The Secret History of Cancer Chemotherapy

“In wartime, truth is so precious that she should always be attended by a bodyguard of lies.” —Winston Churchill, 1943

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“The summons came in the middle of the night. He was awake at the first harsh jangle of the telephone…. Always a light sleeper, Lieutenant Colonel Stewart Francis Alexander attributed the trait to his father, an old-fashioned family practitioner whose response to every late-night distress call was to reach automatically for his medical bag. A doctor’s son through and through, he was ready to go in under ten minutes.” So begins The Great Secret: The Classified World War II Disaster That Launched the War on Cancer by bestselling author Jennet Conant, a riveting tale of war, conspiracy, and medical mystery.

Deadly Secret Cargo

The alkylating agents were the first nonhormonal drugs to be used effectively in the treatment of cancer. Although highly toxic, these agents are still in use today and are effective in several different oncologic settings. There are five categories of alkylating agents, the most prominent being the nitrogen mustards. Although thousands of nitrogen mustards have been synthesized and tested, only five are commonly used in cancer therapy today: mechlorethamine, cyclophosphamide, ifosfamide, melphalan, and chlorambucil.


Title: The Great Secret: The Classified World War II Disaster That Launched the War on Cancer

Authors: Jennet Conant

Publisher: W.W. Norton & Company

Publication Date: September 2020

Price: $28.95, hardcover, 400 pages

The story of these agents and their part in the battle against cancer is the underpinning of Ms. Conant’s book. Chemical warfare was first waged by the Germans in World War I, when mustard gas was used and inflicted damage on the skin, eyes, and lungs. During World War II, the Allies had their own stockpiles of mustard gas, which was actually banned by the Geneva convention and could only be used in retaliation of a first strike.

As the war heated up, the supplies of mustard gas were shipped to Europe, in case Germany deployed the gas on Allied troops. The plan went terribly wrong on December 2, 1943, when German planes bombed the Allied port of Bari, Italy, hitting several American ships and releasing their secret cargo into the bay: 2,000 bombs filled with mustard gas. Desperate sailors jumped from the burning ships into the water, which was covered with yellowish sludge from the released mustard gas.

Many died, but survivors had burns, blisters, and internal injuries, as the author noted in graphic detail: “The sailors were rousing from their hospital beds yelling about the intense heat, tearing off their gowns, desperately ripping off dressing and bandages…. They had developed terrible blisters over their bodies as big as balloons and heavy with viscous fluid, this together with violent nausea and vomiting.”

A Hypothesis Is Born

The Navy’s high command brought in a renowned military doctor, Stewart Alexander, to perform medical forensics on the bizarre circumstances in strict security, as the officials in charge refused to release the cause, which was highly classified. While battling to save lives, Dr. Stewart’s work unearthed an intriguing effect: the nitrogen mustard attacked and killed white blood cells, primarily lymphocytes, which opened the possibility that the power of this highly toxic agent could be harnessed to target cancer cells in the bone marrow. The military brass did its best to muzzle Dr. Stewart and have the records sealed, but he was able to leak his findings before he retired from the military and went into private practice. Thus, the age of chemotherapy was born.

Ms. Conant has deep ties to science, coverups, and war, as her grandfather, James B. Conant, was a scientist who did important defense research and was a leading figure in pushing forward the Manhattan Project. It is worth noting that she wrote an award-winning biography of her grandfather, who, as a younger Army scientist during World War I, actually worked on the poison gas that is at the heart of this book.

A Well-Written Narrative

The first sections of The Great Secret, which is organized into 12 chapters, delve into the conspiracy among American and British military and political figures who were steadfast in keeping secret the deadly debacle of the chemical weapons, the toll it took on unwitting sailors, and the coverup of Dr. Stewart’s remarkable findings.

This is a solid, well-written narrative. Despite a few needless digressions and some medical lingo, which go a bit too deeply at times to garner a hybrid audience of medical and lay readers, this book moves along at a pleasant, readable clip. The book’s interest for readers of The ASCO Post will accelerate when Ms. Conant leaves the war behind for medical research based on the findings of the Bari bombing that led to a new generation of cancer drugs.

A Fascinating History

The account is replete with well-known luminaries in the oncology field. However, perhaps the most compelling character is Cornelius P. Rhoads, MD, a famous American oncologist. During World War II, Dr. Rhoads was commissioned as a Colonel and assigned as Chief of Medicine in the Chemical Weapons Division of the U.S. Army.

In 1940, Dr. Rhoads served as Director of Memorial Hospital for Cancer Research and in 1945 as the first Director of the new Memorial Sloan Kettering Cancer Center. This is where, “Dr. Rhoads gained national fame as the leader of the war on cancer…. He traveled the country giving standing-room-only lectures and beating the drum for research and more research, both basic and clinical.”

The serendipitous disaster in Bari gives the narrative a gritty underpinning, but the stories around the pioneering oncologists that form the bedrock of the book’s later chapters are the real champions of this book. The Great Secret is highly recommended for readers of The ASCO Post.