
Lung Cancer Patients Live Longer with Immune Therapy - adumbledore
https://www.nytimes.com/2018/04/16/health/lung-cancer-immunotherapy.html
======
byteCoder
I’m now 5.5 years post-treatment with immunotherapy for Stage IV melanoma and
have had no evidence of disease for over four years. When immunotherapy works,
it can be impressive.

For me, my treatment (adoptive cell therapy using tumor infiltrating
lymphocytes) used my own white blood cells (130 billion in lab-selected and
expanded form) to overwhelm the mutated cancer cells.

It was a one-time treatment (over 3-4 weeks in the hospital) with no further
meds or other treatments required.

Immunotherapy has become an important tool in the future of fighting cancer,
for sure.

~~~
SteveNuts
What was the treatment like? I've heard it's similar to having the worst flu
of your life * 1000.

~~~
byteCoder
Yes, for the two days of high dose IL-2 every 8 hours, it was pretty bad. My
experience was limited to nausea, fever, sweating, and bed-shaking rigors.
I've heard that some patients experience hallucinations.

Note: IL-2 was administered after I received my lab-grown white blood cells.
It acts as signal to one's immune system to activate. It was used to jumpstart
my immune system after it had been replaced.

~~~
bengarrr
I wonder how a combination of aggressive immunotherapy and "sickness"
counteracting effects of cannabis (for the nausea, fever, sweating) would do
in making the immunothrerapy more effective and tolerable.

~~~
byteCoder
Since the treatment was performed on site at the National Institutes of Health
using Federal research dollars, this wouldn't have been an option. So, I have
no idea.

------
marckemil
I'm a radiation oncologist specializing in lung cancer. Here's my take:

Immunotherapy is really revolutionizing the treatment of locally advanced and
metastatic lung cancer. However, a "revolution" in our world is improving
5-year survival by 10-15% in absolute value. It's not outstanding, but when
your baseline is around 10%, improving it by 10% means doubling it. That's why
immunotherapy is being adopted so quickly despite its price.

A poster mentioned $100 000 is not a lot if it adds 10 years. It's not as
simple. Right now we don't really know if we can stop the treatment. So people
often receive the treatment until they progress. If it's 4 years, we're
looking at $400k... The cost on society in general will have to be dealt with
(and debated) at some point. I doubt insurance companies will continue paying
for those treatments "forever", especially considering how prevalent lung
cancer is.

Immunotherapy benefits from a great "romantic" story, which helps with its
marketing like no other drug. It's your own immune system, your army, waking
up and attacking the greatest villain of all; cancer. The alternative,
chemotherapy, is often seen as poison. Granted, it has fewer side effects, but
it has some, and they can be nasty. Basically, the immune system is in a
constant state of equilibrium. You stimulate it too much and it starts
attacking your own body. We're seeing some cases of thyroid problems, lung
inflammation (pneumonitis), skin problems... Generally speaking though, it's
better than most chemos.

Overall, it’s a great treatment but obviously not perfect, crazy expensive to
a point that it’s likely not sustainable in the long run. Despite all of the
drawbacks, it’s a really exciting time for oncologists as we can finally offer
more hope to our lung cancer patients.

------
shadowtree
This is truly exciting and only just the beginning.

There is a host of bio-tech startups following this initial wave - with two
main goals:

1., Improve the treatments to become 100% cures

2., Lower the price

This is very similar to tech and, say, the storage space. Went from 100k for a
few GBs to peanuts for TBs on AWS pretty quickly. That's what momentum in a
crowded space will do.

Healthcare systems around the globe will have to figure out the effects of
this, similar to autonomous driving. And it is not just simple cost of
treatment.

What if cancer becomes curable? What to do with all the cancer wards?
Specialists in Oncology? Chemo/Radio/Surgery? The spider-web effect here is
gigantic.

