New cancer drug kinder than chemotherapy(bbc.com)
bbc.com
New cancer drug kinder than chemotherapy
https://www.bbc.com/news/health-67793887
140 comments
I am sorry to hear about your dog. Pets can be an integral part of one's family, which often (sadly) goes unacknowledged. My first dog died of hemangiosarcoma. There were no treatments besides chemotherapy at the time. From a cursory search, your dog's treatment appears somewhat reasonably priced. Scientific progress is amazing. I hope the treatments go well.
jackblemming(3)
Coincidentally, physicist Sabine Hossenfelder published on YT just hours ago about a new treatment - "proton flashes".
> one of the most common ways to treat cancer is radiation therapy with x-rays ... You can use these highly energetic photons to kill off cancer cells. The difficulty really is ... killing the cancer cells without killing the patient - but the problem with using x-rays is that you can't shoot them at tumors inside the body without also burning some of the tissue on the way to the tumor and behind it... But you can use beams of other particles instead and this is where particle physics enters ... A beam of protons is far less likely to interact with tissue on short distances
And it is still part of the "kinder" set (protons are "kinder" than x-rays).
New Cancer Treatment With Proton Flashes Goes on Trial
https://www.youtube.com/watch?v=K515uMQQzV4
> one of the most common ways to treat cancer is radiation therapy with x-rays ... You can use these highly energetic photons to kill off cancer cells. The difficulty really is ... killing the cancer cells without killing the patient - but the problem with using x-rays is that you can't shoot them at tumors inside the body without also burning some of the tissue on the way to the tumor and behind it... But you can use beams of other particles instead and this is where particle physics enters ... A beam of protons is far less likely to interact with tissue on short distances
And it is still part of the "kinder" set (protons are "kinder" than x-rays).
New Cancer Treatment With Proton Flashes Goes on Trial
https://www.youtube.com/watch?v=K515uMQQzV4
I actually worked with MGH on their first proton treatment software for non cyberknife proton treatment. Later scaled it into AWS so their dosimetrists could iterate on treatment plans much faster. The initial treatments were incredibly successful and much easier on the patient, but theres no miracle either.
Patients still suffer adverse reactions, and you will have margins of error, not to mention you do not have unlimited time to develop a treatment plan that is perfect. It's a time/efficacy trade off and the goal is to hit as much of the cancer as possible, while maintaining a SAFE dose of radiation, not a zero dose. What is a safe dose? Well, the more aggressive your cancer the higher that number gets too.
Some patients still receive high dose radiation while on proton treatment simply because their cancer is that aggressive, typically suffering the same grade 1-2 diarrhea and vomiting as any other form of radiation.
Proton treatment is far superior for most cancers, especially deeper cancers like colon and prostate.
It's a living example of how tragic a new treatment option is, unfortunately proton centers are expensive to build and take years. So many people are still passing away from treatable disease and having to endure high dose chemotherapy in other cases.
Patients still suffer adverse reactions, and you will have margins of error, not to mention you do not have unlimited time to develop a treatment plan that is perfect. It's a time/efficacy trade off and the goal is to hit as much of the cancer as possible, while maintaining a SAFE dose of radiation, not a zero dose. What is a safe dose? Well, the more aggressive your cancer the higher that number gets too.
Some patients still receive high dose radiation while on proton treatment simply because their cancer is that aggressive, typically suffering the same grade 1-2 diarrhea and vomiting as any other form of radiation.
Proton treatment is far superior for most cancers, especially deeper cancers like colon and prostate.
It's a living example of how tragic a new treatment option is, unfortunately proton centers are expensive to build and take years. So many people are still passing away from treatable disease and having to endure high dose chemotherapy in other cases.
My theory is that cancer is a precision recall problem. Our body has the tools to fight cancer but they need to be precise otherwise they would end up attacking normal cells. Our cells do not have as much high level view that we do. On the other hand if we see a skin cell inside the brain we know that's cancer. Hopefully we can build some treatments that lets us light up cancer cells and have our own cells take care of it. That being said it's easier said than done
> Hopefully we can build some treatments that lets us light up cancer cells and have our own cells take care of it.
That's exactly what many of the new immunotherapies do.
That's exactly what many of the new immunotherapies do.
MGH being Mass General Hospital or something else? I only ask because I'm a colon cancer patient at Mass General.
Worth noting here is that "proton flash therapy" is a new therapy, but "proton therapy" is not. Proton therapy is a lot more recent than x-ray therapy, but still a conventional therapy.
Flash therapy is the part is which just now entering clinical trials, where you treat the patient with ultra-high dose rates (so you deliver the same dose of radiation, but in maybe 90 ms instead of 90 seconds). There are indications that healthy cells are better at recovering from the ulra-high dose rate than tumor cells are, which means it would have a protective effect on healthy tissue, but the mechanism behind it is not known. The type of radiation is not specified, it can be protons, electrons, x-rays, etc.
So "proton flash therapy" is a Flash therapy that uses protons. Other clinical trials are using electrons instead, i.e. "electron flash therapy".
Flash therapy is the part is which just now entering clinical trials, where you treat the patient with ultra-high dose rates (so you deliver the same dose of radiation, but in maybe 90 ms instead of 90 seconds). There are indications that healthy cells are better at recovering from the ulra-high dose rate than tumor cells are, which means it would have a protective effect on healthy tissue, but the mechanism behind it is not known. The type of radiation is not specified, it can be protons, electrons, x-rays, etc.
So "proton flash therapy" is a Flash therapy that uses protons. Other clinical trials are using electrons instead, i.e. "electron flash therapy".
Thanks for explaining this, I'd heard of people being treated with proton beams already and it was pretty confusing to hear this was new and experimental.
What are the theories as to why healthy cells recover better than tumor cells, if any?
What are the theories as to why healthy cells recover better than tumor cells, if any?
