
Is This How We'll Cure Cancer? - kator
http://www.forbes.com/sites/matthewherper/2014/05/07/is-this-how-well-cure-cancer/
======
gambiting
Novartis also produces Glivec, which turned my dad's GIST stomach cancer(which
normally has <1 year survival prediction) to living for over 8 years cancer
free now. Good thing we live in a country which pays for the treatment,as my
dad has to take two boxes a month, and they are ~$3000 each.

~~~
aeberbach
"Gleevec became a breakthrough, helping almost every patient with a particular
rare blood cancer, chronic myelogenous leukemia. Patients stay on it for
years, and it is so valuable that Novartis has quadrupled its annual price
from $24,000 per year in 2001 to more than $90,000 today. Even the stingiest
insurers pay, though some patients get it free."

I am also in a country where you don't have to choose between pay or die, and
I'm thankful for that. Seeing this kind of thing in print certainly makes you
look twice and appreciate what you have.

~~~
gaoshan
Unfortunately I'm in the U.S. and if I had to pay $3,000 per box of that
medicine (at 2 boxes a month) I would have to die because I simply do not make
that much money. It's literally more than 100% of my entire income. I'm
jealous, lol.

~~~
tanzam75
Under Obamacare, your annual out-of-pocket maximum would be $6,350. You still
have to pay the Obamacare premium on top of that. But the end result is that
you would only have to pay about 10% of the $92,000 annual list price of
Gleevec.

Note that grandfathered plans are not subject to the out-of-pocket maximum
until 2015.

P.S. Remember to vote in the 2014 and 2016 general elections if you live in a
swing state.

~~~
venomsnake
> if you live in a swing state

This is toxic to democracy. People should vote no matter the state where they
live otherwise it is only a tiny sliver of the swings that decided who rules
the country and this allows for the money influx because you only have to
buy/brainwash that sliver.

If a modern democracy manages to have 80% voter turnout you will be surprise
how many safe seats will be not so safe.

So just vote - no matter where you live. It is your civil duty.

~~~
chrismonsanto
> If a modern democracy manages to have 80% voter turnout you will be surprise
> how many safe seats will be not so safe.

Are you suggesting that "people who decide to vote" is not a representative
sample of the whole population? I am not sure of that, and a quick Google
search shows mixed results.

> So just vote - no matter where you live. It is your civil duty.

I feel no loyalty to my country. I don't give a crap about civil duty. Most
people I interact with feel the same way.

------
wvenable
From the article: "The current CARTs kill not just cancer cells but any
B-cell, the type of white blood cell that goes wrong in leukemia."

So this really isn't an cancer cure at all; it is B-cell cure. I'm surprised
this isn't a more significant detail in the article. It's really the cell-
equivalent of cutting off a cancerous limb.

