Local teenage cancer survivor meets Pulitzer Prize-winning author

As part of the celebration at the SECU Center Center grand opening on Oct. 27, area resident and cancer survivor Brendan Smith was able to meet with Pulitzer Prize-winning author, Dr. Siddhartha Mukherjee for a short time. Dr. Mukherjee was in Asheville as one of the guest speakers at the grand opening. Brendan, 15, had written a letter to Dr. Mukherjee regarding his book, “The Emperor of All Maladies” and spent some time asking some questions about cancer and ongoing research Thursday morning.

Brendan said after the meeting, “I would never have expected to meet him, but he’s one of smartest people I’ve ever met.”

Here’s Brendan’s original letter to Dr. Mukherjee:

February, 20, 2011

Dear, Dr. Mukherjee,

My name is Brendan Smith and I am writing to you because I am very interested in your research. I am a 9th grader at the Asheville School in North Carolina. I received "The Emperor of All Maladies" for Christmas and when I opened it I had heard nothing about your book and I was tempted to throw it over my shoulder into the dreaded sock and sweater pile that had accumulated as I open my presents. But after my mom explained what the book was about I felt compelled to read it.

When I was fourteen months old, I was diagnosed with cancer. I can only imagine the look of shock and disbelief and fear on my parents’ faces when my family’s general practitioner, Dr. Jeff Tait, diagnosed me with a 1.2 pound stage two Wilm’s tumor isolated in my left kidney. Soon after I was diagnosed, I had surgery to remove the kidney and tumor and then the next four and a half months were spent undergoing chemotherapy. Luckily, I cannot remember any of this because I was too young.

My own experience with cancer makes me wonder: If cancer is caused by the activation of a gene that causes the cell to skip checkpoints in cell division, as you have described it in "The Emperor Of All Maladies," and this activation is often caused by exposure to harmful environmental factors, then why is it that a healthy fourteen month old baby’s kidney cells would suddenly mutate and become cancerous?

When I was an infant, I don’t think I was exposed to toxins in the soil, or long term unnoticeable radiation working in a nuclear power plant. It just doesn’t make sense to me. What caused my cells to become cancerous while those of my older sister, who lived in the same home and shared my environment, remained normal?

I have always been interested in the cure for cancer. I agree with you that it won’t just be “the cure” but many cures since different forms of cancer must be treated differently. I listened to your NPR interview on the “Fresh Air” program and in it you talked about the drug Gleevec. You compared it to the “four minute mile,” a time long thought to be a threshold for running that humans could not break through, because no drug had ever been able to target and turn off the proteins that cause the cancer to grow and multiply.

Besides Gleevec, what new developments in cancer research make you really excited? How have these affected your own research? If many of the new advancements in cancer treatment are drugs, in what ways do they target cancer?

Chemotherapy and radiation are overwhelmingly toxic and need multiple exposures to do their job. My mom tells me she got really good at cleaning up throw-up when I was having chemotherapy. I’m interested in knowing whether or not you think that in the near future we will develop new drugs which get rid of remaining cancer cells in the body without causing harm to healthy cells. Do you think that this is a reasonable goal for cancer research?

When I was diagnosed, because my tumor had not spread outside the wall of the kidney and Wilms tumors respond well to chemotherapy, I was given a 96% chance of survival. Those are pretty good odds! In fact, my pediatric oncologist, Dr. Orren Beaty, told my parents I had “the best of the worst.”

In the book you talk about Carla and how you had to instill confidence in her because she only had a 30% chance of surviving. She survived. Do you believe patients with confidence going into treatment have a greater chance of overcoming this disease? What are the three most important things your patients have taught you about living with this disease that you had never thought about?

Not everybody survives cancer. Have you ever treated a patient for a long time and become attached to the patient and then lost them? Is it hard for doctors to get over situations like this?

At the very beginning of the book you talk about a colleague, freshly out of his fellowship and how he told you to have life outside the hospital or else you will drown. But then you said that it was impossible not to become attached to your patients because you constantly were thinking of them and the unanswerable questions of cancer like, “Is there an end?” What do you do in your personal life to keep a balance between work and your personal life?

With the amount of money currently being spent on cancer research, is it reasonable to cure all forms of cancer at once or would you recommend targeting resources towards specific forms of cancer? Should we focus on the forms of cancer most common in our society, notably breast cancer, lung cancer, prostate cancer, and leukemia. Out of these forms of cancer, which do you believe will we be able to cure first?