On the topic of interesting Physics contributing to new cancer therapies, there is also Boron Neutron Capture Therapy (https://www.neutrontherapeutics.com/about-bnct/). I gather the gist of it is that it builds up boron isotopes around a tumour, then bombards it with neutrons that mostly pass through the body but interact far more with the boron isotopes. Energetic particles are emitted, have a low range, and hopefully kill just the cancer cells. Apparently all in less sessions than with X-ray or proton therapy.
Disclaimer: I am not a doctor or medical physicist, I’m just fortunate enough to briefly use a machine intended for this purpose in separate nuclear physics studies. I believe BNCT has been done before with reactor sources of neutrons, but for some reason not as a standard treatment and there’s only one left in Taiwan for this purpose. The new development, afaik, is the ability to use accelerator neutron sources for this. Would love it if anybody knows more!
Disclaimer: I am not a doctor or medical physicist, I’m just fortunate enough to briefly use a machine intended for this purpose in separate nuclear physics studies. I believe BNCT has been done before with reactor sources of neutrons, but for some reason not as a standard treatment and there’s only one left in Taiwan for this purpose. The new development, afaik, is the ability to use accelerator neutron sources for this. Would love it if anybody knows more!
I asked my daughter the oncologist about this, and the better way of doing this is not to use boron as the payload, but rather some very powerful toxin. The toxin gets linked to a tumor-specific antibody. There are lots of targeted drugs of this kind being developed for various tumors.
Is there a way to like emit energy in a narrow beam from a bunch of different angles around a central target such that they only overlap in the center/target and the frequencies resonate in that location in such a way to reach a higher frequency past which there is a destructive effect but below which is safe and non-destructive?
/knows nothing about physics
/knows nothing about physics
I understand what you are getting at, but the short answer is no.
The longer answer is something called The Superposition Principle. Essentially, waves (photons) pass through one another. The amplitude adds, but only at the intersection. The frequency does not change. (Consider the laser as the ultimate example of this)
(Side note: The superposition principle does not always hold; however, the realms where the addition of MOAR PHOTONZ becomes non-linear are broadly incompatible with life)
So, most techniques involve having many, many beams intersect so that the individual paths are only a little damaged while a specific spot where they all meet takes the hit. I met someone who specifically programs the machines that do this because there's a lot of math involved chucking radiation around irregular hunks of blood, meat, and bone, and the calculations are done because the first idea of "just cross the streams" works fine in a vacuum, but not so much in the human body.
The longer answer is something called The Superposition Principle. Essentially, waves (photons) pass through one another. The amplitude adds, but only at the intersection. The frequency does not change. (Consider the laser as the ultimate example of this)
(Side note: The superposition principle does not always hold; however, the realms where the addition of MOAR PHOTONZ becomes non-linear are broadly incompatible with life)
So, most techniques involve having many, many beams intersect so that the individual paths are only a little damaged while a specific spot where they all meet takes the hit. I met someone who specifically programs the machines that do this because there's a lot of math involved chucking radiation around irregular hunks of blood, meat, and bone, and the calculations are done because the first idea of "just cross the streams" works fine in a vacuum, but not so much in the human body.
They're generally delivered sequentially rather than simultaneously, but that is standard practice. It means you can concentrate the dose in the target area, but constructive interference affects only intensity, not frequency. And photons will still interact pretty evenly along the whole path.
https://en.wikipedia.org/wiki/Radiosurgery there is a subtype called Gamma Knife which uses a large collection of emitters to effectively target a location while keeping other locations under a specific radiation threshold.
Yes, there is beam forming.
Do a websearch about MIMO and beamforming, or ask Bing chatgpt to explain it.
Do a websearch about MIMO and beamforming, or ask Bing chatgpt to explain it.
An inventor named Royal Rife experimented with destroying tumors by finding the resonant frequencies of the cancer cells.
I downvoted you mainly because Sabine is a font of misinformation in areas outside her direct expertise.
Particle beams for cancer therapy aren't new; shortly after the invention of the cyclotrone, EO Lawrence did this with neutrons in the late 1940s and proton beams were being used successfully in the 50's. She leaves out these details and only mentions trials from the 1990s.
Particle beams for cancer therapy aren't new; shortly after the invention of the cyclotrone, EO Lawrence did this with neutrons in the late 1940s and proton beams were being used successfully in the 50's. She leaves out these details and only mentions trials from the 1990s.
Thank you for the warning about Dr. Hossenfelder and for the information about the technology,
but we have not effected any blind endorsement. Just informed of a consistent parallel piece, esp. after the coincidence, which may be useful in itself - or just interesting.
but we have not effected any blind endorsement. Just informed of a consistent parallel piece, esp. after the coincidence, which may be useful in itself - or just interesting.
> I downvoted you mainly because Sabine is a font of misinformation in areas outside her direct expertise.
Just curious, since I've run into her channel recently and found her generally pleasant and informative (minus the unfunny jokes part), do you have any specific examples of this?
Just curious, since I've run into her channel recently and found her generally pleasant and informative (minus the unfunny jokes part), do you have any specific examples of this?
https://www.reddit.com/r/AskPhysics/comments/15o0fx7/i_just_...
To be fair, her criticism isn't that LIGO itself was fake, but it's really hard to tell, from the video and from https://backreaction.blogspot.com/2019/09/whats-up-with-ligo... If you read that blog, you can see she is using a collection of rhetorical techniques to cast down on the LIGO results (for example, using the term retraction out of context).
But it's mainly her videos about health-related stuff that doesn't have good support. She approaches most of these things with a "assume a spherical cow" approach, common when physics folks try to do biology.
To be fair, her criticism isn't that LIGO itself was fake, but it's really hard to tell, from the video and from https://backreaction.blogspot.com/2019/09/whats-up-with-ligo... If you read that blog, you can see she is using a collection of rhetorical techniques to cast down on the LIGO results (for example, using the term retraction out of context).
But it's mainly her videos about health-related stuff that doesn't have good support. She approaches most of these things with a "assume a spherical cow" approach, common when physics folks try to do biology.
