New Radiotracer Can Identify Nearly 30 Types of Cancer • Hacker News Board

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#61

Post by irq » Tue, Jun 11, 2019, 1:11 AM UTC

frisco wrote: post #13

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

I did Health Nucleus which includes a whole body MRI (no ionizing radiation exposure) and a bunch of other stuff geared towards looking for cancer. Apparently Prenuvo in Vancouver is considered the best now. It’s a few $k and insurance doesn’t cover it, but there are a bunch of options for self-pay to be more aggressive in primary care / health surveillance. This stuff about “overtesting” and “iatrogenic risk” is sil…

I'd like to learn more about companies like Prenuvo, is there some online community somewhere where you heard Prenuvo was the best? Or some other resource where I can learn? If so I'd appreciate a link, thanks!

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#62

Post by Randypea » Tue, Jun 11, 2019, 1:50 AM UTC

orr721 wrote: post #49

lipman wrote: post #30

Earlier quoted context omitted.

Good luck with the surgery! You probably got Octreoscan which is used for NET - it's SPECT imaging which is generally worse that PET, but (until now) there wasn't a good PET tracer that works in NET. Awesome to hear a story of how this new tracer could really help patients.

Sorry, this is not true. 68Ga-labelled DOTATOC, DOTANOC, and DOTATATE are used diagnosis and therapy of NETs for more than 10 years. They are widely available in Europe and in some major US centers. If the new 68Ga-FAPI will be better remains to be seen, I suppose the Heidelberg group will publish some research soon.

You are correct it's only in the last several years this Gallium 68 scan has been available in the US, but was available in Europe long before - like many cancer treatments.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#63

Post by Gibbon1 » Tue, Jun 11, 2019, 1:55 AM UTC

Nasrudith wrote: post #37

docker_up wrote: post #28

Earlier quoted context omitted.

Maybe figure out a better way to verify that doesn't require biopsy? Maybe use machine learning in conjunction with better data? I don't know enough but there must be other techniques we could devise that don't require major invasive surgery every single time. Just sitting on our hands on this information and letting people die is the worst decision. We need to improve our technology to get better results, not throw…

Well the ways that don't involve surgery are themselves less accurate heuristics with false positives. How can they calibrate without being certain if it is a true or false positive or negative? Better imaging is an option but that often falls into dangerous in itself or easier said than done like say trying to do detection of cancer by scent. Machine learning is fundamentally GIGO and tends to learn smartass shortcu…

My limited experience is that for small contained cancers imaging can't predict the future course for the tumor because you need cellar resolution that you can't get without a biopsy and a microscope and or genetic tests.

Even then it's really common to see a biopsy come back as 'indeterminate'. If it's indeterminate then now what? You either punt and do nothing or go for excision.

Consider this tidbit: A lot of slow moving low grade cancers it hardly matters when you find them. Early or later matters little. Whereas aggressive cancers often are untreatable. Find them early, find them late you'll die either way. And fast growing cancers often fully develop between screenings.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#64

Post by frisco » Tue, Jun 11, 2019, 2:13 AM UTC

irq wrote: post #61

frisco wrote: post #13

Earlier quoted context omitted.

I did Health Nucleus which includes a whole body MRI (no ionizing radiation exposure) and a bunch of other stuff geared towards looking for cancer. Apparently Prenuvo in Vancouver is considered the best now. It’s a few $k and insurance doesn’t cover it, but there are a bunch of options for self-pay to be more aggressive in primary care / health surveillance. This stuff about “overtesting” and “iatrogenic risk” is sil…

I'd like to learn more about companies like Prenuvo, is there some online community somewhere where you heard Prenuvo was the best? Or some other resource where I can learn? If so I'd appreciate a link, thanks!

I hear about these things through the grapevine in San Francisco. There's a subculture there that's all about optimizing their healthcare with as much data as possible; having seen what's possible, you really come to believe that primary care as it exists today for most people under 55 is basically a scam. I have two personal friends who are probably only alive now because they were more proactive about getting health data! (No joke, abnormalities found on MRIs turned out to be early stage cancer.) And a bunch more friends who are overall much healthier than they were before because now they have numbers to move. (Or numbers that move faster: for example, using Dexcom G6s has been catching on as a hack to lose weight because the gradient is much better behaved than a scale.) I also saw one case where someone was diagnosed with cancer and they put together a research team to help guide their treatment... and they ended up developing all this experimental medicine for him which, while ultimately unsuccessful, is thought to have added about a year of life. (Did you know that the FDA can grant single-patient INDs over the phone within one day? [0])

There's a lot of accumulated knowledge out there on how much better healthcare can be for motivated patients who can afford to pay for some of it out of pocket, but it's seen as pretty contrarian, so not discussed that openly. (Just see the other comments in this thread about how "overtesting" is a dangerous waste of resources...)

