Game-changing? When Biomarker Discovery and Novel Forms of Patient Work Meet

ABSTRACT

I analyze the promised efficacy of Pembrolizumab, an immunotherapy regime under clinical trial for patients with metastatic colorectal cancer. Drawing on anthropological fieldwork with patients and health professionals in a gastrointestinal cancer clinic in London, UK, I tease out the dynamics through which scientists and clinicians assemble personalized technologies to halt cancer growth in patients’ bodies; what patients undergo in order to participate in these innovations; and the constraints that restrict the efficacy of these treatments. Beyond examining the treatment possibilities that clinical trials offer, I illuminate some of the gaps made visible when personalization happens from below.

KEYWORDS:

• United Kingdom
• biomarker
• bowel cancer
• efficacy
• immunotherapy
• personalization

Acknowledgments

I would like to thank Ali, John, Jimmy and Ruth for letting me be part of their lives amidst difficult circumstances. Thanks to the clinical team for allowing me to join their group, follow their routines, and ask multiple questions for over a year. Earlier drafts of this article benefited from insightful feedback from Sophie Day, Sahra Gibbon, Anne Lanceley, and Carsten Timmermann. Special thanks to three anonymous reviewers of Medical Anthropology for their constructive comments.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. “First-line therapy” in metastatic cancer means that the patient has not received prior systemic therapy to treat tumor metastasis.

2. Such a cost-effectiveness adjustment also includes a consideration as to whether the patient cohort has a prognosis shorter than six months considering available treatments.

3. During my fieldwork in the clinic, I met over ten medical students, two clinical research fellows and one psychology PhD student. I was the first social anthropologist doing research with the clinical team.

4. Pembrolizumab clinical trial was designed to openly randomize patients between treatment and control groups, meaning that 50% of the participants were receiving standard therapy. However, as part of an “ethical” drug trial design, participants in the control arm could “cross” to the treatment group if their standard treatment were not working.

Additional information

Funding

Fieldwork for this research was made possible by a doctoral fellowship granted by Comisión Nacional de Investigación Científica y Tecnológica (CONICYT)/Becas Chile 2014 (grant number: 72150288). The writing of this article was supported by a post-doctoral fellowship granted by the Philomathia Foundation.

Notes on contributors

Ignacia Arteaga Pérez

Ignacia Arteaga Pérez is a research associate and an affiliated lecturer at the Department of Social Anthropology, University of Cambridge. She is also a research fellow at Robinson College, Cambridge.