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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

#41

Post by qgin »

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

If you need a heart transplant, are you planning to self-pay that?

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

#42

Post by brigandish »

klyrs wrote: post #29
ta988 wrote: post #26

Earlier quoted context omitted.

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 capitali…

> That's always stuck with me -- the problem with American healthcare is the American interpretation of capitalism.

What should it cost instead?

> Dude was living off of government research grants.

Let's imagine his work comes to fruition. The drug is expensive but efficacious - is this not a good thing? Should the government have not helped fund this drug because now it's expensive?

The alternative is a world without that drug and without as much incentive to produce the drug. I'm not sure that's a good trade.

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

#43

Post by qgin »

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?

Price is only slightly related to production costs. It’s much more about all the work that goes into getting something like this from basic science to trials to approval (and all the other drugs that fail along the way).

In the current model, pharma only stays in business by recouping all of the during the patent protected period of any drug that makes it to market.

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

#44

Post by msandford »

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

The other thing you can do is setup a trust for yourself so that you're broke on paper long before the trust runs out of money. I don't know if it's ethical but it's legal.

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

#45

Post by qgin »

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.

It’s true, but there’s no alternative. 99% of things don’t work.

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

#46

Post by chris_wot »

brigandish wrote: post #42
klyrs wrote: post #29

Earlier quoted context omitted.

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 capitali…

> That's always stuck with me -- the problem with American healthcare is the American interpretation of capitalism. What should it cost instead? > Dude was living off of government research grants. Let's imagine his work comes to fruition. The drug is expensive but efficacious - is this not a good thing? Should the government have not helped fund this drug because now it's expensive? The alternative is a world withou…

I’m sorry, but that’s a non sequitur. The alternative is not that the drug wasn’t produced. It is that the drug wasn’t developed by private enterprise.

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

#47

Post by goodpoint »

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.

Full remission without surgery?

This looks much more like tossing a dice 18 times and getting a 6 every single time!

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

#48

Post by xiphias2 »

This experiment of treating cancer with checkpoint inhibitors before chemotherapy should be widened to all cancers where the CI is available and effective as soon as possible, as it can cure lots of lives.

I'm worried that it will take many years until that happens.

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

#49

Post by georgeburdell »

qgin wrote: post #41
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

If you need a heart transplant, are you planning to self-pay that?

I have health insurance but I don’t trust some company to not dither when time counts

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

#50

Post by epgui »

vervez wrote: post #11
rubicon33 wrote: post #7

Fascinating, this drug (molecule) somehow “unmasks” the cancer cells, allowing the body’s natural immune system to target and destroy them. How does a molecule do that!? Enters the blood stream, is absorbed by the cancer cell, and then…? Blocks some enzyme?

Couldn't read the article but yea, if it's a small molecule, most likely it's inhibiting some protein specific to cancerous cells. In this case, it sounds like it's blocking some protein that blocks human cells' innate ability to produce antigens, which signal to T-cells that they are defective and need to be destroyed. Sometimes we understand the biology after we discover a treatment.

It’s not a small molecule, it’s a biologic (antibody). It was designed specifically to do what it does, and not discovered by chance.
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