
We’re a Lot Better at Fighting Cancer Than We Realized - dnetesn
http://cshl.nautil.us/article/593/why-were-a-lot-better-at-fighting-cancer-than-we-realized
======
trynewideas
From a science and pharmaceutical perspective, maybe.

As the partner of someone in the US dealing with stage 4 cancer in their 40s,
who has two hospitals fighting with each other over whether to keep using a
chemo drug that's sent them into anaphylactic shock twice in two rounds of
chemo because it's _more convenient_ for the infusion clinic to administer,
and all of that currently held up by pre-approval from a relative-to-the-rest-
of-US good insurance company that's still already allowed $40,000 of in-
network medical bills to hit us in just 5 weeks since diagnosis all after
hitting the supposed out-of-pocket max?

From a cancer that had been misdiagnosed as an infection, an iron deficiency,
and a benign tumor for four months prior, to give it a massive head start?

That headline can fuck right and completely off. We might be good at finding
new drugs that can fight cancer, but societally we're absolutely shit at
fighting this disease.

~~~
bserge
> a cancer that had been misdiagnosed as an infection, an iron deficiency, and
> a benign tumor for four months prior

It's absolutely maddening that this is not even uncommon. Doctors think they
know best, definitely _better than you_ , and will stand by their sometimes
quite obviously idiotic conclusions, leaving you helpless. And in some
countries with universal healthcare, it's a lot harder to just go find a
better doctor. Screw the whole system. I've got more words to say, but I'll
stop here.

I am sorry for what you're going through and wish you all the best.

~~~
xenospn
What do you mean? I'm from a country with universal healthcare, and you can
just go see another doctor.

~~~
raffraffraff
It's not that simple. Sometimes you go to two or even three doctors and they
don't take your symptoms seriously. "A mild cough is nothing to worry about,
lots of people have mild asthma and don't realise it, have an inhaler",
"Everybody gets headaches, it's not abnormal", "Your blood results are
perfect", "The X-Ray came up clear". You end up feeling like a hypochondriac.
Most of the time the doctors are right. Twice in my life I was convinced that
something was very wrong (and thankfully it wasn't)

Of course, sometimes the doctors are wrong.

In the last year I lost my sister and our dog to cancer. In both situations,
cancer want diagnosed at first. In the case of my sister, the doctor assumed
"women's problems" \- irregular bleeding, bloating, cramping etc. But the
diagnosis came pretty quickly afterwards because it was a very aggressive
cancer that soon triggered blood clots, fluid on the lungs and a bunch of
other stuff. They could do nothing for her, and catching it earlier wouldn't
have helped. It ate through her in about 6 months. The oncologist was up to
date on the latest treatments and was discussing her case with the world's
best (because she was only 44 and had just had a kid, they did everything they
could).

With our dog, there wasn't a diagnosis for weeks, while he gradually
deteriorated. We have an amazing vet, but nothing showed up in tests (blood
work, x-rays, physical exams). The only hunch we had was that pain killers
seemed to ease his breathing issues - so we took him to get an MRI and found
it. We choose to spare him from the pain (he had a very happy 10 years, and
wasn't the type that could handle chemo and operations - it would have been
incredibly selfish to put him through it for... What, maybe 12 months of
health before it comes back?)

Thing about cancer: sometimes it's treatable and sometimes it's not. I have a
whole new respect (read: "fear of") cancer since last year.

~~~
tazjin
> Your blood results are perfect

This is if you can even get prophylactic blood tests done, which is not a
guarantee in some European countries

I had an awful experience with Sweden's health care system when I lived there
~6 years ago, and didn't get actual help until I went to a private doctor via
private insurance.

Since then, while I still support access to universal healthcare, I personally
have stuck entirely to private healthcare instead.

------
jcims
I was forced to dive headlong into understanding cancer therapy 2 1/2 years
ago. It was obvious at the time that this was the correct direction to head,
developing an entire therapeutic ecosystem to give the body every possible
advantage and assail the disease with every possible disadvantage in order to
get the desired outcome.

However, what I saw was a rather bizarre and disturbing fetish in the
pharmaceutical and medical communities for ‘monotherapies’. I believe I
understand the allure, if you find one thing that works, the proverbial silver
bullet, that’s the best case scenario for treatment. It’s also quite obviously
the best case for shareholders and investors, but let’s set that aside for
now.