Let me guess without looking at the video. Is it about the Bragg curve?
We need to see a much faster ramp in the pace of innovation in this space. We’re eeking out tiny wins over decades, like Rituximab and this agent. Feels like there’s an ossification of this entire sector that happened years ago and there’s no sense of urgency - just businesses as usual with the occasional modest win to show. 80 years since chemo was discovered, our most successful treatment across the board continues to be poison that kills fast growing cells faster than it kills the host. We are oncological troglodytes.
As someone in the industry you're 100% wrong.
These aren't "tiny wins". These are massive advancements in cancer treatment. And they're happening every decade or so, and added together is drastically changing outcomes.
This is one study.
"Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population."
https://jamanetwork.com/journals/jama/fullarticle/2598772
These aren't "tiny wins". These are massive advancements in cancer treatment. And they're happening every decade or so, and added together is drastically changing outcomes.
This is one study.
"Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population."
https://jamanetwork.com/journals/jama/fullarticle/2598772
This has been my experience firsthand in the system too.
Childhood cancer (mostly Leukemia) treatment in the USA is a well-organized country-wide clinical study aimed, at this point, at carefully reducing the amount of high-intensity chemo via replacing it with drugs like the one in the article, Blina.
They have gotten so good at treating Leukemia that they are now optimizing for reducing the long-term negative health impacts that come as a result of the treatment.
There are still tragic cases where the patients systems don't respond well, or there are complications as a result of compromised immune systems, but everything I have experienced points to major advancements and continued progress towards improving outcomes.
Childhood cancer (mostly Leukemia) treatment in the USA is a well-organized country-wide clinical study aimed, at this point, at carefully reducing the amount of high-intensity chemo via replacing it with drugs like the one in the article, Blina.
They have gotten so good at treating Leukemia that they are now optimizing for reducing the long-term negative health impacts that come as a result of the treatment.
There are still tragic cases where the patients systems don't respond well, or there are complications as a result of compromised immune systems, but everything I have experienced points to major advancements and continued progress towards improving outcomes.
While I agree there wasn't much progress for years - actually now is quite an exciting time in cancer - new effective treatments are coming on stream all the time, with many more in the works - not to mention much better diagnostic tools.
There are a ton of challenges to better oncology treatments. First, as many have noted, cancer is a constellation of diseases. Often a single tumor will contain multiple different, but related groups of cells. So most treatments will only work for a subset of cancers, and then only until the cancer evolves to be resistant. So any advance, will be necessarily “modest”, the reality of the situation is that there will never be a silver bullet. The closest we’ve come is immunotherapies, the class of treatment described in the article. These are a legitimately incredible advance, completely curing many people without the side effects of chemo. That said, theyre limited because cancer can evolve to defeat the immune response, and occasionally the immune system either under or over-reacts.
Also if you think there’s no sense of urgency, you haven’t talked to anyone actually in the field. Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients?
Also if you think there’s no sense of urgency, you haven’t talked to anyone actually in the field. Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients?
Plus there is the existing financial incentive. If an individual or company comes up with a revolutionary treatment, it would be an absolute money printer.
Even historic improvements for large demographics have massive returns. Keytruda (major oncology improvement) had more than $20 billion sales in 2023.
It is hard to think of a stronger market incentive to improve drugs as much as possible.
Even historic improvements for large demographics have massive returns. Keytruda (major oncology improvement) had more than $20 billion sales in 2023.
It is hard to think of a stronger market incentive to improve drugs as much as possible.
My pet idea is that rather than targetting cancer, we should be trying to find and correct DNA-errors before they become cancerous. Otherwise we are just playing whack-a-mole with a slowly degenerating cell population.
Most cells that divide will eventually have DNA errors over time, but will not always become cancerous.
If we could find and repair DNA errors in normal cells, we could do it in cancerous cells as well. I don't think there's much of a difference.
If we could find and repair DNA errors in normal cells, we could do it in cancerous cells as well. I don't think there's much of a difference.
>We’re eeking out tiny wins over decades,
I glean from many non-main stream sources (who are generally labeled quacks or naysayers, I have lost track of sources) :
- There have been almost no improvements in cancer treatments especially chemotherapy for _several_decades. Some sleight of hand involving some statistics and the fact that cancer can now be diagnosed in an at an earlier stage, means that the survival rate that is calculated by the survival of people Beyond 5 years of the first diagnosis, is higher.
- The primary approach to treating cancer (especially with chemotherapy and radiation) appears flawed. Cancer is a systemic disease so even if you destroy the tumor, you will have more of those propping up, because the body is already predisposed to creating them.
- It's a money making scam ( just like any other industry) that thrives in keeping a patient as sick as possible for as long as possible
-A lot of naive, but well intention people fall for the above three points mentioned.
Of course any attempt to even mention that people could be wrong would be retaliated with: you don't-care-for-people-dying response. Heroics generally trumps common sense
I glean from many non-main stream sources (who are generally labeled quacks or naysayers, I have lost track of sources) :
- There have been almost no improvements in cancer treatments especially chemotherapy for _several_decades. Some sleight of hand involving some statistics and the fact that cancer can now be diagnosed in an at an earlier stage, means that the survival rate that is calculated by the survival of people Beyond 5 years of the first diagnosis, is higher.
- The primary approach to treating cancer (especially with chemotherapy and radiation) appears flawed. Cancer is a systemic disease so even if you destroy the tumor, you will have more of those propping up, because the body is already predisposed to creating them.
- It's a money making scam ( just like any other industry) that thrives in keeping a patient as sick as possible for as long as possible
-A lot of naive, but well intention people fall for the above three points mentioned.
Of course any attempt to even mention that people could be wrong would be retaliated with: you don't-care-for-people-dying response. Heroics generally trumps common sense
Molecular solutions are punch card science.
I really want to do whole-body clonal work. Our bodies and genes are machines, yet we still haven't put them to work. We're plastering over the breaks with crude tools that feel like modern day bloodletting. The blast radius in the transduction pathways is huge and imprecise.