~~~
revelation
There is no cancer cure. Cancer is what we call cells that have mutated to
_evade_ last years cancer cure.

~~~
pak
You're getting downvoted probably because people do not understand the raw
truth that lies behind what you said.

I detest articles that use the word "cure" and "cancer" in the title. They are
without fail so breathless about the clichéd achievement that they are
exploiting in the headline that they either fail to acknowledge the real
magnitude of the problem or gloss over it with practiced sleaze (not sure
which happened to the writers here).

We've had a "cure" for cancer since the times when barbers also performed
surgery on the side (Egyptian civilization, at least), and that is surgical
excision. It's still the best treatment we have for many cancers, e.g.
melanoma and lung cancer, both of which are much more common than the cancer
in the article. It doesn't work for every cancer, but for some cancers it
works good enough, and even better when combined with chemotherapy (which ham-
handedly slows replication in every cell in your body). The point of any cure
is to remove the cancer cells from your body and for some cancers they
fortunately stay within one excisable area.

Like the GP comment pointed out, this is essentially a much more targeted
version of the same thing. Obviously it would be better for the patient to
retain B cells, without which they will have no adaptive immunity--just like a
patient with melanoma would prefer to keep the hunk of their nose that the
surgeon had to remove. This is an incremental, very fancy and very expensive
improvement on the same old strategy of killing the organ to save the body. It
will never work on non-blood cancers (which are the vast majority of cancers,
BTW).

People do not understand that cancer is a disease that combines the trickiest
parts of fighting aging with the trickiest parts of fighting infectious
disease. Cell replication is one of the hardest things your body has to do,
and it does it several trillions of times per day in your body, essentially
copying about 1 billion TB worth of data while automatically detecting and
fixing every dangerous error that could possibly result. It is natural that
this process will screw up catastrophically at some point--on an infinite
timescale, assuming we fix all other health issues, everybody will still get
cancer just as surely as they age every year. And once they do, you have a
cell that your immune system has carefully trained for decades _not_ to
engage, invading and hogging every resource it can, with mutations that allow
it to adapt to selective pressures, including any drugs you might throw at it.
Essentially, it's an infectious parasite, except it looks 99% like your own
cells to your immune system, and is already perfectly suited to your body's
style of metabolism.

Let's keep in mind that this can arise from any cell in your body that
replicates, and just about every organ system has a good number of those to
replenish malfunctioning or old cells and fix injuries. The possibilities are
staggering and so are the number of known cancers.

There is no "magic bullet" that cures every single cancer, just like there is
no "magic antibiotic" that kills every infectious bacterium. Even the
smartest, most generalizable ideas right now, like cancer vaccines, depend on
your immune system to make the final push, and the immune system is just as
fallible as any other organ system. At the point where somebody can make the
claim that all cancer is cured, we will as a matter of course have gained
control over every replication event that occurs in our body (trillions upon
trillions of nanoscale events per day). That will be a truly remarkable feat,
but is in no way within reach of any foreseeable technology.

When we cure cancer, we will have by necessity cured aging and all infectious
disease will have become a relatively trivial problem. That should put the
claim of "curing cancer" into perspective.

~~~
majkinetor
That is highly doubtful. Cancer will surely not evolve to fight the successful
cure. Each cancer has to start its micro-evolution from 0, since they can not
survive to pass its progeny to other hosts. Each cancer has its own space to
evolve and different spaces do not communicate. If there is a cure, you are
basically reverting its evolution to day 0. All cancers use similar mechanisms
because of concept known as convergent evolution.

Once cure exists - the real cure, meaning no single cell is left from original
cancer that survived the latest 'cure' to then pass its genes to its progeny
(which is maybe impossible, who can say) - there is no risk to adaptation to
the cure.

Now, I can imagine scenarios when this would not hold - for instance vertical
genetic transfer to different hosts via some infectious vector but that is
probably highly improbable.

~~~
pak
_> All cancers use similar mechanisms because of concept known as convergent
evolution._

First of all, this hypothesis is still highly contested in the literature.
There are no doubt certain pathways (usually part of cell cycle regulation)
that happen to be used by most cancers, but there are hundreds of genes
involved in the cell cycle and we aren't even close to enumerating all the
ways that it can malfunction. The fact that most cancers use similar pathways
is no doubt reflective of the fact that they are the _easiest_ pathways toward
malignancy, not the only pathways.

Secondly, say we do take the top N common mechanisms and create a bulletproof
inhibitor. Now your statement about convergent evolution is no longer true.
Anything that kills cancer cells (excision, radiation, chemotherapy, something
targeted) exerts selective pressure, and you will instead start seeing cancers
that utilize the (N+1)th easiest pathway, (N+2)th, and so on. It's like trying
to stop all the ways that a car could break down: possible up to a certain
point, impossible in the long run.

I also contest the statement that "you are basically reverting its evolution
to day 0". Germline predispositions for cancer are an important part of the
disease and not selected against in a society where people have natural-born
kids between 20 and 40. If there were a cure for cancer, it would probably
involve genetically engineering humans that are extremely unlikely to get it
(and also age very slowly, etc.). But then you are looking at a totally
different kind of society.

 _> genetic transfer to different hosts via some infectious vector but that is
probably highly improbable_

This is not only probable, it is known (so far, 12% of human cancers). Viruses
linked directly to cancer include HPV, EBV, HTLV, and polyomavirus [1]. A
virus that causes cancer can be a very successful virus, depending on how long
the infectious/replicative phase is compared to the symptomatic phase.
Replicating infected host cells = more viral production = greater likelihood
of survival and transmission.

There are some researchers that think that all cancer is caused by viruses
that have yet to be identified. I don't think that's literally true, but we
can find all kinds of remnants of ancient viruses in our genome, so in a way,
they might be on to something.

[1]:
[http://en.wikipedia.org/wiki/Oncovirus](http://en.wikipedia.org/wiki/Oncovirus)

------
kator
All I know is I lost a loved one last weekend to Cancer and until you've been
that close to the process you have no idea how you hope and pray for anything
that will help no matter how radical.

------
ihodes
It's one way we're curing cancer. Other promising avenues include personalized
cancer vaccines which essentially recruit your immune system to attack the
tumor[1], or other viral vectors such as the recent Mayo success[2] using the
measles vaccine to counter cancer.

[1]: [http://www.reuters.com/article/2014/05/15/us-health-
cancer-m...](http://www.reuters.com/article/2014/05/15/us-health-cancer-
measles-idUSKBN0DV1Y120140515)

[2]:
[http://en.wikipedia.org/wiki/Cancer_vaccine](http://en.wikipedia.org/wiki/Cancer_vaccine)