For the sake of future patients, I do hope that medicine and regulators
deprioritize the search for monotherapies and receive the type of analysis
represented in this article with open arms. In particular, I hope that the
’standard of care’ is given some flexibility so that doctors are able to adopt
low risk adjunct therapies in order to improve outcomes and the amount of data
available for continued research and improvement of treatment plans.

~~~
tornato7
I've been impressed by the "therapudic ecosystem" developed for coronavirus in
the absence of a 'monotherapy'. The MATH+ treatment is an effective
combination of available drugs and vitamins. I hope any future COVID drug is
used alongside these options, instead of a "here's an expensive drug, now go
home!" Approach that some treatments take.

~~~
copperx
MATH+ seems to me like throwing everything and the kitchen sink into the
disease, which screams “we don’t really know what we’re doing.” I haven’t seen
replication efforts, and the doctor who’s peddling it once claimed to cure
sepsis with IV vitamin C, an effort that failed to do much when replicated. It
doesn’t look like a serious approach.

------
jitendrac
As far as I know, Each cancer in a patient is mostly unique. Not all skin
cancers or cancer tumor cases are same. they may have same underlying cause of
it but not same cancer case. Mostly what treatment do is remove the affected
tumor,tissues, if its related to blood plasma or bone-marrow transplant donor
blood and bone marrow. Use chemo to weaken all cells of body regardless of its
normal functioning or part of cancer. wait for human body to revive on its own
immune system and repeat above task if needed.

so, to fight the cancer first we must find a way to affordably find the type
of cancer with cause case-by-case basis and develop a procedure for custom
treatment and drug-delivery to affected part without disturbing whole body
functions. From my perspective we are still way behind but in better position
then yesterday or decade ago.

~~~
tyingq
Absolutely true. There are many cancers where the only recourse is
disfigurement, dangerous irridation, butchery, poison or death.

No blame on current doctors and nurses, but our current understanding is
brutal. Any real advances are crazy welcome.

------
dstick
So if I summarize correctly they re-evaluated already “FDA passed” but
abandoned substances for anti-cancer workings using new techniques (CRISPR)
and got 50 hits. That’s amazing! Would this work in other fields as well?

~~~
iskander
That's a good summary but it's missing the context that these kinds of "hits"
will most likely fail clinical trials. Many drugs look good at this stage in
preclinical development and almost none of them show both safety (ph1 trial)
and efficacy (ph3 trial).

There aren't actually that many low hanging therapeutic fruit out there,
mostly we have to actually do the work to discover new mechanisms and make new
compounds to target them.

~~~
dstick
It read like that would be different here, using the new method, wouldn’t it?
Or did I misunderstand that?

~~~
iskander
The genes essential for cancer cells to grow in vitro could easily be quite
different from those required to establish the tumor micro-environment, invade
new tissues and fight off the immune system. They'll have many false negatives
from the mismatch in context. Simultaneously, they might have false positives
from e.g. differences in layout and density of tumor cells (2D/uniform vs. 3D
heterogeneous tumor).

And even if they get the right targets, finding drugs with an effective
therapeutic index is hard.

This might be a useful screening technique...but it's not the first high
throughput screening method. They might have some successes, only trials will
tell.

------
iskander
Drug repurposing for cancer is a neat and vaguely plausible idea that's been
eating up attention and grant funding for a decade now, without any successes
in clinical trials.

~~~
TaupeRanger
Precisely. The title is frankly appalling.

------
Gatsky
Cancer is the most difficult health problem humans face. It will still be
there long after we conquer neurodegeneration, atherosclerosis and diabetes.
It is a major failure mode of all multicellular life. Dinosaurs got cancer.
Every animal from mice to elephants gets cancer. It is startlingly common in
humans. The cellular pathways altered in cancer existed before animals
existed. It is an inescapable hangover from our evolutionary origins as
unicellular organisms.

The only way to beat cancer is to upgrade the human organism to design out
anachronistic evolutionary trade offs and prevent cancer development. The way
we treat cancer now - the slash, burn, poison, hunt paradigm - is inhumane,
expensive, and of limited effectiveness.

------
tyingq
Fair enough, but cancer is a broad term. There are still many cancers where
the only treatment is basically poison, irridation and/or butchery/mutilation.
Hopefully that improves soon.

I'm guessing future history will reflect on how dark all of this was.

------
TaupeRanger
Frankly, the title is absolutely idiotic. This article describes a way of
studying drugs that have already been approved by the FDA for other
indications as potential cancer drugs. A vast majority of these drugs will
fail or do no better than current treatments which involve butchery and
poison. The article is basically worthless and I have no idea why it has even
a single upvote from this community. None of this has been shown to do
_anything_ for patients.

~~~
yesenadam
> The article is basically worthless and I have no idea why it has even a
> single upvote from this community.

