
Immunotherapy cancer drug hailed as 'game changer' - sjcsjc
http://www.bbc.co.uk/news/health-37588541
======
randcraw
If you have cancer, as I may still do (after prostate surgery), PD-1 and PD-L1
immunotherapy simply is NOT a game changer. On average, you live another 6
months, but only if you pass a screening to get the treatment, which most
patients fail. So in practice, even with these drugs, the outcome of getting
cancer is significant only in a statistical sense. Hardly a breakthrough.

I also happen to work for one of the two pharmas making these drugs, and it
PISSES ME OFF no end how much overpromotion this advancement is getting. Fact
is, if you have cancer, you're still going to die, at best a year later than
if you were on chemo. So the lucky few who pass immuno-screening and then get
these drugs will benefit mostly by avoiding chemo, not by living significantly
longer, much less getting cured.

Added to its modest actual outcome, the COST of this treatment is insane -
profiteering of the worst kind. Charging a dying person $80,000 for an extra
3-6 months of life while promoting the drug as a 'breakthrough' is just plain
wrong. It's a violation of the Hippocratic oath. And it's caused me to lose
the little bit of my remaining faith in the value of working in this industry.

'As good as it gets' is a pitiful rallying cry when battling cancer, IMHO.

~~~
feelix
It seems like the PR engine is on overdrive for this drug. And it looks the
BBC are spewing it out without giving it any thought at all. Or perhaps the
reported was paid?

I'm not saying it has no value, I'm saying that their PR is wildly out of
control and it's reflecting on the poor state of journalism more than the
efficacy of the drug.

Here is a scathing review of it and the PR engine behind it from the NYT just
a month ago, ironically: [http://www.nytimes.com/2016/08/09/opinion/cancer-
drug-ads-vs...](http://www.nytimes.com/2016/08/09/opinion/cancer-drug-ads-vs-
cancer-drug-reality.html)

OPDIVO is another name for nivolumab.

No one should call a cancer treatment drug a 'game changer' unless it
literally cures cancer in something like 90% of cases. Otherwise it's
spreading false hope and it is actually immoral - if you consider that nearly
everybody has been affected by cancer either directly or indirectly.

~~~
danieltillett
Actually any drug that cures people with cancer even a small percentage is a
game changer. A drug that cured 5% of all cancers would be fantastic given
most drugs just delay progression with very bad side effects.

Our metrics are really skewed - we reward companies that develop drugs that
increase average life expectancy by a few months in a large percentage of the
target population and which cure nobody, not those that cure even if it is
only a small percentage of the target populations.

The really bad thing is we are doing almost nothing to develop treatments that
prevent cancer in the first place (well nothing gets to the clinic). The three
really big advances in cancer treatment in the last 100 years have been the
HPV vaccine, Hep B vaccine / anit-Hep C drugs, and antibiotic treatment of
Helicobacter (stomach cancer). All of these are preventive treatments that
have “cured" millions of cancers.

~~~
feelix
How would you consider a drug that cures 5% of cancers a "game changer"?

Do you know what a game changer is? Hint: It means the game changes. In this
case it would mean that cancer is at least 50% obviated.

~~~
danieltillett
The reason it is a game changer in we are now trying to cure not just increase
survival. Once you have a method that can cure people with advanced cancers
that all other treatments types fail on you have a game changer.

~~~
feelix
I'd certainly like to think that's the case, although unfortunately it does
not seem to be. If you read the article I posted in my initial comment, for
example, it seems like this involves value combined with PR BS.

If you think that's not the case and it truly is a game changer please do
share why

~~~
danieltillett
The immunological drugs really are game changers. Up until now we have had
three basic ways of treating cancer: cut, irradiate or poison. These basically
never work on advanced cancers, or cancers that come back after initial
treatment.

The immunological drugs turn the immune system against the cancer and this
approach can cure cancers that are untreatable using other methods. It is
still really early days, but the immunological drugs are able to take patients
that are weeks from death, and for which everything else has failed, and cure
them.

