Spontaneous Remission of Cancer – Enigma and Paradigm Herbert

Accessible online at: www.karger.com/onk Fax +49 761 4 52 07 14 E-mail [email protected] www.karger.com tumour. We do not know the particulars which make this difference in outcome, but there is no doubt that the pathohistological constitution of the tumours plays a decisive role... But I don’t want to be misunderstood that – because of occasional observations of cancer remissions in spite of incomplete resection – I would discredit surgery as early and radical as possible, which hitherto alone made us advance’ (translation by H. K.) . In 2006 Czerny’s words are still valid and SR remains a scientifically exciting phenomenon. But surprisingly up to now only two major conferences have dealt with SR as a main topic: In 1974 a conference held at the Johns Hopkins University at Baltimore/USA [2] and in 1997 an international symposium held at the German Centre for Cancer Research (DKFZ) at Heidelberg/Germany [3]. Many scientists are still reluctant to focus their attention on SR. They may fear to jeopardize their academic reputation when dealing with a topic which is often found in catching stories of the yellow press and pamphlets propagating unconventional cancer therapies. In fact, cases of SR are considered to be ‘a vital factor in perpetuating many quackery treatmens, whether by ”faith healing”, machines, holistic nutrition or placebo drugs’ [4]. But science learns from reflection on anomalies which help to change paradigms. Historical observations of spontaneous remissions of breast cancer after the onset of menopause lead to approaches of hormonal treatment which nowadays are a mainstay of adjuvant and palliative therapy in breast cancer. Moreover, modern oncological immunotherapy was stimulated by a case of spontaneous remission in a patient with metastatic gastric cancer who survived bacterial peritonitis after resection of the primary and just biopsy of hepatic metastasis [5]. The perception of cancer as a monoclonal uncontrolled proliferation of cells implicitly adhered to a model of a snowball Spontaneous remission of cancer (SR) is defined as a complete or partial, temporary or permanent disappearance of all or at least some relevant parameters of a soundly diagnosed malignant disease in the absence of medical treatment or with a therapy that does not adequately explain the resulting regression. It is a rare but valid phenomenon which has been observed throughout history of medicine. It represents an instructive in-vivo model of biological tumour control and, remaining enigmatical in most cases, it nevertheless has contributed to paradigmatic shifts in oncology. Exactly one hundred years ago at the first International Conference on Cancer Research, held in Germany at Heidelberg and Frankfurt, one of the pioneers of modern oncology and founding father of the German Cancer Society Vincenz Czerny gave a still very remarkable key note lecture ‘On unexpected recoveries from cancer’[1]. ‘...I would like to share some observations which show that even in malignant tumours unexpected recoveries do exist and they caution us to ascribe clinical improvement or recovery in such a case exclusively to the used remedy. In animal studies it may be held for ascertained that some, namely smaller tumours are capable of spontaneous regression. [...] In humans off and on cases have been observed in which an apparent worst prognosis proved to be wrong in the further course of disease. Usually a wrong diagnosis was assumed and as one doesn’t decide with pleasure to this confession, those observations have been either withheld or told bashfully with a question mark.’ And cancer surgeon Czerny finished his lecture: ‘In recapitulating we see that without any doubt malignant tumours are capable of regression. Very rarely this happens without a surgical intervention. Sometimes a surgical intervention may accelerate tumour growth due to incomplete destruction of the tumour tissue and thus harm the patient. In other cases with incomplete cancer resection the human organism is enabled to neutralize or even to destroy the residual Spontaneous Remission of Cancer – Enigma and Paradigm