By Rabbi Yair Hoffman

It is a clear halacha that every Jewish person is obligated to make every possible effort to save life – even to the point where one may put their own life at risk. This principle is derived from the Toras Kohanim (Sifra on Parshas Behar 5:2), and is cited in  Bava Metzia (62a) regarding two people walking in the desert with only enough water for one person to survive. This case led to a dispute between Ben Petura and Rabbi Akiva concerning the interpretation of the pasuk “and your brother shall live with you.” However, all agree that from this verse we learn the obligation to make every effort to save another’s life, even at risk to oneself.

Another proof is in Nedarim 65b, where it teaches that Rabbi Meir said we can open (annul) a vow using verses from the Torah, saying to the person: “Had you known that you would transgress ‘do not take revenge’ and ‘your brother shall live with you’ – for he may become poor and you won’t be able to support him…”   We see from there that it is an obligation and grounds to annul a neder.

In Sefer Yereim (46), it states that the Hashem commanded in Parshas Behar “and your brother shall live with you,” and it was taught that “with you” means your life takes precedence over all others. From the phrase “and your brother shall live” we learn the obligations to redeem him from captivity, clothe him when cold, give him drink when thirsty, and feed him when hungry.  Certainly this includes helping out a victim of yenem machalah.

The Rofeh Cholim Cancer Society (RCCS) stands as a beacon of hope in the challenging landscape of cancer care, demonstrating an unwavering commitment to ensuring that no patient faces their battle alone. For over twenty years, this remarkable organization has been transforming lives by addressing one of the most critical yet often overlooked aspects of cancer treatment: access to comprehensive health insurance. By covering insurance premium payments for patients across the United States and recently expanding to Israel, RCCS removes the devastating financial barriers that can stand between patients and their path to recovery, enabling them to focus on what matters most – their health and healing.  But they are also a remarkable storehouse of critical information.

RCCS also serves as a lifeline that connects patients with the highest quality medical care available. Understanding that a cancer patient’s prognosis is significantly influenced by their access to superior medical resources, RCCS ensures that beneficiaries can receive treatment from the best doctors, undergo essential life-saving procedures, and obtain vital medications that might otherwise be prohibitively expensive. This comprehensive approach to patient support has established RCCS as an indispensable pillar in the cancer care community, embodying the principle that quality healthcare should be accessible to all those facing this formidable disease.

Cancer treatment has entered an exciting new era where doctors can look deep inside tumor cells to find their unique weaknesses. Advanced genetic testing technology called Next Generation Sequencing (NGS) makes this possible, although it is very expensive and can only be done in Germany, at this point. Think of it like having a powerful microscope that can read the instruction manual of cancer cells. This helps doctors understand exactly what makes each person’s cancer different and choose the most effective treatments.

The Study

Three years ago in BMC Med Genomics (14:105. doi: 10.1186/s12920-021-00952-9,), a study was published researchers examined tumor samples from 629 cancer patients, successfully analyzing 610 of them. This high success rate (97%) shows how reliable this testing has become. The researchers used a sophisticated testing method that looked at 161 different genes in each tumor sample. This is much more detailed than traditional testing, which might only look at a few genes.

What the Testing Found

The results were remarkable. Nearly 78% of patients had genetic changes that could be targeted with specific treatments. Here is what that means in practical terms:

For about 55% of patients, doctors found genetic changes that could be treated with medications already approved for use. Another 21% had changes that made them good candidates for clinical trials of new medicines. This means that three out of four patients could potentially benefit from treatments specifically chosen for their type of cancer.

Different Cancers, Different Patterns

The study looked at many types of cancer, and each showed unique patterns:

Pancreatic Cancer: In the 118 pancreatic cancer patients studied, about 75% had changes in a gene called KRAS. While this can make treatment challenging, the researchers found other genetic changes in some patients that could be treated with specific medications.

Lung Cancer: Of the 67 lung cancer patients, about 87% had genetic changes that could be targeted with treatment. About 21% had changes that could be treated with FDA-approved medications right away.

Breast Cancer: Among the 62 breast cancer patients, about 81% had important genetic changes. About 42% had changes that could be treated with approved medications.

The Role of the Immune System

The researchers didn’t just look at genetic changes. They also studied three important markers that help predict whether immunotherapy might work:

Tumor Mutational Burden (TMB): About 25% of patients had high TMB scores, suggesting they might benefit from immunotherapy. Different types of cancer showed different patterns. For example, lung cancer had the highest rate of high TMB scores (43%), while soft tissue tumors had the lowest (4%).

PD-L1 Testing: This test was done on 198 patients, and about 39% showed positive results. For lung cancer patients, the positive rate was even higher at 69%.

Microsatellite Instability (MSI): This was the rarest marker, found in only about 4% of patients tested. However, when present, it’s a very strong indicator that immunotherapy might work.

Combining Different Types of Testing

One of the study’s most important findings was that combining different types of testing gave doctors the most complete picture. When researchers looked at all three immune system markers plus genetic testing, they could find potentially helpful treatments for more than 83% of patients. This is a significant improvement over using any single type of test.

Cost and Practical Considerations

While this type of comprehensive testing might seem expensive, German healthcare systems have found it cost-effective in the long run. By helping doctors choose the most effective treatments first, it can avoid the cost and time spent on treatments less likely to work.

Challenges and Solutions

The research team faced several challenges:

Getting Enough Tumor Tissue: Sometimes it’s difficult to get enough cancer tissue for testing, especially in patients with hard-to-reach tumors. However, the German laboratories developed methods that worked with very small amounts of tissue.

Understanding Complex Results: The tests produce large amounts of data that need expert interpretation. German medical centers have created special tumor boards where experts from different fields work together to understand the results and make treatment recommendations.

Time Pressure: Sometimes patients need to start treatment quickly and can’t wait for comprehensive test results. In these cases, doctors can start with standard treatments while waiting for the detailed genetic information.

The Future of Cancer Treatment

This research from Germany shows where cancer treatment is heading worldwide. Instead of treating all lung cancers or all breast cancers the same way, doctors can now understand each patient’s cancer at the molecular level and choose treatments most likely to work for that specific case.

What This Means for Patients

For cancer patients, this research offers real hope. When doctors understand the specific genetic changes driving a patient’s cancer, they can often find treatments that target these changes directly. This means treatments might work better while causing fewer side effects than traditional chemotherapy.

Even in cases where standard treatments haven’t worked, this testing can reveal new options, including clinical trials or immunotherapy treatments that might not have been considered otherwise.

Global Impact

While this research was primarily conducted in Germany, its implications are global. Medical centers worldwide are beginning to adopt similar comprehensive testing approaches. The German experience shows that this kind of detailed tumor analysis can work in everyday medical practice, not just in research settings.

The study’s success has encouraged other countries to develop similar programs, making this type of personalized cancer treatment more widely available. As more medical centers gain experience with these techniques, they become better at interpreting the results and choosing the most effective treatments for each patient.

This approach represents a fundamental shift in how cancer can be treated, moving from a one-size-fits-all approach to truly personalized medicine. It’s a change that offers new hope to cancer patients and their families, while pointing the way toward even more effective treatments in the future.  If it is nogaya to any individual – they should contact RCCS for further information on the treatment in Germany.  Others should reach out to them to donate.

The author can be reached at [email protected]