A band of “Cancer Cowboys” once known as the ALGB—Acute Leukemia Group B—are, in large part, responsible for flipping the mortality rate of childhood leukemia from 90% to 10%, where it stands today.
“The Cancer Cowboys arguably better utilized many of the newer meds becoming available—6-MP, methotrexate, daunomycin, Cytoxan,” Tim Wendel, member of the Cancer History Project editorial board, lecturer at Johns Hopkins University, and author of “Cancer Crossings: A Brother, His Doctors, and the Quest for a Cure to Childhood Leukemia,” said to The Cancer Letter. “Most of the old guard…were giving them to the patients one at a time. What the ALGB group did was, ‘Screw this. We don’t have time. We’re going to do it in combination two, three, even four at a time.’”
While researching his book from 2013 to 2017, Wendel spoke with the doctors of ALGB, among them longtime St. Jude Children’s Research Hospital CEO Donald Pinkel, who died March 9, Jerry Yates, Lucius Sinks, James and Jimmie Holland, Emil “Tom” Frei, and Emil J Freireich. Wendel’s brother Eric was treated at Roswell Park Comprehensive Cancer Center beginning when he was diagnosed in 1966, until he died in 1973.
Obituaries written by Wendel and Donald Pinkel’s daughter Mary Pinkel appear here and here. Obituaries by Roswell Park Comprehensive Cancer Center and St. Jude Children’s Research Hospital appear on the Cancer History Project.
The ALGB’s approach was not a part of the status quo in the medical community.
“It had to be a conversation with Pinkel, or maybe it was Jerry Yates. They kept saying, ‘Yeah, everybody was against us,’” Wendel said. “It’s got to be doubly difficult to take on a shapeshifter of a disease like cancer and then have no support for extended periods of time from many of your peers or those in your professional community.”
The ALGB would ask questions like “What happens when you put methotrexate with daunomycin?” and answer them with: “I don’t know, but this kid’s dying. Let’s find out.”
“That was where they got really criticized. But, frankly, that leap of faith is also what helped turn the table against childhood cancer,” he said. “These doctors were the ones who dared to take it on. In doing so, they came up with many of the things that we just so much take for granted today when it comes to cancer research and cancer care.”
In speaking with these doctors, Wendel was wowed by Pinkel’s bedside manner—even over the phone.
“His bedside manner and just his empathy was just off the charts. I’ll tell you at first, it was a bit alarming. It was like, ‘Hang on a minute, I’m doing the interview here,’” Wendel said. At times, it led to more understanding on my part. Pinkel was the one who asked me, ‘“How old were you when your brother died?’”
In one conversation with Pinkel, Wendel mentioned that his brother technically died of the chickenpox rather than ALL.
“When Pinkel heard this, he asked for my mailing address. A few days later, a letter from him arrived in the mail. In the envelope was a copy of a clinical trial about the impact chickenpox can have upon kids with cancer. It was written in the early 1960s and Pinkel was the lead author,” Wendel said in a separate interview.
On the other hand, James Holland was a bit “more gruff,” Wendel said. So when Wendel heard a rumor that Holland could recite a favorite poem by heart, Wendel took a risk and asked about it.
“Off the top of his head, he recited this poem I had never heard. He had this beautiful voice, such a baritone voice. This kind of voice that just commands attention, turns heads,” Wendel said. “Now he’s turning the tables on me. He says, ‘And of course you heard that poem.’”
Holland had recited four lines of Elegy Written in a Country Churchyard by Thomas Gray, published in 1751:
Full many a gem of purest ray serene
The dark unfathom’d caves of ocean bear:
Full many a flower is born to blush unseen,
And waste its sweetness on the desert air.
Holland then said: “I love the cadence of that, how it rolls off the tongue. I learned it when I was young and I’ve never forgotten it. To me, it’s about believing good work can be done, how good work can be accomplished if you’re willing to push on.”
“That’s him,” Wendel said. “This is what Holland recited off the top of his head, just blew me away.”
Wendel met with Lucius Sinks several times at a restaurant called the Boar’s Head in Charlottesville. Sinks succeeded Pinkel as the director of pediatrics at Roswell Park when Pinkel left in 1962, and Wendel’s brother Eric was one of his patients.
“Our first few lunches were disasters,” Wendel said. “You could just see him looking at me, thinking, ‘This guy doesn’t know anything. Why is he trying to do this project?’”
One day, Sinks showed up with a white canvas bag full of books about cancer, including 2,000 pages written by Holland and Frei.
“I’ll never forget him saying, ‘You’re starting to ask the right questions. These will help,’” Wendel said. “He had gone through and actually put stickies on—especially that 2,000-page thing, I never would’ve gotten through that.”
“These were key concepts that would help me understand the disease, also what these guys were trying to do,” Wendel said. “I still remember getting in the car to drive back up to Northern Virginia and going, ‘OK. I think we’ve turned the corner here a little bit.’”
An account of the formation of the ALGB appears here in Gordon Zubrod’s “Stairway of Surprise.” A paper titled “A Concise History of the Cancer and Leukemia Group B” appears here.
Wendel spoke with Alexandria Carolan, a reporter with The Cancer Letter and editorial associate with the Cancer History Project. This transcript has been edited for brevity and clarity. A podcast featuring Wendel appears here.