I've written extensively about this topic on HN. Give me a minute and I'll dig up some references.
Edit:
https://news.ycombinator.com/item?id=35321368
https://news.ycombinator.com/item?id=32379247
https://news.ycombinator.com/item?id=30407908
I really want to do whole-body clonal work. Our bodies and genes are machines, yet we still haven't put them to work. We're plastering over the breaks with crude tools that feel like modern day bloodletting. The blast radius in the transduction pathways is huge and imprecise.
I've written extensively about this topic on HN. Give me a minute and I'll dig up some references.
Edit:
https://news.ycombinator.com/item?id=35321368
https://news.ycombinator.com/item?id=32379247
https://news.ycombinator.com/item?id=30407908
We're nowhere near "head transplants" or "creating braindead clones" (not to mention keeping them alive and healthy for decades). This is science fiction.
Actual cancer treatments are moving forward at a good pace. Immunotherapies are a good example. Cancer treatment is an example of medical research working well.
Actual cancer treatments are moving forward at a good pace. Immunotherapies are a good example. Cancer treatment is an example of medical research working well.
Yeah, if we're going to talk sci-fi, at least nanomachines are much less ghoulish than the implications of legalized human cloning.
[deleted]
This is not only a morally ambiguous sci-fi, it also skips on issue that we have no 100% proof way to make sure the blood used in the procedures you proposed will not contain cancer cells that will then invade the transplanted organ.
Not to mention issue of patient being weakened by, say, organ failure, to even survive such procedure.
Not to mention issue of patient being weakened by, say, organ failure, to even survive such procedure.
echelon is proposing head or body transplants. It's not sci-fi because doctors have been able to do it with limited success since 1970. Yes it will cure cancer, assuming the tumors haven't spread to your brain. No, cancer is not HIV it is not contagious in the way that you think. https://www.cancer.org/cancer/risk-prevention/understanding-...
Your comments are basically "what if we had clones guys, why has no one thought of this?"
You didn't "write extensively", you put science fiction plots ideas that have already been done a dozen times into comments.
I'm going to go out on a limb and say that execution might be a bigger factor than ideas here.
You didn't "write extensively", you put science fiction plots ideas that have already been done a dozen times into comments.
I'm going to go out on a limb and say that execution might be a bigger factor than ideas here.
You're my biggest repeat critic on HN, CyberDildonics.
I originally posted a follow-up message, but I revealed to much of the path gradient to build this and so I deleted it. There are so many low-hanging fruit markets, but I have to hold my tongue. It needs the right leadership and angle of attack.
I bet my reputation that none of this is science fiction, though, and I can't wait to prove you wrong about everything you doubt me on. Give me ten years on this one. I'll show you.
The Hollywood thread you keep doubting me on is going to be extremely obvious in about six months. I really want to see you eat your hat on that one. I'm sleeping on the floor every night to make it happen, and we're getting there.
I originally posted a follow-up message, but I revealed to much of the path gradient to build this and so I deleted it. There are so many low-hanging fruit markets, but I have to hold my tongue. It needs the right leadership and angle of attack.
I bet my reputation that none of this is science fiction, though, and I can't wait to prove you wrong about everything you doubt me on. Give me ten years on this one. I'll show you.
The Hollywood thread you keep doubting me on is going to be extremely obvious in about six months. I really want to see you eat your hat on that one. I'm sleeping on the floor every night to make it happen, and we're getting there.
Are you now claiming that you know how to clone and grow people for spare organs?
I've cloned and modified genes in eukaryotes. I think I know where to get started.
That's something people have been able to do for decades. How are you planning on growing a headless clone of a person for spare organs?
I mean, by that standard, I know how to perform a heart transplant, because I can use a scalpel.
The class of drugs are Bi-specific T-cell engagers from what I understand. I have a relative going through treatment and the possibility of these treatments was raised so I have been reading some but I'm not claiming to be an expert. The risk of side effects like the Cytokine storm seems to be similar to CAR-T, but this type of treatment doesn't require the blood harvesting, cell modification, and return for reinfusion. It seems like a better (more generic) way of accomplishing something similar.
In the case of the family member in question it sounds like one of these therapies are an option after CAR-T treatment currently. But it might be a preferable option in the future. I'm not sure if that is related to novelty and lack of data or something else.
In the case of the family member in question it sounds like one of these therapies are an option after CAR-T treatment currently. But it might be a preferable option in the future. I'm not sure if that is related to novelty and lack of data or something else.
From wikipedia:
> When blinatumomab was approved, Amgen announced that the price for the drug would be US$178,000 per year, which made it the most expensive cancer drug on the market. Merck's pembrolizumab was priced at US$150,000 per year when it launched (in September 2014).[14] At the time of initial approval, only about 1,000 patients in the US had an indication for blinatumomab.
I take it they prefer to pump chemotherapy poison ito patients for financial reasons?
> When blinatumomab was approved, Amgen announced that the price for the drug would be US$178,000 per year, which made it the most expensive cancer drug on the market. Merck's pembrolizumab was priced at US$150,000 per year when it launched (in September 2014).[14] At the time of initial approval, only about 1,000 patients in the US had an indication for blinatumomab.
I take it they prefer to pump chemotherapy poison ito patients for financial reasons?
I took blinatumomab in 2015 (in my late 20s). It literally saved my life. However, the risks of blinatumomab were seen as much riskier than chemotherapy. Most notably, blinatumomab has a significant risk of triggering a cytokine storm[0], a frequently-fatal immune reaction cascade. When starting a cycle of blinatumomab, the hospital required that I be inpatient for 7 days and they checked my vitals at least once every two hours. (This was _miserable_ for my sleep schedule, which is already a mess when in the hospital.) My regimen was 7 days in the hospital, then 21 days at home constantly connected to the pump, then 7 days of recovery time before starting another cycle.