What we really need to know if why it does not work for everyone, but it
provides a crack into which we can hammer a wedge.

~~~
feelix
Indeed the class of immunological drugs look like they could be a game changer
at some point in the future.

However the question is around the use of the term for this specific drug
right now.

~~~
danieltillett
Well this drug is curing people with terminal cancers - something we have not
ever been able to do before. Game changer does not have to mean we have
perfection, just the previous approach is no longer valid and we are tackling
the problem in a new way.

In the field, immunological drugs have given investigators hope that we know
that cancer is able to be cured and we now just have to figure out the best
way to do it - in the past we really didn’t have an approach that had a chance
of making cancer a curable disease. Sure there were some approaches that might
work on some cancers or some approaches that would hold the cancer at bay for
a time, but nothing that gave hope of general cure.

To put it more succinctly, terminal is no longer terminal.

------
refurb
To some folks this may not seem like much of a benefit, but these improvements
add up over time. I could only find this example, but in the last 40 years,
the 5-year survival rate for breast cancer patients has gone from ~75% to 92%.
All of that benefit was recognized at once, but rather incremental benefits
added up over time.

I wish I could have the table I saw for colorectal cancer. Really amazing.
We're talking average overall survival going from 6 months to 5 years in the
span of a few decades. This isn't the one I was thinking of, but it's a great
example.[1]

[1][https://www.bowelcanceraustralia.org/images/Bowel_Cancer_Aus...](https://www.bowelcanceraustralia.org/images/Bowel_Cancer_Australia_Advocacy_Therapeutic_Progress_660.jpg)

~~~
danieltillett
Unfortunately a large percentage of this increase has been from detecting
early cancers which push out the time to death by pulling back the time of
detection - we are not having an impact on the course of disease that the
numbers would suggest.

I hate 5 year survival as a metric. We should be targeting 10+ years survival
(or death from any other cause) as a metric. Five years is just too short a
time to know if you have beaten cancer.

~~~
sachingulaya
For measuring survival my old lab championed the Kaplan-meier estimator for
its ability to censor non-cancer causes of death. The 5yr survival can be
heavily skewed if patients are dying from secondary causes such as heart
attacks, getting hit by a bus, etc. Oftentimes patients with cancer have other
serious comorbidities.

~~~
danieltillett
Exactly. Most people getting cancer are pretty old. Time to death might make
sense in paediatric cancers, but not in 80 year olds.

------
wbkang
Just to clarify, this immunotherapy is legit science has nothing to do with
the typical "immune system booster" bullcrap.

------
OrthoMetaPara
Apparently, these tumors proliferate because they are able to trick killer T
cells into not attacking them. The antibody, nivolumab, inhibits this
signaling pathway so that the T-cells are capable of attacking the tumor.

From: Gettinger SN, Horn L, Gandhi L, et al. Overall Survival and Long-Term
Safety of Nivolumab (Anti–Programmed Death 1 Antibody, BMS-936558, ONO-4538)
in Patients With Previously Treated Advanced Non–Small-Cell Lung Cancer.
Journal of Clinical Oncology. 2015;33(18):2004-2012.
doi:10.1200/JCO.2014.58.3708.

 _Programmed death 1 (PD-1) is an immune checkpoint receptor expressed on
activated T cells, which normally serves to dampen the immune response to
protect against excessive inflammation and the development of autoimmunity.
However, in the setting of malignancy, PD-1 signaling, driven primarily by
adaptive expression of programmed death ligand 1 (PD-L1) within the tumor,
inactivates primed T cells that recognize tumor-specific antigens, allowing
tumor growth and metastasis. PD-1 pathway blockade with monoclonal antibodies
offers a novel approach to restoring T cell–mediated antitumor immunity, with
the potential for application across a broad population of patients with
NSCLC._

From the article:

 _In a trial of more than 350 patients, published in the New England Journal
of Medicine, 36% treated with the immunotherapy drug nivolumab were alive
after one year compared with 17% who received chemotherapy._

That seems like a small improvement rather than a "game changer."