~~~
christkv
The good news is that this is happening faster than you would think. Having a
father who is a leader in the field I can tell you the initial trials look
very promising. However vaccines might not be the cure to end all cures. A
very aggressive cancer might kill you before your immune system is able to re-
engage to fight the cancer. So a combination of vaccines and more traditional
treatments is likely to be the answer in this case.

My understanding is that one of the main benefits of vaccines will be to make
relapse much less likely as the stimulated immune system will eradicate any
leftover cancer cells in the body.

~~~
yulaow
I'm a total "noob" in this field so I'm sorry if I can sound stupid: I thought
that traditional methods to cure cancer (like chemio or radio therapy) have
all the side effect of partially (or even totally) destroy the patient immune
system. So how can we combine those with these special vaccines which surely
need a strong immune system to be effective?

~~~
ihodes
Not at all a stupid question. I don't even have a great answer for you. My
understanding is that, at least for some cases, you can target e.g. radiation
enough to shrink the tumor enough for these therapeutic vaccines to be
effective.

------
benjvi
Interesting article, but as it mentions, this is the latest in a series of
breakthroughs in cancer treatment. What is missing for me in there is any idea
of the number of people that this could affect.

Medical statistics ( [http://www.cancerresearchuk.org/cancer-
info/cancerstats/surv...](http://www.cancerresearchuk.org/cancer-
info/cancerstats/survival/all-cancers-combined/) )show that overall cancer
survival rates have been improving according to a linear trend - by an
absolute amount of ~0.65% per year.

This would put the date at which cancer is "cured" at somewhere in the 2090s.
So, are we talking about continuing this trend or surpassing it? How much of a
step forward is this and is it likely to be applied trivially to other forms
of cancer?

~~~
SoftwareMaven
Cancer survival rates are usually five year survival from diagnosis. We've
gotten better at detecting cancer earlier, meaning people are more likely to
make it to five years, but, from what I've read (and I'd love to see research
showing what I've seen is wrong!), the number of people living longer than
they would have 30 years ago has not gone up as dramatically (there are some
cancers that have seen tremendous improvement, though).

Does anybody have numbers on 10-20 year survival?

~~~
benjvi
The linked stats show 1,5 and 10 year survival rates, which are all roughly
following the same trend

------
giarc
I think we should stop saying things like "Is this how we will cure cancer".
It's like saying "X will stop accidents". There are many different types of
accidents, just like there are many types of cancers.

