
Cure for cancer one step closer after 'spectacular' breakthrough - joeyspn
http://europe.newsweek.com/cure-cancer-one-step-closer-after-spectacular-breakthrough-328039
======
Gatsky
Some context. One of the drugs in the combination Ipillimumab has been used
for a while now, and seems to produce long term survival in about 10% of
patients with incurable melanoma. Some of these patients seem effectively
cured, having survived 7 years or more without any other treatment. It seems
likely that combination therapy will produce a better rate of effective cure.
This is a pretty big deal, because advanced melanoma is otherwise a disastrous
cancer to have.

Cost effectiveness... well ipillimumab costs 100k a year for 4 doses, and
nivolumab is probably going to cost another 100k at least on top of that, and
is generally continued indefinitely, and the medication to turn off overly
vigorous immune responses can also be expensive...

But this is modern medical science how it should be. These are incredible,
life changing drugs. The hype is justified. They are already spreading through
many different types of cancer: lung, renal cancer, liver cancer, some breast
cancer, some colon cancers. Toxicity is an issue, but this is generally
temporary, and the quality of life tradeoff is different when there is the
possibility of making the next 7 christmases. Furthermore, you have to balance
the toxicity with the symptoms from progressive cancer or old style
ineffective chemotherapy.

~~~
coldtea
> _Cost effectiveness... well ipillimumab costs 100k a year for 4 doses, and
> nivolumab is probably going to cost another 100k at least on top of that,
> and is generally continued indefinitely, and the medication to turn off
> overly vigorous immune responses can also be expensive..._

I cannot imagine a chemical process to create those drugs that justifies the
prices mentioned.

Is the price at least subsidising the costs of research, or is it an arbitrary
price set by the drug company because "it can"?

~~~
fasteo
Drug R+D plus approval processes are _very_ expensive both in time (>10 years)
and money (>2 American billions) [1]

[1]
[http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014...](http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study)

~~~
jvvlimme
Don't believe everything they say. Tufts is financed by the pharmaceutical
industry AND is based on data provided by the industry.

------
nhstanley
"Cancer" is a word that describes any disease that is the result of
uncontrolled growth of your own cells. However, there are so many types of
cancer cells and the treatment for each so different that saying we've "cured
cancer" is a prime reason why the public doesn't understand or trust these
miracle breakthroughs.

That being said, these PD-1 inhibitors are a huge breakthrough for any type of
cancer that uses this mechanism to evade the immune system. One of the
hallmarks of cancer cell growth is their ability to evade the immune system.
PD-1 (programmed cell death 1) is a receptor on immune cells like T cells that
tells these immune cells to "stand down"/go inactive. Some types of cancer
secrete molecules that activate this receptor, inhibiting the immune cells.
Drugs like Nivolumab block these receptors, keeping the immune cells active,
allowing them to attack cancer cells when they encounter them.

Metastisis (cancer cells spreading around the body) is what kills cancer
patients, and drug strategies that can keep this from happening are key to
keeping people alive. (Re-)activating the immune system against the cancer
cells is a great strategy that's had some recent breakthroughs. Another recent
breakthrough method, called CAR-T cell therapy (chimeric antigen receptor
t-cells) also activates the immune system against cancer. In that case, they
take immune cells out of the cancer patients body, use gene therapy to inject
genetic material needed by the cells to recognize cancer cells, then grow
those cell and re-inject them back to the body. This has been wildly
successful in certain types of cancer, like certain leukemias and lymphomas,
and may be successful for other types. Here is a nice article that covers
these general strategies for those interested:
[http://www.forbes.com/sites/matthewherper/2015/04/20/immune-...](http://www.forbes.com/sites/matthewherper/2015/04/20/immune-
system-drugs-melt-tumors-leading-a-cancer-revolution/)

There have been a lot of breakthroughs recently. If we keep pushing like this
we'll someday soon be fortunate enough to be legitimately surprised when a
friend or family member dies of cancer, and many other diseases.

------
tptacek
Quick notes:

* It's almost 60% of advanced melanoma patients

* Advanced melanoma is difficult to treat

* Small-seeming improvements in lifespans for late-stage cancer patients can be very significant, given the lethality of late-stage cancer

* One of the two drugs, Nivolumab, also recently demonstrated effectiveness against advanced lung cancer --- another difficult-to-treat cancer

Reddit AskScience is probably a good place to watch for updates on this.

