrupt the tumor's blood supply, thereby causing the tumor to die while minimizing damage to the normal cells around it. It worked. She is still alive today, and there is no trace of tumor in her liver.

Although she never met him, she owes her life to Dr. Judah Folkman, as do many others. The world lost one of the great scientific minds of our time when he died two weeks ago. His life's work literally transformed our understanding of cancer and other illnesses. Folkman's ideas were truly revolutionary. Like other scientists throughout history whose ideas were ahead of their time, he endured with grace many years of deep skepticism, even ridicule, from much of the medical community until he was ultimately proved right. He inspired me by his example. Few scientists are able to witness their ideas move from the laboratory to the clinic and change the way medicine is practiced.

His remarkable breakthrough showed that tumors create a private blood supply for themselves in order to grow and spread, a process called angiogenesis. Folkman believed that disrupting this blood supply, called antiangiogenesis, could starve tumors. Undeterred by criticism, he doggedly persevered over four decades and eventually established a new field of medical research based on understanding and controlling new blood-vessel growth.

In 2003, the biotech company Genentech proved the antiangiogenesis concept with Avastin. In 2004, an article published in The New England Journal of Medicine showed that Avastin significantly prolonged the lives of patients with metastatic colon cancer. Today, 10 antiangiogenesis drugs for cancer have been approved in the United States, helping more than 1.2 million patients with cancers of colon, lung, breast, kidney, liver, pancreas, stomach and bone marrow live longer and better. 

While biotech companies are beginning to rally around this idea, Mother Nature may have already given us a practical solution in certain foods. A growing body of research is showing that fruit and vegetables contain an arsenal of naturally occurring angiogenesis inhibitors. These include substances like ellagic acid (berries), resveratrol (grapes), curcumin (turmeric), ECGC (green tea), procyanidin (cocoa) and genistein (soybeans). Increasing the intake of these substances may prove to have antiangiogenic benefits, such as cancer prevention and weight reduction. Antiangiogenesis may be yet another reason why fruits and vegetables are so beneficial. The Angiogenesis Foundation, a nonprofit organization inspired by Folkman's vision, is now building a worldwide research effort to study this approach. 

More than 70 diseases besides cancer are now recognized as "angiogenesis-dependent," and may yield to the same approach to therapy. These diseases include arthritis, psoriasis, endometriosis, Alzheimer's disease and even obesity. Abnormal blood-vessel growth also underlies the most common causes of blindness in Western nations, age-related macular degeneration (AMD) and diabetic retinopathy. Folkman's antiangiogenesis concept also led to the successful development of two new antiangiogenic drugs, Lucentis and Macugen, that effectively treat, and can, in some cases, even reverse vision loss. An editorial in The New England Journal of Medicine accompanying the article used the uncharacteristic word "miraculous" to describe these findings.