We should be saying "Is this how we will cure a cancer?"

~~~
ganeumann
Interesting read is "The Emperor of All Maladies: a Biography of Cancer" by
Siddhartha Mukherjee.

There have been several miracle "cures" for cancer, none of them has turned
out to be a miracle cure. Even the idea that cancer is not "one cause, one
cure" has not been held for a long time, and was never universally held.
Lymphoma was always treated differently than breast cancer, for instance.

But the more interesting point in the book, re a cure for cancer: "the only
intervention ever known to reduce the aggregate mortality for a disease--any
disease--at a population level was prevention. Even if other measures were
chosen to evaluate our progress against cancer...it was indubitably true that
prevention, as a strategy, had been neglected by the NCI in its ever-manic
pursuit of cures."

In other words: cures make good headlines; we get excited by cures. But the
only way to reduce the mortality rate of cancer is through prevention. Long-
term we'll make more progress finding ways to prevent cancer, not cure it.

~~~
bellcurvetopper
That is an excellent book, and the best accessible summary of the disease and
efforts to treat it. Highly recommended.

------
higherpurpose
> Patients stay on it for years, and it is so valuable that Novartis has
> quadrupled its annual price from $24,000 per year in 2001 to more than
> $90,000 today. Even the stingiest insurers pay, though some patients get it
> free.

I understand supply and demand...but come on! We're talking about people's
lives here. This just sounds like exploitation. The fact that the insurance
company has to pay doesn't make it any better. Just easier to get the money.

~~~
landryraccoon
So, there's a compromise. The high price of the drug also drives other
companies into cancer research as they also want a piece of the pie. That
leads to better treatments for everyone. If prices were lower, then there
would be less motivation to develop the drugs.

~~~
tszyn
People need monetary incentives to fight against the worst disease on the
planet? Helping millions of people is not motivation enough?

~~~
PhasmaFelis
The pat, dismissive response (which you've already gotten several times) is
"Hey, cancer research is expensive. Somebody's gotta pay for it."

In a healthy society--at least, a healthy society that is also as wealthy as
ours--the solution would be to recognize medical research as a clear public
good, and reallocate some of our society's wealth to fully fund both research
and production of medicines.

What we have instead is...well, we have a lot of different factors
interacting. But just to name a few: we have a government that has convinced
us that propping up the military-industrial complex is the most important
possible use for billions of dollars, and we have private wealth concentrated
in a small number of people who will fight like mother tigers against any
attempt to appropriate the smallest amount of their money for the public good.

But that's all complicated and unpleasant to think about. So...hey, cancer
research is expensive.

~~~
CamperBob2
I love these sorts of excluded-middle arguments. "Our government wastes
hundreds of billions of dollars on war toys that are at best unnecessary and
at worst a threat to humanity's continued existence. And as if that weren't
bad enough, we have a lot of selfish, wealthy asshats who don't want to give
even more of their money to the same government."

~~~
PhasmaFelis
Because not wanting to fund war is exactly the same as not wanting to fund
lifesaving cancer research, right?

~~~
CamperBob2
Yes, it's exactly the same, when you don't trust the government to allocate
your tax funds in a sensible manner.

The only diseases governments have helped us with are those addressable by
public health programs (and there are quite a few of those, to be fair.) For
the rest, no one has ever found a more effective funding mechanism than
private industry.

------
SeanDav
There appears to be billions to be made in profits from anti cancer drugs, no
surprise that companies are spending like crazy on cancer research.

On finding replacements / alternatives for our fast reducing arsenal of
effective antibiotics - not so much. We are on the brink of a very scary phase
in modern medicine - where antibiotics may soon become almost useless and very
little is being done about it because it is not profitable.

------
thret
"Of 25 children and 5 adults with Emily’s disease, ALL, 27 had a complete
remission, in which cancer becomes undetectable."

It does seem more promising than
[http://en.wikipedia.org/wiki/Spontaneous_remission](http://en.wikipedia.org/wiki/Spontaneous_remission).

~~~
opencheckbook
One must wonder.

Did the other 3 die?

------
DominikR
Using viruses to fight diseases might seem dangerous compared to current
therapies, but viruses are already in use for therapeutic purposes on a large
scale for almost 100 years.

Most people here don't know about it, because it's in use since ~1920 in the
sowjet union/russia/eastern europe and not in the west. (for example to fight
bacteria, that is resistant to all antibiotics)

[http://en.wikipedia.org/wiki/Phage_therapy](http://en.wikipedia.org/wiki/Phage_therapy)

~~~
grifpete
The virus isn't used to fight the disease, is it? Isn't it just used as a
vector to introduce the treatment?

