Stuff You Missed in History Class
Hosted by Tracy V. Wilson
Written by a model from the transcript; not yet reviewed.
This episode explores the history of early cancer immunotherapy, focusing on the late 19th-century work of surgeon William B. Coley. Shocked by the rapid death of an 18-year-old patient named Bessie Dashiel from sarcoma, Coley researched hospital records and medical literature to investigate cases where malignant tumors shrank after patients contracted severe bacterial infections like erysipelas. He began experimenting with live bacterial cultures and later heat-killed bacterial toxins, known as Coley's toxins, to stimulate patients' immune systems and fight inoperable cancers. Despite mixed results, professional skepticism, and competition from emerging radiation therapy, Coley treated roughly 1,000 patients over 40 years. The episode traces how his work was later revived and re-evaluated, laying foundational groundwork for modern cancer immunology.
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Hosts Tracy and Holly welcome listeners and set the stage for the episode’s focus on immunotherapy history.
The hosts explain how William B. Coley pioneered the use of bacterial infections to treat cancer in the late 19th century.
Coley’s experience with a young patient’s tragic death spurs his search for more effective cancer treatments.
Coley refines bacterial toxins, conducts trials, and observes tumor regression in several patients.
The episode discusses opposition from the medical community, AMA articles, and the FDA’s classification of Coley’s toxins.
Coley’s later years, the establishment of the Cancer Research Institute, and the connection to modern immunotherapy are explored.
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Niall Rogers introduces a new podcast series about musicians' pivotal moments.
Unintended Start of Immunotherapyinsight
The hosts discuss how modern news coverage of melanoma vaccine clinical trials prompted a look into the history of immunotherapy, which traces back to early nineteenth-century observations of tumors shrinking after bacterial skin infections.
Early German Infection Experimentsstory
German doctors Friedrich Felison and Wilhelm Bush investigated whether tumor shrinkage after erysipelas infections was a coincidence, with Bush intentionally infecting a cancer patient using contaminated bed sheets in 1868.
Switching to Bacterial Toxinsstrategy
After two early patients died from live bacterial infections, Coley collaborated with bacteriologists in late 1892 to culture the bacteria, kill them with heat, and filter out the toxins to reduce patient risk.
Coley published data showing that in a little over 10 percent of his cases, the degenerative process caused complete absorption of tumors, while other cases showed only temporary improvement.
Journal Opposition and Debatedebate
The Journal of the American Medical Association published conflicting reports, shifting from cautious curiosity in October 1894 to declaring the erysipelas toxins a complete failure by December, sparking a sharp rebuttal from Coley.
Over a span of about 40 years, William Coley treated approximately 1,000 cancer patients and published roughly 150 papers detailing his work with mixed bacterial toxins.
The BCG Connectioninsight
Researchers like Lloyd J. Old later connected Coley's work to the use of BCG, a tuberculosis vaccine, which stimulated immune responses and led to FDA approval for treating superficial bladder cancer in 1990.
“The practice of variolation dates back hundreds of years at least, and it is something that we have talked about in our episodes on Edward Jenner and the eradication of smallpox.”
“In 1892, as his experiments with erysipolis were ongoing, William Coley was appointed to the staff of New York Cancer Hospital, which was the first cancer hospital in the United States.”
“The results were, quote, 'nothing short of marvelous.'”
“Coley's work was also unsurprisingly controversial. To some, the idea of intentionally exposing patients to a bacterial infection or injecting them with toxins seemed antithetical to the practice of medicine.”
“The toxins were effective at inducing fever and robust surges in cytokines. One patient with metastatic bladder cancer had a clear clinical response to treatment, experiencing a 50% reduction in his cancer that correlated with elevated levels of cytokines.”
William B. Coley started using a bacterial infection to treat cancers in the late 19th century, one of the earliest uses of immunotherapy.
9,683 words · 7 speakers
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