The Death of Cancer: combination chemo and Hodgkin lymphoma

Vincent T. DeVita Jr. was one of the young doctors at the National Cancer Institute in the 1960s. They tried giving four chemotherapy drugs at once to people with advanced Hodgkin lymphoma. The regimen was MOPP. In the book's telling, it changed advanced Hodgkin lymphoma from a disease with little hope into one that could often be cured.

He went on to direct NCI's Division of Cancer Treatment. He then ran the institute itself from 1980 to 1988. After that he led Memorial Sloan Kettering, and later Yale's cancer centre. He also edited the standard oncology textbook for decades.

The Death of Cancer was written with his daughter Elizabeth DeVita-Raeburn. It is a memoir from that vantage point, and an argument made from it. The argument is that cancer is more curable now than medical practice reflects. The blocks, he says, are institutional: cautious oncologists, cautious regulators, cautious hospitals.

It is not a patient guide, and it does not pretend to be. It is a career told by someone who was in the room. It is also a case for the prosecution.

The book runs to about 324 pages in the Sarah Crichton Books edition, with notes.

The early chapters are the strongest as history. DeVita describes arriving at NCI and the culture of the place. He also lays out the thinking behind combination chemotherapy. Single agents produced remissions that never lasted. Drugs that worked in different ways, and whose harms did not overlap, might do better. He describes the pushback from senior colleagues. They thought giving four toxic drugs together was close to reckless.

The middle section covers his decades as an administrator. It takes in the National Cancer Act, and what the phrase war on cancer did and did not mean. It covers the building of the NCI-designated cancer centre network and the PDQ information system. It also covers the inside politics of a large federal institute as AIDS arrived.

Later chapters turn to argument. He writes about single patients, some of them friends and family. In each case he believes better or bolder treatment choices were there and were not taken. He is hard on the FDA's approach to approvals and on institutional review boards. He is also hard on oncologists who follow guidelines rather than reason from how a drug works.

The closing pages set out what he thinks should change. Faster access to drug combinations. More room for experienced clinicians to judge. And a research system less tied to small-step grant work.

As a first-hand record of how curative chemotherapy happened, it is hard to better. The thinking behind MOPP is laid out plainly. A non-specialist can follow why combining drugs was the key idea, rather than finding a better single drug.

It is also honest about the human cost of getting there. Early trials involved people who died of the treatment. DeVita does not hide this, and he does not soften it. That candour is worth more than a smoother story would be.

The institutional detail is valuable too. Very few books explain what an NCI director does. Or how budget lines shape which science happens. Or why the cancer centre network has the shape it does.

And the central factual claim holds. NCI's own summary states that up to 90% of newly diagnosed patients with Hodgkin lymphoma can be cured with combination chemotherapy and/or radiation therapy. That is the win the book describes. It is real.

One more quality is worth naming. The book is readable. Oncology memoirs often sink into either sentiment or jargon, and this one mostly avoids both. DeVita-Raeburn's hand as co-author is probably why the institutional chapters move at all.

The argument is more contested than the history. DeVita's position is that available knowledge is underused and that caution costs lives. The other side says the same history shows why confirming trials exist. The field is full of treatments that looked convincing to experienced doctors and did not survive testing. The book gives that reply less room than it deserves.

The single patient stories are also, of course, told from one side. They stand as proof that a different decision would have led to a different outcome. A single case cannot settle that either way.

Treatment specifics have moved on since 2015. Three things have changed practice: therapy adapted to PET imaging, brentuximab vedotin, and checkpoint inhibitors for relapsed Hodgkin lymphoma. The book should not be read as an account of what is offered now.

One point matters most for a patient or survivor. The book celebrates cure. It gives less weight to what cure costs over decades. That is the gap worth filling in.

NCI's health professional summary is the place to see both halves at once.

On cure: NCI says up to 90% of newly diagnosed patients can be cured. Your own outlook depends on your stage and treatment, so ask your care team.

On regimens: ABVD is now the standard first-line regimen. ABVD means doxorubicin, bleomycin, vinblastine and dacarbazine. Part of the reason is late effects, not first response. NCI puts the risk of acute leukemia at 10 years after ABVD at less than 1%. After MOPP-based therapy it is roughly 3%. NCI also notes that ABVD appears to spare long-term testicular and ovarian function better than the other options. So the regimen DeVita helped create was replaced, partly because of what it did to survivors twenty years later.