------
ngoede
Just started reading [http://www.amazon.com/Feed-Mira-Grant-
ebook/dp/B003GFIVSE/re...](http://www.amazon.com/Feed-Mira-Grant-
ebook/dp/B003GFIVSE/ref=sr_1_1?ie=UTF8&qid=1400788634&sr=8-1&keywords=feed)

So yeah, hope we don't cure the common cold with a mutated virus any time soon
LOL.

------
rollthehard6
If you've not read of the effects of naltrexone on [Met5]-enkephalin (OGF -
opiod growth factor) it's worth doing so. A fascinating area.
[https://profiles.psu.edu/profiles/display/113208](https://profiles.psu.edu/profiles/display/113208)

------
Havoc
>rheumatoid arthritis drug that stopped the immune system storm

Damn...that must have been some industrial strength RA meds to work that fast.
Plus that is quite a leap of faith even in isolation...those meds don't always
drop the white cell count as expected.

~~~
jhartmann
Was probably Remicade, it blocks Tumor Necrosis Factor Alpha which is a main
component to the inflamation response. If you are currently experiencing a
cytokine storm (which is basically run away inflamation) it will do the trick
quite quickly. It is basically an artifical antibody that binds to free TNF
alpha and doesn't let it interact with cells to cause its normal immune
response. Very effective, and it is an IV delivered drug so it immediately
starts binding to the factors that are causing the inflamation. I took it
before for Ankylosing Spondylitis and you can feel better quite quickly.

If its not Remicade it is probably something in that family of therapies and
would have similar quick effects against a cytokine storm.

~~~
Havoc
hmmm...didn't know those things work so fast. They gave me a low dose MTX and
that took forever to kick in (month+). Then again there was no major hurry.

------
dredmorbius
Well, considering the success rate of most other therapies for major cancers
is at best quite modest, and likely mostly a result of lower smoking rates,
maybe.

[http://redd.it/266xdj](http://redd.it/266xdj)

------
known
Till science catches up, we should believe in statistics. Shun cosmetics. Many
cinema celebrities have died of cancer.

------
grifpete
And Cambridge University researchers recently reported progress in penetrating
solid tumors.

------
noname123
Glad to see NIBR/Novartis getting some love here. Any NIBR peeps on HN?

------
adnam
My main takeaway from this is that Novartis is seeking a return on a $10M
investment.

------
nollidge
Betteridge's law of headlines:

"Any headline which ends in a question mark can be answered by the word _no_."

[http://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines](http://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines)

~~~
charlesism
That "law" occurred to me too, but I kept an open mind until I reached the
sentence:

"On paper Jimenez seems an unlikely backer for one of the most revolutionary
medical breakthroughs any company has ever tried to develop. He’s a marketer
by trade"

At that point I stopped reading. The answer is indeed "no."

------
givan
Why not go to the root cause instead of using hacks to fix the symptoms?

[http://en.wikipedia.org/wiki/Cancer#Causes](http://en.wikipedia.org/wiki/Cancer#Causes)

We need to fix our environment instead of hacking ourselves to deal with a
broken one.

~~~
NoMoreNicksLeft
"Fixing our environment" won't fix cancer.

Cancer exists because you don't need to live to 150 years old to successfully
reproduce. It costs too much from a biological perspective to prevent cancer,
calories and nutrients better spent on raising children and to some extent
grandchildren.

