In this fast paced sequel to Exchange Rate and Two Timed, Larson and Phillips take on Keller and Jackson. The pairs vie for control of the power to cure cancer. Larson has become the despised President of the US and Phillips the well respected Director of NIH. Keller remains an innocuous biology researcher and Jackson has graduated to premeditated murder. All in all, an even match-up. The ensuing battle threatens to ruin the country financially and morally.

The foolhardy—or farsighted—alien sponsor of the "contest" refuses to halt the proceedings even as it spins out of control. The nemesis of the sponsor plots not only to derail the proceedings, but to pull the plug on the entire human race.

From San Antonio to Washington, D.C. to the Canadian border to a West Virginia bridge, the four contestants face agonizing decisions. As do the sponsor and anti-sponsor. All find the word malignancy applies to more than cancer.