On second cancers: NCI reports that the total risk of solid tumors rises over time. NCI gives 13% at 15 years, 17% at 20 years, 22% at 25 years and approximately 48% at 40 years after treatment. NCI reports that with 30 to 40 years of follow-up, cumulative absolute risks of breast cancer in women treated young range from 8.5% to 39.6%, depending on age at diagnosis. Lung cancer happens more often as well, including after chemotherapy alone.

Those figures are not evenly distributed. They depend a lot on whether radiation was given, how large the field was, the age at treatment, and smoking history. So a survivor's own risk is a question for someone holding their treatment record. It is not a number read off a page.

On the heart: mediastinal radiation plus doxorubicin carries an excess absolute risk of fatal cardiovascular disease of 11.9 to 48.9 per 10,000 patient-years. That added risk lasts more than 30 years after treatment.

None of that argues against treatment. The book's account is that before combination chemotherapy there was little hope in advanced disease. But it does mean a cure in 1975 is a medical tie that continues in 2026. For the regimen itself, see what is ABVD chemotherapy. For the wider picture, see late effects of cancer treatment.

The follow-up picture is less intuitive than people expect.

For patients with negative PET-CT findings after treatment, NCI states that routine scans are not advised because the risk of recurrence is low. If you have new symptoms, call your care team right away. Where higher-risk patients are being followed, NCI prefers conventional CT over serial PET scanning.

So the real work of follow-up is about late effects, not about hunting for the first cancer. NCI's survivorship guidance describes follow-up care as regular check-ups. Those may include bloodwork and other tests. They look for changes in health that show up months or years after treatment ends.

NCI also advises that survivors get a written follow-up care plan. It sums up the treatment they had and the follow-up advised. NCI says to keep it at hand and share it with every doctor they see. Care can go on with the first oncologist, with a survivorship provider, or with a primary care doctor. NCI stresses that notes should be shared between them.

That written record is the practical bridge between a book like this and a life lived after treatment. The drugs, the doses and the radiation fields set what needs watching for the next forty years. Nobody can watch for it without knowing what they were. DeVita's cures came from combining drugs that were each too toxic on their own. The book is honest about what that cost the early patients.

For what that document contains, see what is a survivorship care plan.

The book uses the war language without embarrassment. It is worth being clear about what that image helps with and where it fails.

It helps with funding. The National Cancer Act of 1971 created an institute with unusual control of its own budget. DeVita's chapters show how that freedom was used. NCI still describes research project grants as the largest part of its budget. The rest goes to cancer centres, training awards, clinical trials networks, and an intramural programme of roughly 18% of spending.

It fails as a description of the disease. Cancer is not one foe with one weak spot. The Hodgkin lymphoma story really is a story of a fight won. But it did not carry over. The same thinking applied to pancreatic cancer did not give the same result. A reader who takes the image at face value will find the book's hope more convincing than the evidence allows.

It also loads something onto patients. Wars that can be won imply losers. People with advanced disease did not lose a battle by trying too little. The book is not cruel about this, but the framing is there.

It suits readers who want to know how a cancer became curable, told by someone who did it. It suits people curious about how federal science is run and paid for. It suits anyone who enjoys a strong argument they can disagree with.

It suits Hodgkin lymphoma survivors as history. One caveat: the late-effects picture is not fully drawn in it.

It is a reasonable book for a caregiver who wants context rather than instructions, and a poor one for a caregiver who wants to know what tomorrow looks like.

It does not suit a newly diagnosed reader looking for what happens next. The treatment detail is a decade old. It does not suit anyone who wants a neutral account of the debate about regulation and approvals. The book is a player in that debate, not a referee of it.

• Open Library — The Death of Cancer (ISBN 9780374135607)
• Internet Archive — The Death of Cancer, catalogue metadata
• NCI — Adult Hodgkin Lymphoma Treatment (PDQ), Health Professional Version
• NCI — Budget and Appropriations
• NCI — Follow-Up Medical Care

This page discusses a book for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.