In 2005, I returned to my old school to attend Professor Meng Xianyong’s eightieth birthday. I met the famous hematologist, academician of Chinese Academy of Engineering, Professor Wang Zhenyi. I have known Professor Wang as early as the 1970s. I went to southern China afterwards, being extremely impressed by his invention of differentiation-inducing therapy for promyelocytic leukemia. Professor Wang was pleased to know that I presided over a cancer hospital and said the current cancer treatments cannot solve the fundamental problems. Cancer treatment must have new ideas. When he knew we had applied immunotherapy for cancer, he asked me how we could ensure that all the cancer cells would be destroyed by immune cells? Further adding now there are many therapies, very specialized and targeted, it seems to be scientific, but cancer gene expression is varying and the differentiation process is rather unstable. In other words, cancer cells of today do not mean that they will still be cancer cells tomorrow. Immunotherapy to fight against cancer needs to be forceful and adaptable. It will not work if only one immunological method is applied, various immune measures need to be administered as cancer cells change. ”
An intelligent man is not of the common folk. A few words of an intelligent man are often lifelong lessons. Professor Wang pointed out the true meaning of immunotherapy. Cancer cells are characterized by their genetic instability, the DNA of cancer cells differs from normal cells. When a normal cell divides, the genetic information is perfectly copied into the next generation; when cancer cells divide, the replicated genetic information will change. Moreover, subtle changes of genetic information will cause a significant change in the cancer cell behavior. The result is that when people realize cancer cells are the same, actually the cancer cancers have divided countless differentiated cells, constituting a large family. These cancer cells have their own characteristics, but they are all incomparably cunning.
Based on the above understanding, we can combine various immune approaches, which are referred to as combined immunotherapy, including CIK, DC, T cell transfusion, cytokines injections and non-specific immune stimulation therapies. Combined immunotherapy can be compared to a war, there must be a Land Force, Naval Force, Air Force, even the police (immune cells and cytokines) and intelligence agents
(DC cell). It should not only expand its military to enhance their forces, but also take measures (non-specific therapy) to arouse their enthusiasm so that they dare to make a frontal attack. Of course, which one, or which several immunotherapies are suitable for a patient will be fully considered based on some special examinations in advance. The decisions will be made in accordance with specific conditions, this is called individualized therapy.
One year ago, at a seminar in Manila, Philippines, a fifty-yearold lady suddenly came to me, her face was familiar, but I could not recall which kind of cancer she had(Figure 9). She said, “Professor Xu, you are my great benefactor, do you think that I am still sick?” I recognized that she was a patient with metastatic renal carcinoma, her name was Rus. Five years ago she had surgery. Three years ago, the patient came to our hospital with bone metastasis. For this kind of progressive renal cancer, chemotherapy and radiotherapy do not work at all.
There are ten reports showing that patients with a 5-year survival rate vary from 0-13%. I treated her with Combined Immunotherapy for Cancer (CIC), which she unexpectedly greatly benefited from. I read her latest CT films done in the Philippines and no lesions could be seen. She gave me two beer bottles with flowers that she herself had painted on as gifts. According to her family's custom, these flowers on beer bottle represent their cordial respects and gratitude. She was afraid I would not accept them, saying that she was too poor to send me
valuables, she also did not dare send me valuables as she knew there is a rule in our hospital that all staffs are not allowed to accept gifts from patients. These were not valuables, but a token of her regards, so I accepted. Although I cannot fully understand the true meaning of the painting, I brought back these two beer bottles and put them on the bookcase in my office where I can see them everyday.
On November 19, 2011, the vice president Mr. Binay made an appointment with me in Manila. Mrs. Rus heard that Mr. Binay wanted to meet me, she came to the hotel that I stayed in early that morning, following me to go to the Vice Presidential Palace. Mr. Binay was very excited after listening to my presentation and had his photo taken with Mrs. Rus and her sister.(Figures 12)
Looking back on this patient’s happiness reminds me of a rich patient from Hong Kong.
This patient was mentioned in my book “Nothing But The Truth,” but at that time the rich patient was still alive, so I kept his name confidential. I just implicitly talked about my feelings: “the Rich Man's Sorrow.” Now though I still do not want to reveal his name, I’ll call him Mr. Meng.
It was May 2010, the vice president of Tsinghua University called and asked me to attend a group consultation for Mr. Meng who was the largest donor of Tsinghua University. I was told that he had renal cancer with recurrent disease after surgery. A few days later, the hospital in Hong Kong sent me an invitation. At 7 o’clock in the evening, I arrived at one luxury ward on the 38th floor of the grandest hospital in Hong Kong. His trachea has been cut, and the tracheal cannula was connected with a ventilator. I saw the life indicators on the monitor screen: heart rate 120 BPM, oxygen saturation 90%, and blood pressure 110mmHg. Mr. Meng could not speak, nodding only when he saw me. The moment he stretched out his hand, he burst into sudden shortness of breath and fainted. Mr. Meng had extensive bleeding and ecchymosis. The CT films showed that the lung markings thickened with sporadic flaky shadows. It was not tumor metastasis, but interstitial
pneumonia; the MRI scan suggested that there were no obvious lesions on the brain, but several bone metastases. Four doctors came in, made brief introductions with each other, exchanging business cards. They were all professors from Hong Kong University who also ran private hospitals. The system of private hospitals in Hong Kong differs from the ones in China, doctors of specialized hospital’s are visiting doctors. We discussed the patient’s condition, he was diagnosed with renal cancer in July 2009 and underwent nephrectomy, after four months, the bone metastases was unlikely to cause such a serious condition, there seemed to be other reasons. In terms of his medication history, I suddenly realized that the original cause was that chemotherapeutic drugs had lead to “on-infectious interstitial pneumonia.”
The chemotherapeutic drugs Mr. Meng used were not ordinary but the latest targeted drugs that were effective against renal cancer but with more side effects. The most serious situation was that the patient had non-infectious interstitial pneumonia, which was rare. But once present, it is almost impossible to reverse. Unfortunately Mr. Meng happened to have this side effect.
That night I returned to the hotel and thought about how we should treat the renal cancer patient? Mr. Meng was rich and could afford to use the most expensive drugs. The drugs he had used were those that ordinary people cannot afford. However, only about 20% of renal cancers have a response to the drugs such as tumor shrinking, and the duration is only three to four months. That is to say, even though this medicine would be effective, it is only temporary. If the patient happens to have serious side effects it can even lead to death, it begs to think that all his generous kindness did nothing to help him came? Renal cancer is closely related with immune mechanisms, so why not
firstly consider immunotherapy? I asked the fellows in Hong Kong, they said: if you do not use the latest most expensive drugs for the rich, how will they trust you?
I had this indescribable feeling. If Mr. Meng was not a rich man in Hong Kong, he probably would not have used this drug. If he had been an ordinary person, routine immunotherapy could have been applied leading to other consequences. It may be true that a rich man could be happy, but wealth will not necessarily get the best results, which seems to be the rich man’s sorrow!
Mr. Meng passed away on July 21st 2010. The Hong Kong newspaper reported: “King of XX was diagnosed with prostate cancer in 1995 and was plagued by the disease. He began to stay in hospital for treatment before the Chinese New Year, recently he died of pneumonia and blood disease”. This report did not mention renal cancer, for what reason I am not sure, but it was already not important.
So far, I recall the above poor and rich patients and they make me always think about how we should medically treat patients?