I don't know of an online community or blog that collates all this info well, but Peter Attia's blog/podcast is a good place to start: https://peterattiamd.com/

[0] https://www.fda.gov/drugs/investigational-new-drug-ind-appli...

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#65

Post by lipman » Tue, Jun 11, 2019, 2:40 AM UTC

orr721 wrote: post #49

lipman wrote: post #30

Earlier quoted context omitted.

Good luck with the surgery! You probably got Octreoscan which is used for NET - it's SPECT imaging which is generally worse that PET, but (until now) there wasn't a good PET tracer that works in NET. Awesome to hear a story of how this new tracer could really help patients.

Sorry, this is not true. 68Ga-labelled DOTATOC, DOTANOC, and DOTATATE are used diagnosis and therapy of NETs for more than 10 years. They are widely available in Europe and in some major US centers. If the new 68Ga-FAPI will be better remains to be seen, I suppose the Heidelberg group will publish some research soon.

I just took him at his word that it was FAPI & was asking if it is available in the US - also I favor PET as a modality b/c it's quantitative. No judgement on a particular tracer.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#66

Post by sheeshkebab » Tue, Jun 11, 2019, 4:45 AM UTC

Gibbon1 wrote: post #63

Nasrudith wrote: post #37

Earlier quoted context omitted.

Well the ways that don't involve surgery are themselves less accurate heuristics with false positives. How can they calibrate without being certain if it is a true or false positive or negative? Better imaging is an option but that often falls into dangerous in itself or easier said than done like say trying to do detection of cancer by scent. Machine learning is fundamentally GIGO and tends to learn smartass shortcu…

My limited experience is that for small contained cancers imaging can't predict the future course for the tumor because you need cellar resolution that you can't get without a biopsy and a microscope and or genetic tests. Even then it's really common to see a biopsy come back as 'indeterminate'. If it's indeterminate then now what? You either punt and do nothing or go for excision. Consider this tidbit: A lot of slow…

In other words - you’re dead either way - go have a beer instead?

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#67

Post by inimino » Tue, Jun 11, 2019, 5:35 AM UTC

frisco wrote: post #64

irq wrote: post #61

Earlier quoted context omitted.

I'd like to learn more about companies like Prenuvo, is there some online community somewhere where you heard Prenuvo was the best? Or some other resource where I can learn? If so I'd appreciate a link, thanks!

I hear about these things through the grapevine in San Francisco. There's a subculture there that's all about optimizing their healthcare with as much data as possible; having seen what's possible, you really come to believe that primary care as it exists today for most people under 55 is basically a scam. I have two personal friends who are probably only alive now because they were more proactive about getting healt…

> who are probably only alive now because they were more proactive about getting health data!

Or "who think they are"? How can you be sure?

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#68

Post by jtms » Tue, Jun 11, 2019, 4:12 PM UTC

skybrian wrote: post #46

docker_up wrote: post #42

Earlier quoted context omitted.

This type of attitude is typical, where one likes to dismiss new ideas and keep status quo instead of coming up with new ideas or innovations. The point is that there is an opportunity for the Steve Jobs of health care to come up with a way, a new innovative novel way, for classification of tumors to be improved without needing biopsy. Once we have that, then we can take tests to our heart's content. Right now, the a…

Presumably none of us here are inventors of new medical technology. We are just amateurs talking about this casually on Hacker News. Saying it's "unacceptable" doesn't change anything from either the doctor or patient's point of view. Until the new tech comes along, we need to accept the limitations of what we have now.

I agree with you, but I think the original point was that we may already have technologies that could be employed, but that there is concern they are not being used

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#69

Post by markus92 » Tue, Jun 11, 2019, 9:28 PM UTC

Gatsky wrote: post #60

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

Other comments have spoken about why random screening is a bad idea. But the real problem is the tests we have just aren’t good enough. What are you hoping to diagnose with a CT scan? If you don’t smoke, the most common cancer you’ll get is breast/prostate and colon. CT scans are close to useless for detecting those cancers (If you do smoke then there is some evidence for CT screening). Also note that image based scr…

Just FYI: CT/MR can nowadays be performed at sub millimeter resolution pretty much everywhere with up to date equipment, even out of plane.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#70

Post by Gatsky » Tue, Jun 11, 2019, 9:34 PM UTC

markus92 wrote: post #69

Gatsky wrote: post #60

Earlier quoted context omitted.

Other comments have spoken about why random screening is a bad idea. But the real problem is the tests we have just aren’t good enough. What are you hoping to diagnose with a CT scan? If you don’t smoke, the most common cancer you’ll get is breast/prostate and colon. CT scans are close to useless for detecting those cancers (If you do smoke then there is some evidence for CT screening). Also note that image based scr…

Just FYI: CT/MR can nowadays be performed at sub millimeter resolution pretty much everywhere with up to date equipment, even out of plane.

This doesn’t change anything, I’m sure you know that the smaller the lesion the harder it is to determine what it is, and they are impossible to biopsy or resect.