At the time I took blinatumomab, I had already had unsuccessful treatments with two different chemo regimens. At the hospital system I was at, at least one failed chemo regimen was a pre-requisite for blinatumomab, as it was only indicated for "refractory" or "recurrent" cancers. I assume this is more related to the chance of acute death and (at the time) relative newness of blinatumomab compared to established chemotherapy regimens. (B-cell ALL is sadly very common in children, but this fortunately means that there is a LOT of funding research into the disease.)
After going through 3 one-month cycles of blinatumomab, it was becoming less effective, but I was able to line up a allogenic stem cell transplant which has (knock on a thousand woods) kept me clean for the 8 years since.
[0] https://en.wikipedia.org/wiki/Cytokine_storm
At the time I took blinatumomab, I had already had unsuccessful treatments with two different chemo regimens. At the hospital system I was at, at least one failed chemo regimen was a pre-requisite for blinatumomab, as it was only indicated for "refractory" or "recurrent" cancers. I assume this is more related to the chance of acute death and (at the time) relative newness of blinatumomab compared to established chemotherapy regimens. (B-cell ALL is sadly very common in children, but this fortunately means that there is a LOT of funding research into the disease.)
After going through 3 one-month cycles of blinatumomab, it was becoming less effective, but I was able to line up a allogenic stem cell transplant which has (knock on a thousand woods) kept me clean for the 8 years since.
[0] https://en.wikipedia.org/wiki/Cytokine_storm
Amazing story. Thanks for sharing. For all of us who work in drug discovery the hope is to hear cases like yours become more common and hopefully one day we can push cancer out of the range of common causes of death. There is still a ton of work to do.
I read up on it. In the case of blinatumomab, it is called Cytokine release syndrome (CRS), it's very rare to have a high grade (dangerous, life threatening) CRS and seems to be survivable and treatable in the vast majority of those rare cases.
In this review, it seems like only 2% of 189 blinatumomab patients got a grade 3 CRS (requires hospitalisation) and 0% a grade 4 CRS (requires ventilation).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142489
To me as a non impacted layman, the side effects of even one of the several chemotherapeutics one seems to get appear to be much more destructive, uncomfortable and scary than the well manageable CRS from blinatumomab that primarily appear in the first cycle.
Also looks like after blinatumomab, there are now also "Anti-CD19 CAR T cells" available which are even more effective (but have stronger side effects).
I hope I don't get cancer.
In this review, it seems like only 2% of 189 blinatumomab patients got a grade 3 CRS (requires hospitalisation) and 0% a grade 4 CRS (requires ventilation).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142489
To me as a non impacted layman, the side effects of even one of the several chemotherapeutics one seems to get appear to be much more destructive, uncomfortable and scary than the well manageable CRS from blinatumomab that primarily appear in the first cycle.
Also looks like after blinatumomab, there are now also "Anti-CD19 CAR T cells" available which are even more effective (but have stronger side effects).
I hope I don't get cancer.
Literally, yes. On the NHS, they will exhaust cheaper solutions that have a fair probability of working before trying more expensive ones. Age, long term prognosis, whether they have dependents, and some other factors are also considered.
> dependants
You mean ones life is valued more if one has children?
You mean ones life is valued more if one has children?
There's an entire subfield dedicated to calculating life values for making difficult decisions.
https://en.wikipedia.org/wiki/Value_of_life
I don't recall seeing having children as a variable in that valuation, it's typically more about how many years of work you continue to do, cast back into current dollars ("present value lifetime earnings", see https://escholarship.org/content/qt82d0550k/qt82d0550k.pdf?t...) and normalized for base rates.
I don't recall seeing having children as a variable in that valuation, it's typically more about how many years of work you continue to do, cast back into current dollars ("present value lifetime earnings", see https://escholarship.org/content/qt82d0550k/qt82d0550k.pdf?t...) and normalized for base rates.
If you have young children that depend on you, yes.
Do they look up records? Is this ethical? Does this also happen in the US or other countries?
It’s the UK, they have the medical history. They also ask the patient about their situation.
And I made it sound mechanical, but AI has not taken over all decisions like this yet. I believe it’s a discussion between a team of doctors where they are considering the humanity and ethics of the situation as well as the cost. Like, what would be the impact on the child/dependent if the parent was to die, do they have another parent or family members they can live with, can they fend for themselves, etc.
And I made it sound mechanical, but AI has not taken over all decisions like this yet. I believe it’s a discussion between a team of doctors where they are considering the humanity and ethics of the situation as well as the cost. Like, what would be the impact on the child/dependent if the parent was to die, do they have another parent or family members they can live with, can they fend for themselves, etc.
I mean, yeah. Of course it is.
No, I wouldn't say a life with dependents has more value. However, I do think it should be prioritized over those without dependents.
But that has nothing to do with inherent value.
But that has nothing to do with inherent value.
But I'm not talking about inherent value, I'm talking about the calculations that go into health care. The life of a person raising children should absolutely be valued higher than that of one who isn't. And I want to be clear, I don't have children, and I don't plan to, so this isn't selfishly motivated, it's just common sense to me.
More children mean a bigger climate footprint. Also, some children will be net negative on the tax and societal side (violent criminals that will never be gainfully employed). So it's not black and white. And I at least pay more taxes than a family of 3, assuming all of them are, for example, "just" store clerks.
So, what I want to say is, assuming we follow this value of life calculation, I am more valuable than this whole family of three.
So, what I want to say is, assuming we follow this value of life calculation, I am more valuable than this whole family of three.
Ok, but the children already exist. Do you think if their parents are allowed to die they will become less of a tax burden?
This isn't an argument about whether or not we should incentivize couples to have children (we absolutely should, in my opinion), but whether parents of young children should be prioritized for life saving treatment. Maybe I'm crazy, but I think the additional value of not leaving children parentless is worth including in the calculation.