~~~
Brakenshire
The NHS has a site called 'Behind The Headlines' which analyses articles about
medical discoveries which appear in the media. It's also worth a look:

[http://www.nhs.uk/news/2015/06June/Pages/Immunotherapy-
drug-...](http://www.nhs.uk/news/2015/06June/Pages/Immunotherapy-drug-combo-
could-combat-melanoma.aspx)

Some useful points:

> "Severe side effects were seen in 55% of those taking the combination, 27%
> of the ipilimumab group and 16% of the nivolumab group. The most common of
> these side effects were diarrhoea and bowel inflammation...Side effects of
> the drugs were also a considerable problem. After one year, only a
> relatively small proportion of people in all treatment groups were still
> taking the drugs. In the combination group people had often stopped taking
> the drugs because of side effects. It will be important to compare people’s
> quality of life while taking these different drugs and their combination."

...

> "Some of the wide media coverage of this study, arguably moves into the
> realm of hype. Much of the reporting could give the impression that
> immunotherapy is a new discovery. In fact it was first used in the late
> 1980s, and has been used in the treatment of various conditions."

...

> Overall, people taking the combination lived longer without the disease
> progressing (average 11.5 months) compared with either drug alone (average
> 6.9 months with nivolumab and 2.9 months with ipilimumab). People whose
> tumour displayed the protein that nivolumab targets (PD-L1), did just as
> well with nivolumab alone as the combination. The study is ongoing and it’s
> not yet known whether people taking the combination treatment live longer
> overall than those taking the individual drugs.

------
carbocation
The phrase "cure for cancer" does a disservice in general, and even more
clearly so on a site like HN where people generally speak precisely. (This is
not intended for the person who posted the article - I know that HN guidelines
recommend keeping the original title.) Inevitably side-discussions come up
about whether something is truly a cure and then we get into discussions of
the wording (I am currently guilty of this).

The novel therapies for melanoma are by no means curative in general, but they
add a tremendous amount (relative to the overall life expectancy) and should
rightly be heralded (and their cost debated).

------
pinaceae
as someone who lost a friend last year to skin cancer and has a work colleague
with end-stage breast cancer that has spread to her bones - bring it on.

as someone working in life sciences - years off, even with FDA fast track. the
incentive to reap billions is justified, this is far more important than a
fucking social sharing app - it better be more profitable. the best minds
should work on a cure for cancer not bullshit timewasters.

~~~
ccvannorman
In principle I agree with you, however I doubt it was a scrappy startup team
of 3-10 scientists who will be reaping the billions, and I bet it will be
incumbent pharmaceutical gargantuans who will earn the bulk of profits.

~~~
pinaceae
"scrappy" biotechs are the backbone of pharma innovation. genentech as the
best known grandpa in that league.

biotech is the other big startup area of the modern economy. full of VCs,
unicorns and abysmal failures. but, their blockbuster products actually help
people. :)

------
nazgulnarsil
>after it's gone, after it's cured once and for all, this bane of human
existence, this No. 2 Cause of Death, we will have extended human life a grand
total of (drum roll, please) 3.3 years

[http://asserttrue.blogspot.com/2013/02/taeubers-paradox-
and-...](http://asserttrue.blogspot.com/2013/02/taeubers-paradox-and-life-
expectancy.html#)

~~~
andyjohnson0
...and eliminated a vast amount of suffering.

------
ksenzee
tldr: They studied two drugs in people with advanced melanoma, and the
combination works better than you would expect: median survival for people
taking both drugs was almost a year, compared with ~3 months for one of the
drugs and ~7 months for the other. It confirms that the newer immunotherapy
drugs are great, and save a lot of lives. It's not a new scientific
breakthrough, as you might think from reading just the headline.

------
jreed91
I'm guessing this just controls the tumors and prolongs their life? That is
great but most people have serious side effects or the cancer becomes immune
to these drugs. But we are headed in the right direction. My father passed
away from melanoma a year ago. Since I have a high chance of getting this
later in life, I'm happy that we are advancing this quickly.

