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A cancer trial’s unexpected result: Remission in every patient

nytimes.com

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Re: A cancer trial’s unexpected result: Remission in every patient

#181

Post by weezin »

MontagFTB wrote: post #9

> The medication was given every three weeks for six months and cost about $11,000 per dose. That’s an $88,000 treatment for the medication alone. Given the apparent success of the drug, is it expected for the price to drop as the volume of patients spike?

No, the prices for drugs don't follow the same fundamentals that a normal economic market does.

If you want to learn more about pricing in healthcare the "Pricing, Value, and Ethics" lectures for this course is really interesting.

https://openlearninglibrary.mit.edu/courses/course-v1:MITx+1...

Re: A cancer trial’s unexpected result: Remission in every patient

#182

Post by rjm226 »

Gordonjcp wrote: post #72

I'm not sure which immunotherapy drug my mother has been receiving, but after being diagnosed with lung cancer nearly two years ago - a tumour roughly the size of a tangerine right in the top corner of one lung, utterly inaccessible by surgery, in absolutely the wrong place to attempt radiotherapy - it's now gone, save for a little bit of scarring and fibrosis where it used to be. The treatment has left her tired and…

Any idea what cancer she had and what treatment? My mom is currently battling stage 4 metastatic neuroendocrine primary lung cancer atypical carcinoid and being treated with Lutathera, a nuclear injection that targets the somatostatin receptor on the cancer cells and hopefully shrinks, slows, or kills them off. The treatment is 1 injection every 2 months over the course of 8 months. So 4 total injections. She has already been through 4 rounds of chemotherapy and targeted radiation. She has many tumors at this point but the largest sounded similar to your moms, upper left lung, the size of a golf ball. Partially collapsed her left lung. She's being treated at Sloan Kettering in NYC.

Re: A cancer trial’s unexpected result: Remission in every patient

#183

Post by elhudy »

adamredwoods wrote: post #82
axpy906 wrote: post #66

Earlier quoted context omitted.

What treatments in particular?

Car-T seems promising for leukemia and lymphoma, but not as efficacious in solid tumors: https://www.lls.org/treatment/types-treatment/immunotherapy/... Also 2nd gen BTK inhibitors: https://en.wikipedia.org/wiki/Acalabrutinib https://en.wikipedia.org/wiki/Bruton%27s_tyrosine_kinase

BTK inhibitors are technically in 3rd gen (noncovalent) already if you can get in the trials (which are very promising considering they use the same mechanism).

Re: A cancer trial’s unexpected result: Remission in every patient

#184

Post by hp48fan »

Wowfunhappy wrote: post #180
hp48fan wrote: post #157

Earlier quoted context omitted.

Because it would degenerate into pharmaceuticals selling false hope in exchange for lab rats that are too far along to be saved even if the drugs work. That being said I disagree with prescription pads. I should buy antibiotics for my kid without waiting four, five hours to be seen and processed

The more we use antibiotics, the more opportunities there are for bacteria to evolve resistance.

So Ive been told.

And yet the Dr gives them out in exactly the same circumstances as I would if I could. Perhaps more liberally, since Im far more concerned about the consequences to my kids of destroying their gut flora.

Re: A cancer trial’s unexpected result: Remission in every patient

#185

Post by Aransentin »

rad88 wrote: post #127
Aransentin wrote: post #20

Some napkin math: Given rectal cancer's rate of survival of 67%, and the small size of the study (18 people), you should see similar results due to random chance every 1350th study. A cursory search on clinicaltrials.gov and I can find 7131 cancer studies started in 2021 alone. It's therefore not unreasonable for this one to be just a random fluke.

This analysis is mindless and inappropriate. If you care about this at all do yourself a favor and just read the study. https://www.nejm.org/doi/full/10.1056/NEJMoa2201445 Otherwise redo your napkin math and cursory search to answer, specifically, whether all these cancers disappearing within weeks of dostarlimab treatment could be a fluke. And do not compare this to "rectal cancer's rate of survival", which is irrel…

The point of that napkin math is not to get an exact prediction, it's to get a order-of-magnitude estimate to see if this study is different from any other of the large amount of "promising drug cures X" articles that never actually turn out to work.

I concede that if a quick remission is extremely rare that does change the outcome, though I don't know how common that it.

Picking 'Total number of "cancer studies"' was not arbitrary. A similar article could have been crated for e.g. "promising drug cures breast cancer" so you need to take all of them into account. Actually probably every study conducted of all high-profile diseases that are likely to wind up on the HN frontpage - in a counterfactual universe we could be discussing a miracle Alzheimer drug or the like.