This isn't an argument about whether or not we should incentivize couples to have children (we absolutely should, in my opinion), but whether parents of young children should be prioritized for life saving treatment. Maybe I'm crazy, but I think the additional value of not leaving children parentless is worth including in the calculation.
Slamidan(1)
It'll be substantially cheaper in the UK.
For those who need it will be free - but not to the health service, who do have to pay the sticker price.
Sticker price varies by country, and national health systems can negotiate those prices with quite a bit of market power.
https://www.pgpf.org/blog/2022/11/how-much-does-the-united-s...
> According to a 2021 study by the RAND Corporation, a non-profit global policy think tank, prices of prescription drugs in the U.S. are 2.4 times higher than the average prices of nine other nations (Austria, Australia, Belgium, Canada, Germany, Japan, Sweden, Switzerland and the United Kingdom). That higher cost is largely related to brand-name drugs, which are 4.9 times more expensive in the U.S. than in those countries. In fact, brand-name drugs are responsible for 84 percent of total drug costs in the United States despite accounting for only 8 percent of drugs dispensed.
The US is just starting to negotiate pricing, beginning with ten specific drugs. Until 2022, it was illegal for Medicare to do so.
https://www.hhs.gov/about/news/2023/10/03/biden-harris-admin...
https://www.pgpf.org/blog/2022/11/how-much-does-the-united-s...
> According to a 2021 study by the RAND Corporation, a non-profit global policy think tank, prices of prescription drugs in the U.S. are 2.4 times higher than the average prices of nine other nations (Austria, Australia, Belgium, Canada, Germany, Japan, Sweden, Switzerland and the United Kingdom). That higher cost is largely related to brand-name drugs, which are 4.9 times more expensive in the U.S. than in those countries. In fact, brand-name drugs are responsible for 84 percent of total drug costs in the United States despite accounting for only 8 percent of drugs dispensed.
The US is just starting to negotiate pricing, beginning with ten specific drugs. Until 2022, it was illegal for Medicare to do so.
https://www.hhs.gov/about/news/2023/10/03/biden-harris-admin...
I understand your cynicism, but let’s inject some actual data.
The price that the manufacturer charges for a course of blinatumomab (in a different indication for adults, not that this is especially relevant in this discussion) is ~£56k [0] - so significantly lower than the price quoted from the US.
NICE (the organisation which published the document referenced) exists to achieve value for money for the NHS for higher-priced and specialist treatments. If, following a thorough assessment, a medicine does not achieve the required value for money standard at the price proposed by the manufacturer, they are presented with two options: to not have the drug reimbursed in the UK at all, or to lower the effective price, so that the drug becomes cost-effective.
[0] https://www.nice.org.uk/guidance/ta589/documents/final-appra...
The price that the manufacturer charges for a course of blinatumomab (in a different indication for adults, not that this is especially relevant in this discussion) is ~£56k [0] - so significantly lower than the price quoted from the US.
NICE (the organisation which published the document referenced) exists to achieve value for money for the NHS for higher-priced and specialist treatments. If, following a thorough assessment, a medicine does not achieve the required value for money standard at the price proposed by the manufacturer, they are presented with two options: to not have the drug reimbursed in the UK at all, or to lower the effective price, so that the drug becomes cost-effective.
[0] https://www.nice.org.uk/guidance/ta589/documents/final-appra...
> If, following a thorough assessment, a medicine does not achieve the required value for money standard at the price proposed by the manufacturer, they are presented with two options: to not have the drug reimbursed in the UK at all, or to lower the effective price, so that the drug becomes cost-effective.
Which is effectively price controls, because the number of people with the money to pay out of pocket will be low, so the choice is essentially to sell at the regulated price or not at all. And the company would be crazy to choose the latter because the high cost is to pay for R&D, not manufacturing, so they'll never be better off to abandon the market than to take whatever they're offered.
Then you have prices being set by the political system. If the regulators get captured by pharma companies (as would be likely if implemented in the US) they'd overpay when the drug isn't worth it. If not, the regulators would have all the leverage and very little reason not to set prices too low, reducing the incentive for R&D and causing more people to die.
Which is effectively price controls, because the number of people with the money to pay out of pocket will be low, so the choice is essentially to sell at the regulated price or not at all. And the company would be crazy to choose the latter because the high cost is to pay for R&D, not manufacturing, so they'll never be better off to abandon the market than to take whatever they're offered.
Then you have prices being set by the political system. If the regulators get captured by pharma companies (as would be likely if implemented in the US) they'd overpay when the drug isn't worth it. If not, the regulators would have all the leverage and very little reason not to set prices too low, reducing the incentive for R&D and causing more people to die.
I'd assume this kind of pricing negotiations between government entities and state of the art pharmaceutical companies is a deadly dance around how much money needs to be paid to the companies to incentivise research, lobbying and how much money a life is worth.
Yes, selling for cheap is better than not selling at all, but if the government entities keep being stingy, maybe next time the company won't develop a treatment for a rare disease at all because it's just not worth it...
Yes, selling for cheap is better than not selling at all, but if the government entities keep being stingy, maybe next time the company won't develop a treatment for a rare disease at all because it's just not worth it...
> Yes, selling for cheap is better than not selling at all, but if the government entities keep being stingy, maybe next time the company won't develop a treatment for a rare disease at all because it's just not worth it...
Which is exactly the problem. And it's even worse than that, because it's a global market with national monopsony buyers. If your country is 4% of the global market, whatever you do isn't going to change the math for the drug company very much and you can ride on the coattails of other countries, so you might as well be as stingy as possible. But then everyone has the same incentive and the net effect is tragedy of the commons.
Or in practice, the US disproportionately funding drug development for the whole world and then people from other countries criticizing them for having higher drug prices.
Which is exactly the problem. And it's even worse than that, because it's a global market with national monopsony buyers. If your country is 4% of the global market, whatever you do isn't going to change the math for the drug company very much and you can ride on the coattails of other countries, so you might as well be as stingy as possible. But then everyone has the same incentive and the net effect is tragedy of the commons.