Sticker price for the drug vs. long term treatment (multiple chemo rounds,
surgery, palliative care) if its 100k is NOTHING.

~~~
randcraw
Yes, this news is exciting. But right now we're a very long way from curing
cancer.

In 50% of the full range of cancer types treated so far by the drug in
question, immunotherapy does absolutely nothing. And for another 25% it helps
only a little. Only about 25% see a game-changing response. Even then, among
high responders, most are not cured. They do live longer than if treated only
with chemo. (In this study announcement, there's a 51% better survival rate
after one year. That's great for those who are near death. But it offers them
additional months of life, not decades.)

As of today, the fraction of patients who are fully cured of cancer by
immunotherapy is unhappily small. It's also important to remember that these
therapies are too new for us to know how long the positive effects will last.
Will the lucky ones add months or years to their lives? We don't know. As of
today it's just too soon to tell.

I do agree that the potential of treating cancer using the immune system _is_
exciting. Certainly. But right now we're nowhere near able to declare victory
or start worrying about the implications of ending cancer. That's not fair to
the unlucky majority of cancer patients.

~~~
mdekkers
_But it offers them additional months of life_

Personally, I always wonder why people go through the pain and expenses to add
a few more months. Years/cure - yes, go for it. A few months? I'll take the
painkillers and anti anxiety drugs, thanks - it was a good run.

------
iooi
> After a median follow-up of 10.5 months, the estimated rate of overall
> survival at 12 months was 69.2% in the pembrolizumab-combination group
> versus 49.4% in the placebo-combination group.

Seriously groundbreaking. This is a once-in-a-decade paper. [1]

[1]
[http://www.nejm.org/doi/full/10.1056/NEJMoa1801005?query=fea...](http://www.nejm.org/doi/full/10.1056/NEJMoa1801005?query=featured_home&)

~~~
mft_
There have been lots of similar 'groundbreaking' data from the various anti-
PD1/-PDL1s over the pest few years. This is great, but not greater than lots
of others.

------
hprotagonist
complaints about study funding aside, checkpoint inhibitors really are
stunningly effective for some cancers.

it’s the first major advance we’ve had in oncology in maybe 25 years.

~~~
DubiousPusher
Haven't there been fairly significant advances in using specialized
chemotherapies for specific forms of cancer? This at least has been my
impression from a few books I've read.

~~~
patall
More or less correct, the parent comment is nonsense. There are multiple
special types of cancer that can be specifically targeted now (for example
CML), though few of those are chemotherapies aside some improved targeting
mechanisms via antibodies. Also, prognosis accuracy has and is improving
dramatically. And there are HPV vaccinations now, targetted virus treatments
comming up and so much more. Immunotherapies are great but not the first and
only thing in 25 years.

------
killjoywashere
AACR meeting in Chicago is the real event. If you're a science junkie,
[http://webcast.aacr.org/s/2018annual/PL01](http://webcast.aacr.org/s/2018annual/PL01)

~~~
killjoywashere
Also from AACR: Google Augmented Reality Microscope:
[https://www.youtube.com/watch?v=9Mz84cwVmS0](https://www.youtube.com/watch?v=9Mz84cwVmS0)

------
schappim
My Father is currently on a trial in Australia which combines Immune Therapy
with traditional chemo treatment. The results can only be described as a
miracle. He has gone from being inoperable stage IV melanoma (with the disease
first being spotted in his lung, not his skin) to showing next to no evidence
of the disease.

When I read many medical studies in the media, they often sound too good to be
true. In this instance it is the real deal.

I hope access to this treatment becomes readily available for the rest of the
public.

~~~
lopmotr
Not to be dismissive, but those other media stories often had someone
incredibly improve their condition too and that someone would have had
children to go around saying "this is the real deal" but it's still only an
anecdote and it still only works on some patients. Even quack therapies have
people recovering naturally sometimes. Not so say immunotherapy is quackery.

------
aaavl2821
This is a really significant public health advance.

In the US, cancer is the second leading cause of death, and lung cancer is one
of the largest causes of cancer death. Curing this disease, even in a subset
of patients, is really amazing

[https://www.cdc.gov/nchs/fastats/leading-causes-of-
death.htm](https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm)

[https://jamanetwork.com/journals/jama/fullarticle/2678018](https://jamanetwork.com/journals/jama/fullarticle/2678018)

------
zpatel
Thanks for sharing. I wish that instead of building destructive weapons, there
was more focus was on building cures for the many diseases and fighting hunger
and poverty..

------
kuwze
I remember reading this recent Financial Times article[0] about how China is
innovating in the area of providing immunotherapy and other breakthrough
treatments.

[0]: [https://outline.com/tdDNdd](https://outline.com/tdDNdd)

[1 non-outlined link]:
[https://www.ft.com/content/30b5a944-3b57-11e8-b9f9-de94fa33a...](https://www.ft.com/content/30b5a944-3b57-11e8-b9f9-de94fa33a81e)