People often upvote if the discussion is good. The discussion on this page was
very good, I thought, very much worth reading - informative and touching.
Thanks all, and good luck.

------
racecar789
There is a firewall that exists between doctors and billing. Or maybe it's
blissful ignorance. I have noticed doctors often have no idea what their tests
and procedures will cost the patient.

Moreover, a doctor's vocal tone often changes when discussing cost. The tone
changes from friendly/caring to annoyed/defensive.

I don't think the firewall can last forever.

~~~
jimbokun
> I have noticed doctors often have no idea what their tests and procedures
> will cost the patient.

Maybe they don't know the amounts, but they are forced to know a lot about how
the billing process works. For example, my company develops a product that
helps doctors create documentation in a way that makes it more likely they
will get reimbursed by insurance companies with the least amount of hassle and
push back.

Also, they probably have no idea what it will cost you until the insurance
company and hospital fight it out over the price.

> The tone changes from friendly/caring to annoyed/defensive.

Every doctor is triggered by having to deal with bureaucratic insurance and
billing processes that consume their time and keep them from spending more
time on treating patients. You are sensing their barely controlled rage at the
system.

(This is all for the US system, probably not true in most other countries.)

------
_nalply
My wife is getting FLOT chemotherapy. She also does:

\- cannabis

\- bromelain and acetylcysteine

\- the next two times longevity fasting mimicking during four days around a
chemotherapy administration

Cannabis is well known for its medical traits. Bromelain is a meat-digesting
enzyme, and a study suggest to combine it with acetylcysteine to reduce the
adenocarcinoma. Another study suggests that acetylcysteine protects from
neuropathy, a chemotherapy side effect. Fasting is said to switch the body
into an energy-saving mode, protecting from chemotherapy, too; something which
the tumor cannot so that it experiences the full brunt of the chemotherapy.
Longevity fasting mimicking is not fasting but a diet having the same effects
as fasting, but I think this is still dangerous. I hope that my wife
compensates by eating more when she does not have chemotherapy.

Perhaps this is useful to others. Take care!

------
pps43
Yet there is no visible shift in cause of death distribution. Cancer is still
up there, successfully competing with cardiovascular diseases for #1 spot.

~~~
deeg
I don't think that's necessarily a knock against cancer treatments. In the end
we all have to die of something and late-life cancer is probably always going
to be a leader. I think a better stat would be the average age of those who
die of cancer and the survival rates of child cancers.

~~~
phendrenad2
Yeah I wish people would account for this when making statements. What is the
incidence of cancer death in 50-year-olds then vs now.

------
29athrowaway
Fenbendazole, active ingredient in dog deworming medication, has shown some
anti-cancer properties.

[https://www.nature.com/articles/s41598-018-30158-6](https://www.nature.com/articles/s41598-018-30158-6)

------
the-dude
I am instantly reminded of Lou Reed's "Magic and Loss".

Not easy to listen to the first few times. Learned to appreciate.

Much later on I lost a loved one to acute leukemia. At least there was no
months long struggle.

------
codecamper
I'm sorry but re-purposing existing drugs does not sound promising at all.

Having computers that can fold the proteins and understand how molecules bind
sounds like a much better shot. Figuring out how to do this with quantum
computers to really really speed it up would be wonderful.

------
ne01
There is a tendency to fight our way out of every problem. But what we truly
need is to accept the problem, take responsibility and look for the root
cause.

That is true “fighting”. But most try to destroy the symptoms so they can
continue their path and usually continue the root cause.

Of course finding the root cause is not easy and it takes one to study oneself

I highly recommend the following book to everyone (including the “healthy”)

The 12 Stages of Healing: A Network Approach to Wholeness Book by Donald M.
Epstein and Nathaniel Altman

~~~
_jahh
while I'd be the last to say root approach should be discounted (diet, lack of
exercise, smokes, and bad sleep contributing more to bad outcomes that just
about anything else), I worry that the thinking in this post can be used to
judge people who have cancer for their actions when unfortunately the true
root cause for many people is actions taken long before they're born because
of environmental exposure. So while yes most everyone could benefit from more
self study some cancerous situations require vigorous assault on the symptoms,
like death.

~~~
dstick
Agreed, and even then, doesn’t cancer “just happen”? There’s a BRCA2 gene
defect in my family (that I’m lucky enough not to have inherited) and that
increases the likelyhood of developing breast cancer to 80% for women and
prostate cancer to ~20% for men. But to the best of my knowledge, everyone has
an innate %, just by virtue of being alive.