Or in practice, the US disproportionately funding drug development for the whole world and then people from other countries criticizing them for having higher drug prices.
They have a disincentive to sell to other countries at a discount if those countries allow medical tourism from the US. They don't want US patients taking advantage of the lower cost there.
And then many countries don't allow that, for exactly that reason.
That's not the real price in the UK because manufacturers will negotiate a confidential price with NICE.
And the quoted price is not the price insurers pay in the US either.
As someone who has worked in this space, the EU is lower than the US, but for oncology drugs the difference isn't that large.
And the quoted price is not the price insurers pay in the US either.
As someone who has worked in this space, the EU is lower than the US, but for oncology drugs the difference isn't that large.
NHS is approximately a monopsony, which probably has some advantages for price negotiation.
A family member has had immunotherapy on the NHS and it was disclosed to them (not sure how reliable or accurate this is) that a single dose cost the NHS 4 figures. It needed several layers of approval for it to be administered.
For one of the same drugs discussed above by Traubenfuchs? If so, unless I've misread the discussion, that looks like 12-140 times cheaper depending on which drug and exactly where in the 1000-9999 GPB it was?
Prices in earlier comment are per year, prices the NHS paid were per dose. Do we know how many doses per year?
Indeed it was per dose, and IIRC the figure was over £5000. It wasn’t intended to be public knowledge, I don’t think the patient was supposed to be shown it. The various supporting chemos ranged from below £100 to about £250/dose IIRC.
I mention it because in the UK people don’t really understand that drugs can be really expensive. The assumption is that due to the scale of the NHS they’re heavily discounted or even free, and that the high prices mentioned by US folk is due to the unusual healthcare situation there.
But there’s real money being paid by taxes, as well as procedures that determine whether you’re worth the expenditure.
I mention it because in the UK people don’t really understand that drugs can be really expensive. The assumption is that due to the scale of the NHS they’re heavily discounted or even free, and that the high prices mentioned by US folk is due to the unusual healthcare situation there.
But there’s real money being paid by taxes, as well as procedures that determine whether you’re worth the expenditure.
I'm sure some (many) make that kind of mistake, so it is worth pointing out.
But also:
> and that the high prices mentioned by US folk is due to the unusual healthcare situation there.
Are they wrong? I keep hearing that the US government spends more per person on healthcare than the UK government, even though the US also has mostly private insurance on top of that and the UK mostly doesn't?
But also:
> and that the high prices mentioned by US folk is due to the unusual healthcare situation there.
Are they wrong? I keep hearing that the US government spends more per person on healthcare than the UK government, even though the US also has mostly private insurance on top of that and the UK mostly doesn't?
Not wrong at all.
The NHS probably does barter discounts. But consider that a discount of 50% off $150k/yr would be incredible, yet still be a vast amount of money for a single treatment.
The NHS probably does barter discounts. But consider that a discount of 50% off $150k/yr would be incredible, yet still be a vast amount of money for a single treatment.
>It wasn’t intended to be public knowledge
The price the NHS pays for drugs is published in the BNF.
The price the NHS pays for drugs is published in the BNF.
Thanks! That means I did misread.
That poison chemo was and is a vast improvement on puberty-killing radiation, for instance. It’s a spectrum
dumb question... is it purely the demand that makes it this expensive? The "you need this or you die" aspect? Or is the cost of research and manufacturing for this stuff so astronomical that it warrants such a high price?
I almost don't want to even know... if I find out it costs only ~$5 to develop a dose, and they're charging $200k to dying people... ugh
I almost don't want to even know... if I find out it costs only ~$5 to develop a dose, and they're charging $200k to dying people... ugh
There is zero chance it costs $5 per dose because blinatumomab is a bi-specific T cell engager which is a monoclonal antibody made by extracting it from a cloned white blood cell created from recombinant DNA. The yield for this process is extremely low and it's really complicated in the best of times. The cost of the pipette tips and other consumables used by the lab automation alone probably costs more.
The flip side is that it treats a rare form of leukemia so the market isn't very big and since they can't lower the price enough to compete with chemo, they have to actually charge more to get their money back. For example chemo might cost $10k, but their drug costs $10k to make per person so if they charged $50k they might not even get enough customers to break even. So instead they charge $200k to get the most from the patients they can capture like the X% of patients who are allergic to the chemo drugs and have no choice (Just an example, I don't know the specifics for blinatumomab)
The flip side is that it treats a rare form of leukemia so the market isn't very big and since they can't lower the price enough to compete with chemo, they have to actually charge more to get their money back. For example chemo might cost $10k, but their drug costs $10k to make per person so if they charged $50k they might not even get enough customers to break even. So instead they charge $200k to get the most from the patients they can capture like the X% of patients who are allergic to the chemo drugs and have no choice (Just an example, I don't know the specifics for blinatumomab)
The research, development, approval process, and production all absolutely cost money that needs to be recouped from the sale, but we shouldn’t ever forget the reason why the company exists: to make profit.
You also need to pay for all the other research projects that did NOT yield a successful drug.
In other words, no it is not only supply and demand - it’s the desire to maximize profit as far as the market will bear
Or like the other response to your parent comment said, it could cost a ton to make, which lowers the number of people who can get it, driving costs even higher due to low volume.
It’s both. But it’s ultimately the profit motive that drives a business at all.
I'm interested in studies that address the 800 lbs. gorilla in the room: widespread over-nutrition with the post-WW2 "Western diet" is likely the primary suspected cause of a subset of cancers not seen in holdout individuals adhering to traditional diets and portion sizes that avoid too many calories and processed foods. My hypothesis is our immune system and cellular machinery can only effectively kill emergent cell lines under the assumption of sufficient cellular stress and restricted caloric intake. Chemotherapy are late substitute nuclear options, i.e., pausing cell division and/or clamping down on nutrient uptake pathways.
I'd be curious to know if people who have endured famines, controlled for age, have lower (and/or higher) rates of some cancers in certain phases of their lives.