~~~
aaavl2821
Right now China is playing fast-follower in general with this work, but
rapidly becoming more innovative.

There are quite a few Chinese companies developing their own PD 1, PD L1 and
CTLA4 inhibitors (these are the first gen immunotherapy treatments), and a lot
of innovation in CAR-T cell therapy (first approved products of this type were
US and European, Novartis and KITE pharma). There is less regulation of cell
therapy in China, so potential for some breakthroughs.

A company called Legend Biotech in China surprised the biopharma world at a
major confreence last year with breakthrough work with a cell therapy
targeting BCMA.

However, the amount of US and EU investmnet in immuno-oncology is still
greater than in China

------
hanspragt
Someone close passed away from lung cancer last year. He received immune
therapy (keytruda), and while it may work wonders for others, it comes with
drawbacks; My main issue was that it takes 4 to 5 treatments (with weeks
between each treatment) before you even really know if it worked or not. This
is valuable time that could be used to treat the cancer with chemo (which
admittedly has way worse side effects than keytruda, but still).

~~~
wellboy
Are there numbers that say what the success rate of immuni therapy is?

~~~
hanspragt
It sort of depends on what you define as success. The goal was never to "cure"
the cancer, rather, to shrink the tumor.

I hesitate to assign an exact percentage to the effectiveness since there are
so many factors to consider, but I remember Keytruda being reported to shrink
tumors in less than a third of patients who took it.

~~~
iooi
The goal _is_ to cure, from the article, quoting the head of lung at Yale:

> “Chemotherapy has limitations. Immunotherapy has the ability to cure. I lead
> the Yale lung team. We have patients on these immunotherapies alive more
> than eight years.”

~~~
hanspragt
I am sorry, that wasn't clear; That was the goal in the specific case of my
family-member. The tumors would never fully disappear, and he would likely
need more treatments later on.

------
agumonkey
Went to a talk about immunotherapy last year, toxicity of these class of
therapeutics was way better than the best other available treatment. Sadly
still too nascent, but don't forget to ask for it if you can.

------
suyash
Bad reporting - fails to explain what Immunotherapy actually is, jargons all
over. Can anyone explain in simple terms?

~~~
leodeid
Check out the cancer.gov page[1], which does a decent job of giving an
overview. The drug in question, pembrolizumab, is a monoclonal antibody (you
can tell because the name ends with '-mab'), and you can read more about how
those work on this page[2].

[1] [https://www.cancer.org/treatment/treatments-and-side-
effects...](https://www.cancer.org/treatment/treatments-and-side-
effects/treatment-types/immunotherapy/what-is-immunotherapy.html)

[2] [https://www.cancer.org/treatment/treatments-and-side-
effects...](https://www.cancer.org/treatment/treatments-and-side-
effects/treatment-types/immunotherapy/monoclonal-antibodies.html)

------
waynecochran
Immunotherapy is not new. My mom went to Greece in 1980’s and received it. It
was illegal in the US then. She would go to Mexico for booster shots. I
believe it really extended her life w quality. She passed in 1990 but looked
good... not a bag of bones like chemo patients.

------
keepper
Odd they don't mention the cuban work on this field.

"Researchers with Cuba’s Center for Molecular Immunology have developed and
approved an immunologic cancer therapy that improves survivability for certain
types of cancers in some cases; as of January 2017, the drug has begun
clinical trials for the treatment in the United States."

[https://www.usatoday.com/story/news/world/2018/01/09/cuba-
ha...](https://www.usatoday.com/story/news/world/2018/01/09/cuba-has-lung-
cancer-vaccine-many-u-s-patients-cant-get-without-breaking-law/1019093001/)

