PBS filmmaker: ‘We’re at a threshold moment’

‘Emperor of All Maladies’ director, Hutch researchers and a cancer survivor preview the upcoming cancer documentary
Dr. Fred Appelbaum, director Barak Goodman and Dr. Phil Greenberg at Seattle Town Hall panel discussion about PBS cancer documentary, "The Emperor of All Maladies."
From left: Dr. Fred Appelbaum, PBS filmmaker Barak Goodman and Dr. Phil Greenberg discuss the documentary "Cancer: The Emperor of All Maladies" last night at Seattle Town Hall. Photo by Robert Hood / Fred Hutch News Service

Two and a half years ago, filmmaker Barak Goodman got a call from one of his most famous peers: Ken Burns. The Academy Award-winning director and producer of such documentaries as “The Civil War” and “The Roosevelts” told Goodman about an “amazing project”: a chance to make a film out of the Pulitzer Prize winning book “The Emperor of All Maladies: A Biography of Cancer” by Dr. Siddhartha Mukherjee. The project was deeply personal for Burns — his mother died of cancer when he was 11 years old — but he had no time to do it. Would Goodman be interested?

The answer — once Goodman confirmed that it really was Burns on the line and not a colleague playing a joke — was a resounding yes.  His six-hour film will air over three nights beginning March 30 at 9 p.m. on PBS stations nationwide.

“We had two principal goals in making the film,” Goodman told a crowd of about 700 people Tuesday night at a Seattle Town Hall panel and screening presented by KCTS 9. “One was to translate this sometimes complex science for the general public. The second goal was that we could sit in a room with cancer experts and not be embarrassed.”

Goodman, who shared the panel with two well-known researchers from Fred Hutchinson Cancer Research Center and a breast cancer survivor, got his wish on both counts.

Like the book, the film follows developments in cancer research from the mid-1940s to the present, interspersed with personal stories of cancer patients. While it does not sugarcoat cancer’s human impact — an estimated 1.6 million people in the United States will be diagnosed with cancer this year and almost 600,000 will die of the disease — Goodman said that his overwhelming impression after making the film was one of optimism.

“I was amazed by the unanimity of opinion, how optimistic world-class researchers seemed to be,” he said, citing enormous gains in understanding the biology of cancer just in the last 10 years. He pointed out that some of the most promising developments in immunotherapy, many of them developed at Fred Hutch and its partners in Seattle Cancer Care Alliance, are not even included in the book, which was published in 2010 and completed before that.

“We’re at a threshold moment,” he said. “I don’t think many in the general public know that.”

Two revolutions

Dr. Fred Appelbaum, Fred Hutch executive vice president and deputy director and an expert in blood cancers and stem cell transplants, agreed, pointing out that although the actual number of cancer deaths in the U.S. has grown as the population itself grows and ages, the death rate from cancer has dropped by 20 percent in the last 20 years.

Part of that decline comes from a better understanding of how lifestyle choices can cause cancer, he said, leading to big drops in smoking and in the use of combined hormone-replacement therapy to combat hot flashes and other symptoms of menopause. The latter came about after a landmark study by the Fred Hutch-based Women’s Health Initiative found that HRT significantly raised a woman’s chances of developing cardiovascular disease, stroke and breast cancer.

Now two new revolutions are reshaping cancer treatment, Appelbaum said. The first is a better understanding of the genetic underpinnings of cancer — of what goes wrong in a cancer cell. The second is developing therapies to target those mutations.

“At heart, cancer is a disease caused by mutations in DNA — the information that tells a cell what to do,” he said. “We are now at the point where we can find those mutations that can pinpoint what’s going wrong in a cell.”

Some mutations, for example, allow a cell to reproduce but not function.

“Think of a teenager,” said Appelbaum, to laughter from the audience.

Dr. Phil Greenberg, an expert in discovering how disease-fighting immune cells known as T cells can be manipulated to treat a range of cancers, noted that both he and Appelbaum grew up and underwent medical training as new chemotherapy drugs were transforming treatment of what once were considered incurable cancers. It was exhilarating to see patients survive, he said, but terrifying to witness the toxicity of the treatment.

“We saw an opportunity,” he said. “We can do better.”

Trained as an immunologist, Greenberg works on ways to manipulate the immune system to recognize and attack tumors the same way it kills viruses and bacteria. The portion of the documentary screened Tuesday night included a poignant segment on treating childhood leukemia with a genetically engineered immune response.

“That’s the tip of the iceberg right now,” he said. “Our lab is heavily invested in targeting pancreatic cancer, ovarian cancer and lung cancer. There’s no question this can be done. Cancer treatment is going to be very different in the next decade and the decade after that than it has been in the past.”

Bridging the gap

The future may look bright but the present can still feel murky for cancer patients and survivors such as panelist Wendy Weeks. A 17-year Boeing employee, Weeks was diagnosed with stage 3B lobular breast cancer in 2010 and underwent a single-side mastectomy, chemotherapy and radiation. She will continue to take cancer-prevention drugs until 2020.

Having a patient on the panel underscored what’s at stake in the same way that Goodman’s documentary is both deeply researched and very human. Weeks said that months elapsed before her doctor or a mammogram could detect the lump she felt. When it was finally removed and she received the diagnosis — including her doctor’s recommendation that both breasts be removed — she was shocked.

“I went straight to Ray’s Boathouse to the bar and had a martini,” she said, referring to the iconic Seattle seafood restaurant.

After talking with her radiologist and others, she decided instead on a single-side mastectomy.

“It was a hard decision and I had to do it quickly,” she said.

In the interviews he did for the film, Goodman saw time and again how patients grappled with tough choices and sometimes conflicting medical advice.

“For all the progress we’re making, it’s a difficult time for patients,” he said. “We’re in a bit of a gap moment between what’s coming and what is.”

To help bridge that gap, Goodman called for more federal funding for cancer research. So did researchers in the documentary and on the Seattle panel.

“This is the moment when we need federal funding more than any other because the data is just pouring out,” he said. “We can make more progress in the next generation than we have in hundreds of years.”

If Goodman has a third goal for his film, it is to overcome what he called “cancer fatigue” and convince funders that the progress being made is worth the investment.

“Speak out,” he told an 18-year leukemia survivor from the audience who asked what could be done to spur more support. “You’re a cancer survivor. You’re living proof of the remarkable progress we’ve made.” 

Solid tumors, such as those of the breast, lung and pancreas, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.

Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.

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