~~~
leecho0
I haven't read the paper, but according to the article, "The treatment, known
as immunotherapy, uses the body's immune system to attack cancerous cells."
Rather than trying to kill the cancerous cells, the drugs allow your body to
attack the tumors.

To give some background, your own body already tries to kill cancerous cells
through cytotoxic t cells. The tumors that get serious are the ones that
escape the immune system. However, strengthening the immune system has its own
problems, since it can attack your own cells (autoimmune diseases), or cause
other problems (like Crohn's disease).

So I'd imagine the cancer cells probably won't get immunity to the drugs, but
other serious side effects could come from the treatment.

~~~
kolev
It's a vicious circle as doesn't the Crohn's disease itself lead to
suppressing the immune system?

------
datashovel
Based on the linked article from The New England Journal of Medicine would one
be able to tell if this is a cure that will be patented by Evil Corp? Or are
these researchers publishing these findings as "open source"?

I'm presuming the 2 drugs themselves are patented? Otherwise I have a hard
time believing 4 doses would cost 100k?

------
eip
Run From the Cure:
[http://www.youtube.com/watch?v=0psJhQHk_GI](http://www.youtube.com/watch?v=0psJhQHk_GI)

------
known
I prefer a vaccine for cancer prevention;

------
msie
Another 999 steps to go...

~~~
msie
Dear Downvoter, Am I wrong?

~~~
dntrkv
Your comment was just unnecessary cynicism.

[http://blog.ycombinator.com/new-hacker-news-
guideline](http://blog.ycombinator.com/new-hacker-news-guideline)

"Critical thinking is good; shallow cynicism, on the other hand, adds nothing
of value to the community. It is unpleasant to read and detracts from actual
work. If you have something important but negative to say, that's fine, but
say it in a respectful way."

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

"Avoid gratuitous negativity." "Resist commenting about being downvoted. It
never does any good, and it makes boring reading."

~~~
jndsn402
> "...and it makes boring reading."

I've always felt that this was wishful thinking on the part of the mods.
Discussions about downvotes (or completely legitimate questions as to why
something was downvoted) are no more boring than hundreds of other topics
discussed here every day.

------
tosseraccount
Some people with a particular mutation profile get to live a few months
longer.

For $100,000.00

I guess the upsides are it does appear to be more than a month or two and the
side effects are manageable.

~~~
tluyben2
Well worth the $100k I would say.

~~~
daveloyall
Pretty sure that I speak for most humans when I say that a $100k medical
treatment might as well be a $100m treatment.

There's some quote like "any quantitative value is qualitative at sufficient
scale". $10,000 is the most expensive thing I've ever purchased--and I'm still
paying it off.

~~~
mb_72
I am no expert, but I am guessing like with most things the newest medical
technology starts of at it's most expensive point, then decreases over time
(as economy of scale or improvements in production efficiency kicks in). So if
this treatment is 100k now, but 10k in 5 years and 1k in 10 years (just
postulating) it makes it very affordable for people 10 years down the track.
Once governments add the treatment to their pharmaceutical benefits programs
the cost at that time could be close to zero for a lot more people.

Of course we all want the best treatment Right Now, and sadly some people will
die who cannot afford a certain medical procedure or medication, but this
still seems like a discovery and advance worth thinking positively about.

~~~
unclebucknasty
Just caught part of the 2013 documentary, "Fire in the Blood", wherein pharma
actively worked to keep affordable generics out of government programs in poor
nations. Millions suffered and died nedlessly as a result.

And, "true costs", of course, had little to do with it. Our economic
priorities are heartbreaking. Little wonder, as our most important economic
entities (corporations) are granted personhood, but would essentially be
classified as psychopaths if they were actually human.

