Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nytimes.com

Post reply on HN
Print view View original

61–70 of 242 posts

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

#61

Post by adamredwoods »

instagraham wrote: post #13
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?

That is the function of checkpoint inhibitors, according to an explanation I got from a cancer researcher after asking a similar question. Essential, cancer cells convince the immune system not to attack them, so these inhibitors target the mechanisms by which they do so to get the immune system to take note of these cells. Hope someone more knowledgeable will correct me if I'm wrong.

Cancer cells express proteins that communicate with lymphocytes (white blood cells) to block apoptosis (cell death).

We can't target the cancer cells, so we tweak the lymphocytes to block PD-1 receptors, thus ignoring ALL cells that express a lot of PD-L! protein.

This unfortunately includes healthy cells.

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

#62

Post by adamredwoods »

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 price won't drop, it isn't common enough and still in clinical trials.

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

#63

Post by pkaye »

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. Dude was living off of government research grants.

Do the drug companies in Europe do any different though?

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

#64

Post by bwb »

nootropicat wrote: post #57
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 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 pa…

That is not true, look up medical outcome data. Most of europe is far ahead or even with the USA.

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

#65

Post by abeppu »

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…

But so two patients in different financial circumstances would both pay basically as much as they are able for a life-saving treatment, arriving at very different amounts, right?

- that sounds a lot like ransom?

- I think if they adopt a policy of price-discrimination to the point of literally taking you for all (or most) of what you're worth (or projected to be worth), we should turn around and apply the same reasoning to corporate tax rates.

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

#66

Post by axpy906 »

adamredwoods wrote: post #59
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.

What treatments in particular?

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

#67

Post by sonicggg »

After reading it, my suspicion was confirmed. Yet another mab. Very powerful, but expensive to scale and synthesise. I guess poor people will have to just suck it up and die. We don't have the tech yet to make these cost effective. Big pharma loves this natural barrier of entry though.

Also, don't expect this stuff to be available anytime soon. FDA process is pretty slow, and sometimes political. Maybe if it were effective against Sars-Cov-2, FDA would be willing again to rush it though the door. Still can't wrap my head around how stuff like Molnupiravir made the cut. They just don't have any shame.

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

#68

Post by Merad »

spywaregorilla wrote: post #31
horsawlarway wrote: post #27

Earlier quoted context omitted.

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 turn…

I'd rather just die. Throw a party. Tell my kids they're getting a ton of cash. Say good bye on happy terms. Vs. a miserable decay for everyone involved at huge expense. It's not worth it. Forget the money. The emotional toll is large and for whose benefit?

Even ignoring the fact that human euthanasia is illegal in most of the US, it's rarely that easy. Both of my paternal grandparents lived into their 90s but suffered from mental decline (different forms of dementia) and died as shells of their former selves. If you could have spoke to either of them at the end of their lives but with their full mental capacity, I suspect they would have said that they'd have preferred to die earlier rather than live through that decline... but in reality by the time anyone understood how severe their mental decline would become they were already well past the point that they could have consented to euthanasia.

In theory you could presumably have some kind of system where a person of sound mind could that said, in effect, "if my condition declines beyond _____ then I want to end it," but doing so would be an incredibly touchy subject even if euthanasia was legalized. Unfortunately there is a very real potential for such a directive to by abused by people motivated by greed (gimmie that inheritance) or who simply don't want to deal with an aging relative who needs more help but hasn't reached the point where their euthanasia directive should be triggered.

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

#69

Post by ImHereToVote »

xiphias2 wrote: post #48

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.

Maintaining well established medical procedures is much more important than some bio-robots dying.

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

#70

Post by adamredwoods »

xiphias2 wrote: post #48

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.

The treatment is not without side effects. It's still a general therapy (it blocks all lymphocyte PD-1 receptors), not a cancer-target one.

Oncology is slow. It really is up to the patients to push the oncologist teams.

Post reply on HN