A Universal Cancer Treatment? • Hacker News Board

Re: A Universal Cancer Treatment?

#31

Post by nighthawk454 » Thu, Oct 06, 2022, 7:38 PM UTC

sam537 wrote: post #28

Oncologist here. You can think of drug development as an extremely wide funnel with a minuscule exit hole. At any given time a medium sized pharmaceutical company has 300-500 drug candidates. From this group 50 make it to phase 1 trials. 40 get slashed due to toxicity, company abandons them, gets bought by third party and sits in sleepy storage. 10 advance to phase 2 trials where 5-8 may not end up having enough effi…

Thanks, that's an interesting insight into the dropoff rate for these ideas. Do you have an opinion on what the bottleneck is? Volume of ideas, length of testing, or perhaps flawed approach in general?

Re: A Universal Cancer Treatment?

#32

Post by sam537 » Thu, Oct 06, 2022, 7:39 PM UTC

mentos wrote: post #25

Early detection? Whats the best way to detect cancer (money is no object) and how do we get that cost down 10x and get everyone to participate?

Look at GRAIL therapeutics. Cancer sheds DNA that can be detected and amplified. We use this sometimes to try to tell if someone will have a recurrence before scans actually show it. Sequencing is hard, and there are contaminants and difficulties calling a mutation/sequence cancerous, but I have had patients self-refer after a positive GRAIL test, no symptoms, and bam, biopsy from area of interest shows early cancer.

Re: A Universal Cancer Treatment?

#33

Post by pella » Thu, Oct 06, 2022, 7:40 PM UTC

mentos wrote: post #25

Early detection? Whats the best way to detect cancer (money is no object) and how do we get that cost down 10x and get everyone to participate?

problems:

- False-positive results

- False-negative results

"Mammograms are the best breast cancer screening tests we have at this time. But mammograms have their limits. For example, they aren’t 100% accurate in showing if a woman has breast cancer. They can miss some cancers, and sometimes they find things that turn out not to be cancer (but that still need further testing to be sure)."

https://www.cancer.org/cancer/breast-cancer/screening-tests-...

Re: A Universal Cancer Treatment?

#34

Post by sam537 » Thu, Oct 06, 2022, 7:41 PM UTC

JanSt wrote: post #22

Does anyone know about updates on mRNA treatments for cancer? I had big hopes after the impressive corona-virus vaccines. I know BioNTech is investing heavily but not much has changed since then?

There are a few vaccines that try to 'make' your immune system recognize an abnormal (read cancerous) protein as foreign (Sipleucel T for prostate, GMCSF vaccine for melanoma). Minimal activity.

Re: A Universal Cancer Treatment?

#35

Post by asdff » Thu, Oct 06, 2022, 7:41 PM UTC

yshrestha wrote: post #24

I may be missing something but the article does not explain how the bacteria target is actually targeting the cancer cells. Of course, if you can design an ideal universal cancer targeting mechanism, the active ingredient itself is beside the point. Did anyone else catch this? Stopping DNA replication across the body will be fatal. This is what eventually kills with radiation toxicity.

It does, from the article: "“Normally, our blood vessel walls are all sealed pipes,” Brahmbhatt says. “But around wherever the cancer is growing, the blood vessels are known to be very defective. They have got a lot of holes in them.”

Brahmbhatt and his collaborator Jennifer MacDiarmid devised a clever ploy. They would send a Trojan horse into malignant cells and turn cancer’s own trickery against it.

The Trojan horse, in this case, is a product of a harmless bacteria that’s been genetically engineered to have specific qualities. When this genetically engineered bacteria divides, it yields a tiny non-living cell of 400 nanometers in diameter—the right size to slip through the damaged vessels and mingle with the tumors."

Re: A Universal Cancer Treatment?

#36

Post by pfdietz » Thu, Oct 06, 2022, 7:42 PM UTC

nighthawk454 wrote: post #31

sam537 wrote: post #28

Oncologist here. You can think of drug development as an extremely wide funnel with a minuscule exit hole. At any given time a medium sized pharmaceutical company has 300-500 drug candidates. From this group 50 make it to phase 1 trials. 40 get slashed due to toxicity, company abandons them, gets bought by third party and sits in sleepy storage. 10 advance to phase 2 trials where 5-8 may not end up having enough effi…

Thanks, that's an interesting insight into the dropoff rate for these ideas. Do you have an opinion on what the bottleneck is? Volume of ideas, length of testing, or perhaps flawed approach in general?