I'd be curious to know if people who have endured famines, controlled for age, have lower (and/or higher) rates of some cancers in certain phases of their lives.
I’m new to this idea and NOT educated in biology let alone oncology, but here’s a meta study that suggests early exposure to famine is associated with increased cancer risks, if tenuously: https://www.sciencedirect.com/science/article/pii/S127977072...).
Of course looking at the effect of famine on an adult populations would do more to investigate your hypothesis than the effect on developing children.
But famine seems a bit extreme, no? Aren’t there also regional studies that show regional dietary/nutritional factors that correlate with lower cancer rates?
Of course looking at the effect of famine on an adult populations would do more to investigate your hypothesis than the effect on developing children.
But famine seems a bit extreme, no? Aren’t there also regional studies that show regional dietary/nutritional factors that correlate with lower cancer rates?
Life was not good for people who ate traditional diets. https://jacobin.com/2015/05/slow-food-artisanal-natural-pres...
Most cancer papers in the literature: "We found a new way to kill cells. Maybe it will kill cancer cells better than normal cells!"
Chemotherapy means "Chemical Therapy" so this is still technically categorized under that. But the general term has gotten really negative in recent decades so I suppose it's why they're distancing the branding from it.
If you otherwise completely healthy, wouldn’t you want to still keep the chemo therapy (even if it’s only a small asditional contribution) I’d want the greatest chance of winning
Chemo has tons of well-known long term negative effects. The idea with replacing Chemo with Blina is that it has a measurable similar short term effect (get rid of the bad cells) with less (so far) long term effects.
Why has chemo go through the whole body. Why not ecmo chemo only the combat zone?
Usually the cancer cells are throughout the body, even if the tumors themselves have not spread. This is why you might cut out a solid tumor, and then give chemo
For me, they cut out most of a giant tumor, but couldn't get all of it without risking some vital organs. Then I got chemo for the rest. Interesting process.
Usually the cancer cells are concentrated where the tumor is. One of the first things they may do upon diagnosis of cancer is a PET scan (which shows you where cancerous stuff is throughout your body).
Life advice for all the young folks: don't get cancer.
Usually the cancer cells are concentrated where the tumor is. One of the first things they may do upon diagnosis of cancer is a PET scan (which shows you where cancerous stuff is throughout your body).
Life advice for all the young folks: don't get cancer.
my understanding is that the word "concentrated" does a lot of heavy lifting, and modern thought is that most cancers started spreading cells all over the body, even at very early stages.
metastatic cancer is a numbers game. for example. at stage 0-1, you might still have millions of cancer cells throughout your body, and there is a good chance your immune system can clean them up. At stages 2 or 3 there might be trillions of non-local cancer cells, with a proportionally greater chance of propagation.
metastatic cancer is a numbers game. for example. at stage 0-1, you might still have millions of cancer cells throughout your body, and there is a good chance your immune system can clean them up. At stages 2 or 3 there might be trillions of non-local cancer cells, with a proportionally greater chance of propagation.
Antibody drug conjugates are one attempt at doing this. Basically attach chemotherapy drugs to molecules (antibodies) that bind only to proteins on cancer cells
In particular, this is a treatment for leukemia; a blood cancer.
When my dog had a subcutaneous form of cancer, one treatment discussed was local injection of a chemotherapy agent in the tumor area along with electrochemotherapy to help make the tumor more susceptible to the chemo treatment.
We opted for surgical removal instead.
https://en.wikipedia.org/wiki/Electrochemotherapy
We opted for surgical removal instead.
https://en.wikipedia.org/wiki/Electrochemotherapy
Things like that are done where we can figure out how to get the drugs there. Not an easy problem though.
There's "topical" chemo for some stuff, but it's uncommon. Most chemo is either in pill form, or (as was for me) delivered intravenously. So it goes through the whole body.
Radiation therapy can target specific areas. It's still used instead of chemo in some cases.
Radiation therapy can target specific areas. It's still used instead of chemo in some cases.
Why can't they say which company made it?
Any chemotherapy that damages the immune system should be avoided.
As I sit here getting chemo for B-Cell ALL, most of us don’t have any other option, it’s chemo or death.
From one internet stranger to another, I wish you a speedy recovery friend!
I hope for your speedy recovery. Be strong.
My own immune system is attacking my joints. Without treatment I'll be disabled within 10 years. What's your advice doc?
It can be preferable to having your body slowly town apart by its own immune system.
Theres a field of auto-immune disorders, where patients suffer from their own immune system. I believe they would disagree with you.
Yeah okay. I could have chosen to die instead. Think that would have been better?
Can you speak from personal experience? Not meant to be a rhetorical question, just wanted to give you a chance to elaborate.
ryeights(2)
A couple of times on Twitter I encountered people that used a dog dewormer medicine (Fenbendazole) to treat their cancer and these people claimed it cured them. Or people they know of.
Interesting and extremely cheap.
Seems scientist did find benefits as well in various trials, examples (more can be though with Googling, e.g. I know of a study of the effects on breast cancer in mice):
- https://pubmed.ncbi.nlm.nih.gov/30093705/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9437363/
- https://baltimorepostexaminer.com/human-patients-are-given-f...
Not everyone has had success:
- https://karger.com/cro/article/14/2/886/820730/Drug-Induced-...
Interesting and extremely cheap.
Seems scientist did find benefits as well in various trials, examples (more can be though with Googling, e.g. I know of a study of the effects on breast cancer in mice):
- https://pubmed.ncbi.nlm.nih.gov/30093705/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9437363/
- https://baltimorepostexaminer.com/human-patients-are-given-f...
Not everyone has had success:
- https://karger.com/cro/article/14/2/886/820730/Drug-Induced-...
There's not enough data to say if the immune therapy is helping (he's on traditional low-dose chemo as well), but it seems promising. The company (Torigen.com) is focused on animal treatment for now, but sees applications for humans in the future.