Re: A cancer trial’s unexpected result: Remission in every patient

#186

Post by Wowfunhappy »

hp48fan wrote: post #184
Wowfunhappy wrote: post #180

Earlier quoted context omitted.

The more we use antibiotics, the more opportunities there are for bacteria to evolve resistance.

So Ive been told. And yet the Dr gives them out in exactly the same circumstances as I would if I could. Perhaps more liberally, since Im far more concerned about the consequences to my kids of destroying their gut flora.

Then the doctor is doing a bad job.

Making all antibiotics available over the counter would not improve the situation.

Re: A cancer trial’s unexpected result: Remission in every patient

#187

Post by hp48fan »

pastacacioepepe wrote: post #177
hp48fan wrote: post #157

Earlier quoted context omitted.

Because it would degenerate into pharmaceuticals selling false hope in exchange for lab rats that are too far along to be saved even if the drugs work. That being said I disagree with prescription pads. I should buy antibiotics for my kid without waiting four, five hours to be seen and processed

> I should buy antibiotics for my kid without waiting four, five hours to be seen and processed Disagree. Antibiotics should not be taken lightly, especially by kids. Doctors have been far too liberal in prescribing them even when unnecessary and this has caused people to think antibiotics are to be taken like vitamins. This antibiotic abuse causes issues that are out of scope to discuss here.

Which is why I get annoyed when Dr. prescribe them more liberally than I would; for things that they'll admit are probably viral.

But when a girl with a history of UTI is screaming in pain they come back with "Id rather wait for the cultures to come back"

No. Bugger off and give me the meds. I know my kid. I know what she has. And the culture confirms it three days layer every time.

Re: A cancer trial’s unexpected result: Remission in every patient

#188

Post by Aransentin »

X6S1x6Okd1st wrote: post #53
Aransentin wrote: post #20

Some napkin math: Given rectal cancer's rate of survival of 67%, and the small size of the study (18 people), you should see similar results due to random chance every 1350th study. A cursory search on clinicaltrials.gov and I can find 7131 cancer studies started in 2021 alone. It's therefore not unreasonable for this one to be just a random fluke.

Pretty sure the base rate you'd want to compare against is either placebo given -> remission or simply spontaneous remission. It appears that spontaneous remission is really quite rare. > [sponanteous remission of cancer] incidence is roughly one in every 60 000–100 000 cancer patients, but the true figure is unknown (2). Spontaneous regression of colon cancer seems to be particularly rare https://academic.oup.com/jj…

If spontaneous remission is super rare it does change the conclusion, yeah.

(Tangentially I think your stats are a little messed up there - you calculated the expected number of people out of 43000 surviving, not the trials returning a false positive. Assuming 0.0016% that chance is astronomically small, so your argument is stronger.)

Re: A cancer trial’s unexpected result: Remission in every patient

#189

Post by pas »

weezin wrote: post #181
MontagFTB wrote: post #9

> The medication was given every three weeks for six months and cost about $11,000 per dose. That’s an $88,000 treatment for the medication alone. Given the apparent success of the drug, is it expected for the price to drop as the volume of patients spike?

No, the prices for drugs don't follow the same fundamentals that a normal economic market does. If you want to learn more about pricing in healthcare the "Pricing, Value, and Ethics" lectures for this course is really interesting. https://openlearninglibrary.mit.edu/courses/course-v1:MITx+1...

Could you explain that a bit? How does that interact with this?

https://www.fda.gov/about-fda/center-drug-evaluation-and-res...

Re: A cancer trial’s unexpected result: Remission in every patient

#190

Post by moneywoes »

macdaknife wrote: post #171
gjreda wrote: post #129

Earlier quoted context omitted.

Imatinib (Gleevac) revolutionized treatment for patients with chronic myeloid leukemia (CML). Prior to the drug’s discovery, CML patients generally had seven years to live (possibly less depending on how advanced the cancer was). Now their lifespan mirrors the general population. I’d highly recommend the book The Philadelphia Chromosome if you’re interested in learning more.

I am currently taking a similar drug for Myelofibrosis on a clinical trial holed up after a stem cell transplant here at MD Anderson Cancer Center. It's called Itacitinib, and is supposed to prevent GVHD. It's by the same company that makes Jakafi (brand name). These are expensive drugs for sure, and my DR is running the clinical trial. Just wanted to chime in from the inside. ;p

Best of luck for your treatment
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