James Malpas: pioneer of medical oncology who developed combination chemotherapy

Before the 1960s the only modalities of therapy for cancer were surgery and radiotherapy, and these could be successful only if the cancer was localised. There were no treatments for disseminated diseases, including leukaemia.

It was during a junior registrar post at Barts that James Malpas was encouraged by Ronald Bodley Scott to take an interest in oncology. Gordon Hamilton Fairley was senior to him, and he went off to the US to look at combination chemotherapies that were being developed for lymphomas and leukaemia.

Previously the advice from pharmacologists had been that to avoid resistance of cancer cells, only one drug at a time should be given. Responses were seen, but few were sustained.

Combining drugs seemed to produce much better response rates, but the drugs were toxic, with unpleasant side effects. The Barts team modified the drugs used to make them less toxic and remarkable results were seen. Their game changing paper showed that when the combination of mustine, vinblastine, prednisolone, and procarbazine (MVPP) was used, two thirds of patients who had received no previous treatment for …