The stakes are high. The breast cancer patients in Emens' trials are the "almost dead," as one puts it. And the odds are against this new therapy they have pinned their hopes on. Most experimental drugs never make it to market.
Yet this is how new medicines are developed. And at the heart of each trial is an extraordinary bargain between researcher and patient.
For joining Emens' study, for submitting to the pain of many injections, the sometimes-daily blood tests and the terrifying uncertainty of it all, women receive one more chance to extend their lives. Want to be around to see your kids and grandkids grow up? Try this vaccine. Maybe it will hold off your cancer.
No promises
Emens is careful not to promise anyone a cure. She knows this disease too well. When she was a teenager, her mother died of it. For Emens, the payoff from this study won't be measured in the number of women who live longer than most with metastatic breast cancer - on average, one to two years. It will be measured in the lab, in blood tests that detect a specific immune system response to the vaccine. Even if that response is insufficient to prolong life, it gives Emens something to build on in future research.
Future versus present, the long arc of scientific progress versus the shrinking life span of a woman with aggressive cancer. Emens and her patients have been brought together by hope, but there they part company.
They've been on different paths and will end this journey in different places.
For the past six months, the doctor and several of her patients have offered a rare and intimate look inside a clinical trial. At times, the women are optimistic; at others, despondent. They face their fears and draw on their faith. Some manage to find one another despite procedures designed to discourage that, sharing information that can comfort and sometimes hurt.
All the while, Emens and her vaccine inspire and frustrate them. They have questions she can't or won't answer. Some mice were cured when they were injected with the same substance, but there is no way to know whether it will work in humans.
The consent form the women sign to join the trial tells them explicitly: "It is unlikely that you will be cured of your cancer if you join this study." What they hear is: "This is your chance to be the rare one who survives terminal breast cancer."
