An excellent introduction to immunotherapy in the race to cure cancer. Easy to read, very accessible, and short in length. ( )

There are a lot of exciting advances in medicine, but surely none are as exciting and game changing as cancer immunotherapy. (Perhaps I am a little biased though having seen these treatments in action). Immunotherapy is not chemotherapy, but utilises new research breakthroughs to help allow the immune system to see cancer as something foreign and fight it. Unfortunately, it won’t help every cancer (some look more like foreign monsters to the immune system, others look like something normal) but immunotherapy and future breakthroughs in the field are going to be talked about for a long time. This book is timely because cancer therapy is no longer cut, burn and poison (surgery, radiation therapy and chemotherapy). As I’ve heard one person tell another, ‘I’m not on chemotherapy, I’m on immunotherapy’. Soon they won’t even have to emphasise that word as immunotherapies are being used more and more in various cancers. It’s given life extending options to people with melanoma (a deadly form of skin cancer), kidney cancer and lung cancer. For some patients, questions have been more about if and when immunotherapy should be stopped rather than how long they are going to live. It is early days though and by no means is immunotherapy the cancer panacea for all cancers.

Charles Graeber mixes patient experiences with various cancers that have been changed by immunotherapy and detailing the history of immunotherapy from William Coley’s experiments with bacteria and sarcoma to the discovery of CTLA and PD-1/PD-L1. Like other ground-breaking research, cancer immunotherapy hasn’t always been the coolest kid on the block. Graeber explains in detail the many failures and tiny steps forward that occurred before the latest breakthrough. It makes for fascinating reading. He also explains how the immune system operates very well and simply. My knowledge on reading this book has become much more detailed and because of it, my interest in immunotherapy has skyrocketed. (Just ask anyone who has spoken to me recently– I’ve been talking about immunotherapy all week). If you don’t know anything about B cells and T cells, it might be worth a quick refresher via the internet before you jump in.

One of the problems with talking about a field that is moving forward in leaps and bounds is that further breakthroughs will occur during the writing. Most of the recent discussion in this book is about CTLA-4 and the drug that acts on it (ipilimumab). PD-1 and PD-L1 (nivolumab, pembrolizumab, durvalumab atezolizumab and avelumab) don’t get quite as much page time – maybe that should be the sequel?! CAR-T cells – or T cells engineered to target cancer cells also gets a nice summary too (important as this is going to be used more and more in Australia). But overall, this is a great book to whet your appetite for what’s happening in cancer therapies these days. It’s clearly written, has the human touch and explains the technology in a way the non-medical person can understand. Those in healthcare will find it just as interesting (plus there are many references to scientific papers to keep you very busy).

http://samstillreading.wordpress.com ( )

I THINK IT'S IMPORTANT TO UNDERSTAND WHY A REVIEWER READ THIS BOOK

Disclaimer: I am not aware that any relative, friend, acquaintance, nor myself has or is currently being treated for cancer. So, why did I read “Breakthrough” (BT)? An acquaintance recommended it very enthusiastically and he gave me a very brief description. I generally read crime fiction, history, and biographies. I had recommended a number of books to him, he read several, and had not recommended anything until T; I felt I owed him one. And on occasion I like to read something totally different to break the pattern and/or keep up with things.

I thought BT was OK, but not great. I felt I learned a good deal about immunotherapies, and other associated topics. One that was a bit unexpected and rather interesting was all the factors that are considered when allowing a patient to become part of a trial for a new drug. I also noted some occasional nuggets of information like all the layers of immune protection we have surrounding and protecting us if laid end-to-end could cover a doubles tennis court. There were some interesting case histories, some with happy endings and some with sad ones including some that seemed to be on the pathway to a successful treatment, only to suddenly do a 180. The book is relatively brief, only 193 pages of text spread over nine chapters. There are also three appendices; I read only one of them but it turned out to be only a summary of the main points made earlier and there was nothing new there for me.

In the acknowledgments, the author writes: “This book was made possible in part by the vision and generosity of the Alfred P. Sloan Foundation.” I’m not sure exactly what that meant. I note that the author, Charles Graeber, is not an M.D. He is the author of a true-crime book, “The Good Nurse” for which he received an Edgar Award nomination. I thought the writing in BT was good; I understood most of the process as described but I don’t think I could repeat it in any detail nor answer questions about it. Maybe more detail would have helped. I wish there were more dates for various incidents and milestones – most of the writing was in chronological order but I got tripped up once or twice when it wasn’t. I would not recommend this book unless someone had a very specific interest in the subject and then only with the caveats above. ( )

My expectations were far too high. There's very little detail on the science or background on the scientists. Graeber basically admits this, and tries to excuse it by saying that science is a team effort and you can't honestly credit just one person for any major discovery. That's true, but it's a cop-out. I didn't expect a profile of every single scientist involved, but an interesting selection of scientists—even just one or two—would have made the book much better.

Instead of people interested in the science, its development and progress, Graeber seems to have targeted his book at cancer patients and patient advocates. So we get minimal details on the science—little more than you'd already know from magazine articles—we get several unedited, poorly researched appendices on the science. And this is thrown in with supposedly inspirational stories about cancer survivors. It doesn't work well. ( )

I've given this 5***** but that's not to suggest that it's a book for the average reader. It does tend toward "teckiness" so you're going to have to give it some very careful reading. It can also be a bit cumbersome because there are extensive and very substantive endnotes that really should be read but that will require an amount of flipping back and forth. But it is a book for the lay reader, so you don't need an M.D. or a Ph.D. to understand it. And the author does combine "tecky" discussion with human interest stories.

If you don't have a personal interest/involvement in this subject, this is a book you might want to pass on. And if you do have a particular interest and read it, be prepared to do it slowly and to reread it later on. Get a general grasp of the subject and then put it aside to come back to later as a reference when you have an actual need for some specific information.

For a somewhat more basic read, go to the 100 Questions and Answers About.... series and check out the particular cancer you're concerned about. (There are numerous books in this series, and cancer's only a subset of the topics covered; make sure you check all half-dozen or so pages of book listings.) After you've gotten a more general introduction, then you might want to turn to The Breakthrough for more specific discussion of immunotherapy. And realize that the current level of available immunotherapy treatments seems to be limited to certain particular cancers, or at least to be more effective with some cancers than others. ( )