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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

#81

Post by caddemon »

bwb wrote: post #64
nootropicat wrote: post #57

Earlier quoted context omitted.

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.

Unless you are looking at outcomes of only the top institutions it's not really what he was saying. The US has a bad system for the average person for sure, but that does not mean that the US doesn't have one of the best systems if you can afford the best care. If you have medical outcome data that disputes that specifically I'd be interested.

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

#82

Post by adamredwoods »

axpy906 wrote: post #66
adamredwoods wrote: post #59

Earlier quoted context omitted.

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?

Car-T seems promising for leukemia and lymphoma, but not as efficacious in solid tumors:

https://www.lls.org/treatment/types-treatment/immunotherapy/...

Also 2nd gen BTK inhibitors:

https://en.wikipedia.org/wiki/Acalabrutinib

https://en.wikipedia.org/wiki/Bruton%27s_tyrosine_kinase

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

#83

Post by foobiekr »

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?

Normally, I would not comment on this.

You say that now.

I am close to someone looking at this now after holding that exact view for a lifetime, what I see them actually doing is delaying and delaying and confronting that, even on their darker days when they are thinking hard about doing it, the logistics of zero-risk-of-survival suicide are pretty terrible.

It's sobering to watch because I, too, hold the view you lay out above, and now watching this, I think I'd better work out my logistics while I'm relatively young and healthy.

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

#84

Post by dash2 »

abirch wrote: post #58
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.

But then I guess it is slightly less surprising that all 12 people had remission, rather than all 18. (Or if all 18 had remission, then that's amazing but might not be to do with the drug.) Maybe it is still a great result, just slightly less significant.

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

#86

Post by nicoburns »

foobiekr wrote: post #83
spywaregorilla wrote: post #31

Earlier quoted context omitted.

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?

Normally, I would not comment on this. You say that now. I am close to someone looking at this now after holding that exact view for a lifetime, what I see them actually doing is delaying and delaying and confronting that, even on their darker days when they are thinking hard about doing it, the logistics of zero-risk-of-survival suicide are pretty terrible. It's sobering to watch because I, too, hold the view you la…

I wonder if that is due to the lack of good options for the ending life? I currently feel like I would like to go on my own terms when the time comes, but none of the options available look very appealing! (and many of them can come with legal trouble for anyone who helps).

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

#88

Post by nicoburns »

Merad wrote: post #68
spywaregorilla wrote: post #31

Earlier quoted context omitted.

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…

> but doing so would be an incredibly touchy subject even if euthanasia was legalized.

It would, but the alternative is to make people live though this mental decline as we currently do. IMO it would be well worth the risks to be able to ameliorate the end of peoples lives.

My plan is to end my life well before I hit severe mental decline (not “if it gets worse”, with all the ambiguities that entails). If that cuts a few years off then a be it!

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

#89

Post by pc86 »

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…

Probably a decade ago a friend of mine passed from Acute Lymphocytic Leukemia in his 20s. I'm not sure what the differences are between ALL and CLL (other than knowing the differences between acute and chronic in a more general sense of course) but glad to see they are making at least some progress.

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

#90

Post by ufo »

_Microft wrote: post #37
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?

The name of the drug ends in "-mab" [0] indicating that the drug is based on monoclonal antibodies [1,2]. Those antibodies are tweaked to bind to cancer cells which makes the immune system attack the cancer cells. [0] https://en.wikipedia.org/wiki/Drug_nomenclature#List_of_stem... [1] https://en.wikipedia.org/wiki/Monoclonal_antibody [2] https://en.wikipedia.org/wiki/Monoclonal_antibody_therapy

IIRC, in this particular case the antibodies bind to immune cells. Immune Checkpoints are a mechanism that keeps the immune system from attacking the own body but in cancer it can also stop the immune system from destroying the cancer. The checkpoint inhibitor antibodies remove these restrictions and allow the immune cells to attack the cancer. (The price is that they also become free to attack other things they shouldn't; autoimmune inflamations are common side effects.)

https://en.wikipedia.org/wiki/Checkpoint_inhibitor

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