~~~
randcraw
Vaxira / Racotumomab

[https://www.ncbi.nlm.nih.gov/pubmed/25420897](https://www.ncbi.nlm.nih.gov/pubmed/25420897)

[https://www.frontiersin.org/articles/10.3389/fonc.2012.00150...](https://www.frontiersin.org/articles/10.3389/fonc.2012.00150/full)

This drug has completed a limited Phase II study in 2014 (71 patients), adding
about 5 months of life over the control group (11 mo vs 6 mo). Then it began a
large international phase III NSCLC (lung) study which apparently hasn't ended
yet.

It's approved for use in Cuba and Argentina, probably only for lung cancer.

~~~
keepper
Thanks! Weird I got down voted for my comment..

------
delbel
Cuba has a lung cancer vaccine for $2. Peer reviewed. You don't hear about it.
Edit: I don't even know why I go here if this site is so toxic I get downvoted
for pointing out something. Enjoy your guys toxic conformation bias

~~~
leodeid
The "vaccine" you refer to here is racotumomab. It's not a vaccine in the
common-parlance sense ("prevents disease"), but a different immunotherapy
treatment which is only approved for use in Cuba and Argentina. I'm mildly
curious why it doesn't exist in the US. All of the clinical trials in the USA
which I can find on that drug are either incomplete[1] or completed-but-
without-results[2][3][4]. For all of those trials, "Laboratorio Elea" is the
sponsor or a collaborator, so I presume they have the rights to the drug in
the USA. That's apparently a company out of Argentina[5]. I don't know why
they seem to have given up on getting the drug approved in USA, but wikipedia
says "[a study] is underway in Argentina, Brazil, Cuba, Indonesia,
Philippines, Singapore, Thailand and Uruguay", though the citation for that
seems incredibly suspect[6].

[1]
[https://clinicaltrials.gov/ct2/show/NCT02998983](https://clinicaltrials.gov/ct2/show/NCT02998983)

[2]
[https://clinicaltrials.gov/ct2/show/NCT01460472](https://clinicaltrials.gov/ct2/show/NCT01460472)

[3]
[https://clinicaltrials.gov/ct2/show/NCT01598454](https://clinicaltrials.gov/ct2/show/NCT01598454)

[4]
[https://clinicaltrials.gov/ct2/show/NCT01240447](https://clinicaltrials.gov/ct2/show/NCT01240447)

[5] [http://www.elea.com/](http://www.elea.com/)

[6]
[https://en.wikipedia.org/wiki/Racotumomab#Clinical_trials](https://en.wikipedia.org/wiki/Racotumomab#Clinical_trials)

------
stochastic_monk
The prohibitively expensive nature of any immunotherapy leaves me profoundly
skeptical of its practical usefulness. $100,000/year? That's more than twice
the median income in this country.

Is it simply that expensive to get mabs from animals, is drug development
disgustingly expensive, or is there unbounded greed in pharmaceutical
companies?

~~~
abarringer
I've been in and out of the hospital a bit lately (broken back). That seems
downright cheap. I average about $4,000 an hour when I'm in. The most recent
"study" took an hour with one low paid tech using one ultrasound machine and
it cost over $2,000. CT Scan? 15 minutes $7K. Heck, they charged nearly $800
to "start an IV" when they didn't even start it, it was the ambulance EMT that
put it in (billed separately) they just injected morphine into it. If you
don't have good insurance you are one small slip away from bankruptcy.

~~~
murukesh_s
CT scan is less than 100$ in most places in India. It could go up to 200$ in
some hospitals and is considered expensive by the patients.

~~~
murukesh_s
And ultrasound is 10-20$. I find it seriously expensive in US. One thing is
the health insurance or public backed healthcare is not widely adopted and
patients still pay from their own pockets in India so charging exorbitant
amounts is a big no-no.