People got cancer back when the environment was pristine, they were just more
likely to get eaten by the crocohippo first.

~~~
tiglionabbit
I have heard this argument a lot, and I've also heard there is data to refute
it. I haven't looked up the references, but this is covered in several
nutrition books I have read, including: The Diet Delusion by Gary Taubes, In
Defense of Food by Michael Pollan, and The Perfect Health Diet by Paul
Jaminet.

The observation is always the same: Cancer is one of the "western diseases"
that starts appearing in native populations when they are exposed to
colonists. And it's not just because of longer lives: people start getting
cancer at higher rates at earlier ages.

Taubes blames the problem on insulin-like growth hormone that is secreted in
response to high-carbohydrate foods, and creates an environment perfect for
rapid cell growth. Pollan doesn't speculate on the cause, other than to say
that there is something wrong with the western diet. Jaminet speculates that
we will find more types of cancer are cause by infectious agents, since cell
immortality and rapid reproduction is a perfect strategy for a virus and since
we have found several so far:
[http://en.wikipedia.org/wiki/Infectious_causes_of_cancer](http://en.wikipedia.org/wiki/Infectious_causes_of_cancer)

~~~
Florin_Andrei
That's pseudo-science.

Galen in 2nd century AD observed cancer, and used the term "oncos" to describe
it. Celsus in 1st century AD did the same, and used the term "cancer" for the
first time. Hippocrates in 4th century BC described _several different types
of cancer_ and called them, generically, "carcinos" ("crab" in Greek).

Egyptian texts from at least 1600 BC, with some going back to 3000 BC,
describe different cases of cancer, noting with regret: "there is no
treatment".

 _Dinosaurs_ , 65 million years ago and more, suffered from various types of
cancer such as hemangioma, desmoplastic fibroma, and osteoblastoma.

Cancer is, has been, and always will be the evil shadow of all multicellular
life.

Please, don't take your medical and scientific information from a "liberal
foodie intellectual" with a B.A. in English (not that there's anything wrong
with any of these attributes in particular, they're just not qualifications to
talk competently about cancer).

[http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer...](http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-
history-of-cancer-what-is-cancer)

[http://web.archive.org/web/20110716111312/http://www.cancerd...](http://web.archive.org/web/20110716111312/http://www.cancerdecisions.com/speeches/galen1989.html)

[http://www.bordet.be/en/presentation/history/cancer_e/cancer...](http://www.bordet.be/en/presentation/history/cancer_e/cancer1.htm)

[http://www.academia.edu/227680/Epidemiologic_study_of_tumors...](http://www.academia.edu/227680/Epidemiologic_study_of_tumors_in_dinosaurs)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131/)

~~~
gone35
Well; the fact that cancer was known in antiquity and that it is found in the
fossil record in itself doesn't say anything about its _adjusted prevalence_
[1] which, as it happens, was indeed much lower than it is in modern societies
today. From your fourth link[2]:

"An interesting phenomenon has arisen during the course of multi-year studies
related to the rarity of cancer in antiquity. This is of interest especially
when considering that hundreds of Egyptian mummies and more than 10,000
dinosaur bones were evaluated. In contrast, the rate of cancer incidence has
dramatically increased since the Industrial Revolution. The rarity of cancer
in antiquity has been attributed to the lack of pollution and changes in diet
and lifestyle, and most recent findings suggest that cancer may be a manmade
disease (Nat Rev Cancer 10, 728–733). _Thus, while a lack of adequate
techniques for disease diagnosis and detection may partially explain the
overall lack of cancer found during the millennia, the current cancer trends
are now primarily associated with carcinogens in our modern industrialized
society (Nat Rev Cancer 10, 728–733)._ "

I am not a fan of pseudo-scientific, moral-panicky speculations about the
evils of "modern life" from the likes of Pollan _et al._ myself; but in this
particular case, as your article explains, there is considerable evidence that
cancer (standardized) prevalence was indeed much lower in pre-modern
societies. Also, for some types such as colorectal cancers, some dietary
habits (prevalent, as it happens, in modern societies) are very well-known and
well-established risk factors, accounting for up to a _70% increase_ in
relative risk in some studies [3].

As I said: I symphatize with your view, but be mindful of confirmation bias.

[1] _Eg._ controlling for age and other risk factors in the study population.

[2]
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131/)

[3]
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796096/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796096/)

~~~
Florin_Andrei
I agree that we have more cancers today. I was just strongly disagreeing that
it's an entirely new phenomenon, or mostly determined by food choices.

