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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

#51

Post by goodpoint »

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…

> What should it cost instead?

To patients? It should be free.

To society? The initial research cost plus the bare manufacturing cost.

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

#52

Post by brigandish »

chris_wot wrote: post #46
brigandish wrote: post #42

Earlier quoted context omitted.

> 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 .

Please don't give insincere apologies, they're rhetorically weak and pairing insincerity with something that should be sincere isn't a good look.

Which segues nicely to this pairing of public funding and private enterprise. No, if the drug wouldn't be sold for a profit then the incentive to make it wouldn't exist and the funds would not be applied for and the ironic pairing - if it is ironic, which I don't think it is - wouldn't exist either.

Unless we're going to believe that researchers go through the mill of applying for funding and doing research simply to get the funding and stay in badly paid employment?

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

#53

Post by X6S1x6Okd1st »

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/jjco/article/45/1/111/888056

So using 0.0016% and 12 patients (which is what the paper the NYT actually links)

For a ~50% chance of seeing one trial with 12 patients have complete remission you'd expect to see ~43k trails.

(1 - 0.000016)^43000 = 0.502577

I wouldn't discount this study based off of those numbers.

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

#54

Post by abirch »

zzzeek wrote: post #32

My dad was fortunate enough to get into a trial at Sloan for Obinutuzumab for Chronic Lymphocytic Leukemia. At the moment, after 6 weeks of treatment, the percent of cancerous cells in his bone marrow has gone from 95% to 5%. The treatment was very intense as it overloads the kidneys on the first few treatments due to the dramatic amount of cells being flushed out. This is a cancer for which there was not much treatm…

That's great for your dad. Thank you for also distinguishing between types of cancer and the nebulous term cancer, many people don't make the distinction.

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

#55

Post by mkoubaa »

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

Pay lots of money to spend more of your life dying

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

#56

Post by zzzeek »

abirch wrote: post #54
zzzeek wrote: post #32

My dad was fortunate enough to get into a trial at Sloan for Obinutuzumab for Chronic Lymphocytic Leukemia. At the moment, after 6 weeks of treatment, the percent of cancerous cells in his bone marrow has gone from 95% to 5%. The treatment was very intense as it overloads the kidneys on the first few treatments due to the dramatic amount of cells being flushed out. This is a cancer for which there was not much treatm…

That's great for your dad. Thank you for also distinguishing between types of cancer and the nebulous term cancer, many people don't make the distinction.

googled first to get the correct spellings and all that, been on hacker news a long time...

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

#57

Post by nootropicat »

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 not the problem, that's the reason almost all medical development happens in America.

Rich people from all around the world travel to American hospitals if they have serious health problems, not to public hospitals even in rich countries like Norway. Public healthcare works (poorly) as a way to distribute existing treatment, but is worthless at incentivizing development. Really, the entire world is unfairly parasitizing on Americans to fund medical research.

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

#58

Post by abirch »

pella wrote: post #23

> 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

As with most experiments there's a control group (6 patients). The original statement of 18 participants is correct along with yours of 12 patient treatment group.

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

#59

Post by adamredwoods »

zzzeek wrote: post #32

My dad was fortunate enough to get into a trial at Sloan for Obinutuzumab for Chronic Lymphocytic Leukemia. At the moment, after 6 weeks of treatment, the percent of cancerous cells in his bone marrow has gone from 95% to 5%. The treatment was very intense as it overloads the kidneys on the first few treatments due to the dramatic amount of cells being flushed out. This is a cancer for which there was not much treatm…

For leukemia, there are a lot of promising new treatments and clinical trials. For metastatic solid-state tumors, much less. We're still in the dark ages of cancer treatment.

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

#60

Post by hughes »

msandford wrote: post #44
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

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.

What's unethical is a system that completely drains a person's wealth for getting sick.
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