The extreme complexity of biology. There's no substitute to just trying things and seeing if they work, because you will never understand what's going on beforehand.

Re: A Universal Cancer Treatment?

#37

Post by asdff » Thu, Oct 06, 2022, 7:42 PM UTC

mentos wrote: post #25

Early detection? Whats the best way to detect cancer (money is no object) and how do we get that cost down 10x and get everyone to participate?

You can detect tumor cells circulating in blood for certain cancers. You can get the cost down by having these tests covered at regular intervals by insurance companies.

Re: A Universal Cancer Treatment?

#38

Post by sam537 » Thu, Oct 06, 2022, 7:43 PM UTC

nighthawk454 wrote: post #31

sam537 wrote: post #28

Oncologist here. You can think of drug development as an extremely wide funnel with a minuscule exit hole. At any given time a medium sized pharmaceutical company has 300-500 drug candidates. From this group 50 make it to phase 1 trials. 40 get slashed due to toxicity, company abandons them, gets bought by third party and sits in sleepy storage. 10 advance to phase 2 trials where 5-8 may not end up having enough effi…

Thanks, that's an interesting insight into the dropoff rate for these ideas. Do you have an opinion on what the bottleneck is? Volume of ideas, length of testing, or perhaps flawed approach in general?

This is the bottleneck for one company. We have many companies this size doing the same thing.

The issue is large companies (novartis/BMS) sometimes sit on compounds and refuse to develop because they think it may not be worth it, may think a certain disease (read market) is saturated, or they may be waiting for the 'right time'. It can be frustrating.

Smaller companies have 2-3 compounds which they actively work to develop but most of them end up getting acquired by the big fish.

Re: A Universal Cancer Treatment?

#39

Post by nyx » Thu, Oct 06, 2022, 7:46 PM UTC

borbulon wrote: post #18

nyx wrote: post #2

It really is remarkable how far cancer treatment has progressed, even in the last few years. I'm one of the unfortunate people who, through a close family encounter with cancer, knows more about this stuff than anyone should have to. The oncologist told my relative that if they had presented with this particular cancer just a decade ago, his recommendation would have been to start hospice care. However, in recent yea…

As a person who currently has stage IV NSCLC, I can add some context to this: YMMV. One thing to remember is that "Lung Cancer" is not just one thing. There are mutations of different genes, there are overexpressions of different genes. Each one has its own new medicines. Also, some peoples' cancers are more aggressive than others, and while for many they can find the right drug, for some nothing works. Keytruda work…

Thanks for sharing your story and treatment details. I should add that my relative's cancer has no particularly interesting mutations, but does have a high PD-L1 expression, which from what I can tell is the reason Keytruda was more likely to work for their situation.

> that was geared towards my specific mutation

This is actually one of the things that gives me hope for the future: genetic testing on a tissue sample of the patient's cancer is standard, and for many of the specific oncogenes that we know about, there exist therapies targeted to those specific mutations: https://www.cancer.org/cancer/lung-cancer/treating-non-small...

One thing I've learned is that even in the face of good news, cancer is a horrible time, and I wouldn't wish it on anyone. But I'm likewise glad to hear about your results from the latest treatment, and hope things stay as positive as they can for you.

Re: A Universal Cancer Treatment?

#40

Post by asdff » Thu, Oct 06, 2022, 7:48 PM UTC

chrisamiller wrote: post #30

mentos wrote: post #25

Early detection? Whats the best way to detect cancer (money is no object) and how do we get that cost down 10x and get everyone to participate?

Money is absolutely an object. People are starting to do trials of early detection from circulating tumor DNA, and finding that the hit rate is alarmingly high. A decent portion of the population has some kind of malignancy, but most of these will either be cleared by the immune system, or be completely benign. Another problem is, if we detect this tumor DNA, it doesn't tell us where in the body the tumor might be. S…

>Another problem is, if we detect this tumor DNA, it doesn't tell us where in the body the tumor might be.

This isn't necessarily the case. A lot of CTCs have markers that are indicative of certain cancers or tissue types of origin. Different tissues have specific patterns of gene expression even if they all have the same underlying DNA, and there are databases with thousands of samples sequenced supporting these patterns.