A cancer trial’s unexpected result: Remission in every patient • Hacker News Board

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

#21

Post by georgeburdell » Sun, Jun 05, 2022, 3:09 PM UTC

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?

This is why although I’ve almost got enough money to retire (~20x yearly expenses) but I’ll keep on working for another decade or two. All of these whiz-bang new treatments are going to be expensive. The most expensive medical procedure right now is a heart transplant at about $1M. Then there’s the $10k/mo for a nursing home

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

#22

Post by ta988 » Sun, Jun 05, 2022, 3:13 PM UTC

georgeburdell wrote: post #21

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?

This is why although I’ve almost got enough money to retire (~20x yearly expenses) but I’ll keep on working for another decade or two. All of these whiz-bang new treatments are going to be expensive. The most expensive medical procedure right now is a heart transplant at about $1M. Then there’s the $10k/mo for a nursing home

Is that the real price of a nursing home in the US? Who can afford that?

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

#23

Post by pella » Sun, Jun 05, 2022, 3:15 PM UTC

> It was a small trial, just 18 rectal cancer patients,

just 12

"All 12 patients (100%; 95% confidence interval, 74 to 100) had a clinical complete response, with no evidence of tumor on magnetic resonance imaging, 18F-fluorodeoxyglucose–positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. "

https://www.nejm.org/doi/full/10.1056/NEJMoa2201445

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

#24

Post by aperson_hello » Sun, Jun 05, 2022, 3:15 PM UTC

civilized wrote: post #3

hprotagonist wrote: post #2

relatedly, the only good reason to stop a trial early is that it becomes unethical not to treat the control group because the effect size in the treatment group is so huge. And it does happen, sometimes.

I sometimes wonder if the exhilaration of such a result comes with a twinge of regret that the result could not have been foreseen before the science reached it, and more people given the lifesaving treatment immediately. But that is the human condition, I guess. Scientific progress and learning brings regrets, often very momentous ones in retrospect.

The number of trials that don't work in humans when it worked in every pre-clinical trial up to that point is enough that it makes sense to be extra cautious.

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

#25

Post by rossdavidh » Sun, Jun 05, 2022, 3:15 PM UTC

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.

Your basic result stands, but "survival" and "remission" don't necessarily equate. But I agree with your basic point.

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

#26

Post by ta988 » Sun, Jun 05, 2022, 3:16 PM UTC

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?

Something I saw in drug pricing conferences is that there is a push to price drugs according to how much personal and social benefit they provide and how much a person would be willing to pay to extend their life or resolve a condition. An extreme example for that model, if a drug allow a kid to survive and have a productive life it can be priced millions whereas a palliative drug could be much cheaper.

This has nothing to do with research and cost of development anymore (if it even ever did).

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

#27

Post by horsawlarway » Sun, Jun 05, 2022, 3:20 PM UTC

ta988 wrote: post #22

georgeburdell wrote: post #21

Earlier quoted context omitted.

This is why although I’ve almost got enough money to retire (~20x yearly expenses) but I’ll keep on working for another decade or two. All of these whiz-bang new treatments are going to be expensive. The most expensive medical procedure right now is a heart transplant at about $1M. Then there’s the $10k/mo for a nursing home

Is that the real price of a nursing home in the US? Who can afford that?

Yes - that's not unreasonable for a full time care facility for something like dementia or Alzheimer's in the US (it's below what we paid for my grandmothers).

If you're lucky - they have long term care insurance, and that covers most of the expenses for approx 2 to 10 years (depending on how old the insurance is - it's getting harder to find long plans, and they're all getting significantly more expensive as it turns out more folks needed them).

Otherwise... you spend everything, and then your kids pay.

We split my grandmothers down the middle - my mom's had insurance, we covered my dad's.

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

#28

Post by yakak » Sun, Jun 05, 2022, 3:23 PM UTC

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.

If I understand the article correctly they were excluding patients enrolled in chemo and radiation?

If that's what they mean the survival rate wouldn't be 67% so this would imply a 1349 in 1350 chance the treatment is better than the average treatment?

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

#29

Post by klyrs » Sun, Jun 05, 2022, 3:32 PM UTC

ta988 wrote: post #26

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?

Something I saw in drug pricing conferences is that there is a push to price drugs according to how much personal and social benefit they provide and how much a person would be willing to pay to extend their life or resolve a condition. An extreme example for that model, if a drug allow a kid to survive and have a productive life it can be priced millions whereas a palliative drug could be much cheaper. This has noth…

I met a researcher once who was doing what appeared to be groundbreaking research on cancer care. He had this beautiful, tear-jerker story about losing his wife that cast a rosy, altruistic hue on his research. When he was asked what the device would cost, he cheerily replied "whatever the market will bear." That's always stuck with me -- the problem with American healthcare is the American interpretation of capitalism. Dude was living off of government research grants.

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

#30

Post by inglor_cz » Sun, Jun 05, 2022, 3:34 PM UTC

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 napkin math ignores some very significant circumstances.

People who suffer from rectal cancer usually undergo surgery to remove the primary tumor. But those trial patients weren't operated on, their treatment was non-invasive.

How many rectal cancer sufferers who never undergo a surgery survive? I would bet that it is a lot less than 67 per cent.