Even if the new liver staved off organ failure, the immunosuppressants necessary to avoid organ rejection "can reduce the body's ability to fight off any cancer cells that remain," Saltz says. And factoring the many other variables of real life, it's ultimately not possible to conclude whether the liver transplant "made him live longer, the same or shorter—we don't know," Saltz remarks.
Keys for a cure
Steinman, however, is a much different case. With his collection of therapies, he did manage to beat the average odds for his type of pancreatic cancer—by years. But "which thing made the difference, we will still never know," Schlesinger says. "My personal belief is it is a combination of therapies." Steinman, for his part, "had so much faith in dendritic cells," Schlesinger says. "He believed that his dendritic cells played an important part." She notes that even though they did apply and get special, individual treatment protocols for Steinman to receive each of the experimental therapies, she never doubted what they were doing; "I only felt inadequate," she says, having a background in dendritic cells and HIV rather than cancer research.
To truly be able to hack into the inner-workings of pancreatic cancer, "there needs to be more basic science work in humans," Schlesinger says. Saltz points to the current efforts to better grasp the molecular and genetic differences of each tumor, in hopes of finding patterns in growth rate and treatment response, which might turn into better therapeutic targets. But much of what determines why one patient might live for seven years and another for seven months seems to depend on the biology of these cancers. Which, Saltz says, "is a nice elegant way of saying that we truly don't understand."