~~~
JoshTko
Doubling survival rates while having far less severe side effects along with
proven effectiveness on multiple different types of cancer is definitely a
major breakthrough. This is also based on human trails and not rats in a lab.

~~~
danieltillett
I wish most cancers treatments were tested in rats in the lab - most of the
time they only get tested in inbred mice which are a terrible model for human
cancer.

------
ourmandave
Forget flying cars. I'd love to live in a future where we can say, "Remember
when cancer was a thing people had to worry about?"

And the anti-vaxxers would be stupidly blessed to not know what it was like.

~~~
apathy
Hey if they have their way, we'll all "continue to study" HPV vaccines so that
more girls can die of cervical cancer.

Fuck those cynical monsters. I don't wish people ill lightly, but they're
taking chances with the lives of their children and of others, and I just
can't stand that.

~~~
nikolay
I think you're a cynical monster. And, by the way, this is not a binary
situation - you either get vaccinated, or you don't.

I'm not per se against vaccines, but I'm against the following I can think of
right now:

\- To lower insurance costs, we inject infants, and toddlers with many
vaccines at a time, often without much space between shots either. My kids are
fully vaccinated but on a spaced-out schedule, and our family doctor fully
supports this as a smart choice. There are toxins in vaccines and the more you
put at once, the greater the toxicity, so, an intelligent person would try to
space out, don't you agree?

\- Again, to lower costs, all kinds of questionable preservatives were/are
used in vaccines - just like with drugs where you have generics and brand
ones, I'd rather have choices and pay extra to get a less toxic form if
available. Although ethylmercury is pretty much out (mostly thanks to anti-
vaxxers), I'm pretty sure there are other better choices at higher costs;

\- Hepatitis vaccine given to infants is usually not justified and could be
delayed unless justified by a simple blood test;

\- Studies just confirmed that tetanus vaccine works twice long as previously
thought - why schedules are not immediately adjusted to both cut costs, and
reduce risks?

\- Flu vaccine is useless if not harmful.

~~~
apathy
The only reason you know that Tamiflu is useless is "cynical monsters" like me
who bite the hand that feeds them.

As far as spacing doses, just like anything else it's subject to revision.

Nonavalent HPV vaccines produce antibodies against nearly every HPV variant
known, reduce the likelihood of HPV integration, and for someone who has
verified that at least a quarter of head & neck squamous, almost half of anal,
and far better than half of cervical carcinomas show HPV integrations,
typically right into the middle of tumor suppressors or onto oncogene
promoters, this is a big deal. These cases are preventable. Not preventing
them, when it's relatively cheap and available, is (to me) APPALLING.

The antivaxxer pricks are cynical for relying on the rest of us, who are
responsible enough to assume a TINY risk to our kids in order to protect them
and others, to take the risks so they can enjoy the benefits of herd immunity.

If that isn't the definition of cynical, I don't know what is. It's on a level
with the Soviets celebrating the "eradication" of smallpox while internally
working to weaponize it.

Provided a child develops appropriate immunity by the time they're regularly
interacting with others, I could care less about the spacing. But that's not
really what this is about, is it?

If you have kids and you don't get them vaccinated on an appropriate schedule,
you are being a cynical prick. If you fight HPV vaccination because it might
"make girls promiscuous", you are a cynical prick. You are presuming to judge
risks for others, risks which we as a society have determined are
unacceptable. And that makes you a cynical prick, if indeed you do it. (Maybe
you're playing devils advocate, I don't know. But I really hate this line of
reasoning, and on balance, it doesn't hold water.)

~~~
nikolay
Sorry, but Tamiflu is an anti-viral drug, not a vaccine, and it is effective.

Everybody's entitled to their opinion, and instead of low-class name calling,
which is what cynical pricks do for a living, use solid arguments, and clever
policies. So far, there's being only arrogance from the pro-vaxxer community.

~~~
apathy
I see. Where's your rebuttal regarding nonavalent Gardasil, the actual topic
of conversation here? When you can provide some evidence (any evidence,
really) that the immediate risks outweigh the benefits, I'll be impressed.

Meanwhile, enjoying the benefits of herd immunity while other people and their
kids take the risks is the definition of cynicism.

