
Cancer Drug Proves to Be Effective Against Multiple Tumors - seibelj
https://www.nytimes.com/2017/06/08/health/cancer-drug-keytruda-tumors.html?module=WatchingPortal&region=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=none&state=standard&contentPlacement=19&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2017%2F06%2F08%2Fhealth%2Fcancer-drug-keytruda-tumors.html&eventName=Watching-article-click
======
pflats
I hate these articles. They give people a lot more hope than they probably
should.

Keytruda/pembrolizumab is not new. It's the same drug that Jimmy Carter
famously took for his melanoma. It and Opdivo/nivolumab are PD-1 inhibitors
that are amazing developments in treating late-stage cancer that doesn't
respond to chemotherapy.

They're also not the miracle that news articles like to breathlessly push.
This one does a decent job of pointing out that this is the first time a drug
has been approved to treat cancer based on its genetic profile, rather than
the type of cancer. That's an awesome development!

But then you get language like this:

"All carried genetic mutations that disrupted the ability of cells to fix
damaged DNA. And all were enrolled in a trial of a drug that helps the immune
system attack tumors.

The results, published on Thursday in the journal Science, are so striking
that the Food and Drug Administration already has approved the drug,
pembrolizumab, brand name Keytruda, for patients whose cancers arise from the
same genetic abnormality."

Compared to the abstract:

"Objective radiographic responses were observed in 53% of patients and
complete responses were achieved in 21% of patients."

That's around the 30% success rate these drugs usually have. They're great,
and they can change your life - if you're one of the lucky ones. If you have a
family member that needs this treatment, I hope it works.

But it's a lot of money and a lot of hope for a treatment with some rough side
effects that for the average patient will either do nothing or give them a few
more months to live.

It's a development, a great one, but the reports really need to rein in their
enthusiasm. I'd be curious to see the entire statements the doctors in the
article made, because I imagine they were more tempered than the selected
quotations imply.

~~~
jszymborski
Shame on the author, who really should know better given her background[0]...
The bar for science journalism, imho, is dirt-low. As long as it doesn't claim
vaccines cause autism or climate change is bunk, it seems to pass as valid.

I feel like when articles like this get written, it's the success of the
university's PR team. Frankly, I think this kind of behaviour by universities
actually hurt them in the long run.

[0] "Gina Kolata is a reporter at The Times, focusing on science and medicine.
Her training is in science: She studied molecular biology on the graduate
level at M.I.T. for a year and a half and has a master’s degree in applied
mathematics from the University of Maryland.

Her work at The Times has led her to be a Pulitzer finalist twice — for
investigative reporting in 2000 and for explanatory journalism in 2010."

(via [https://www.nytimes.com/by/gina-kolata](https://www.nytimes.com/by/gina-
kolata))

~~~
pflats
It's not just the reporter, and I wouldn't want to single her out.

"Important incremental progress in ________" just doesn't get an article in
the Times.

------
RcouF1uZ4gsC
That is awesome. I hope that the people who worked on this drug make a lot of
money. I would rather people who cure cancer become billionaires than people
who write selfie-taking apps.

~~~
cdelsolar
¿Porqué no los dos?

~~~
lwhalen
Because the world really only needs two selfie-taking apps, and that's me
pontificating generously.

------
hentrep
This is a great move toward biomarker-driven, tumor-site agnostic targeted
therapies in oncology. I attended ASCO 2017 last week, where LOXO showcased
data from larotrectinib in a variety of adult and pediatric indications with
Trk-fusions. The waterfall plot is fairly impressive, and I'd be shocked if
this drug was not the next to be approved across cancers based on biomarker
status alone. A decent summary about it here: [https://endpts.com/loxo-takes-
center-stage-at-asco-with-its-...](https://endpts.com/loxo-takes-center-stage-
at-asco-with-its-groundbreaking-shot-at-a-biomarker-based-cancer-drug-
approval/) Company presentation here:
[https://www.loxooncology.com/docs/presentations/Hyman_Larotr...](https://www.loxooncology.com/docs/presentations/Hyman_Larotrectinib_ASCO_2017_FINAL.PDF)

------
petra
And together with that, the FDA is adopting to precision medicine, adding new
ways of testing drugs:

[http://www.xconomy.com/national/2017/05/30/woodcock-new-
appr...](http://www.xconomy.com/national/2017/05/30/woodcock-new-approvals-
show-fda-is-adapting-to-precision-medicine/#)

Which could open new paths, not only in cancer but other types of diseases.

------
davidf18
This is great, but in general when it comes to cancer, we need to focus more
on putting in fire extinguishers and sprinkler systems primarily, and then
building better fire fighting equipment secondarily.

Much of cancer is caused by smoking. Not only lung cancer but 12 different
types have been implicated by smoking, IIRC. In the US warning labels have
been on cigarettes for more than 50 years, yet people still start smoking.

In NYC, they implemented WHO's MPOWER program with great success. This
includes raising the cost of tobacco through tax, banning smoking in public
places, very, very strong anti-smoking ads and more. Yet, the Federal tax on
tobacco is only about $1.

~~~
freeflight
And next, we introduce a "big portions" tax on fast food meals and a minimum
steps-walked-per-day quota for every US American?

Imho smoking, just like drinking or binge eating, are symptoms for far more
common problems with wich everybody deals differently, like stress and mental
imbalances.

Add to this the fact that some people seem to be genetically more prone to
addiction [0] and there is really no easy solution to any of this. In that
regard, raising taxes on tobacco feels like a real sucker move because
nicotine is considered more addictive than heroin[1].

While it might outprice the addict from his/her drug, it doesn't deal with the
actual problem and most likely will result in the addict looking for something
else to feed his/her addiction.

[0]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715956/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715956/)

[1] [http://www.nytimes.com/1987/03/29/magazine/nicotine-
harder-t...](http://www.nytimes.com/1987/03/29/magazine/nicotine-harder-to-
kickthan-heroin.html?pagewanted=all)

~~~
davidf18
> "...like stress and mental imbalances."

About half of tobacco consumed in the US is by people who are mentally ill
and/or alcohol abusers because they are self-medicating for their illness.
They are very heavy smokers. 90% of people with schizophrenia, 60% of those
with severe depression.

That said, we should be helping these people with other treatments instead of
smoking.

Also, there are other ways of dealing with stress (such as exercising) that
using cigarettes. I live in NYC which can be very stressful, but only about
14% of adults and 7% of teens smoke.

~~~
freeflight
>That said, we should be helping these people with other treatments instead of
smoking.

Indeed, but that would require a far more holistic approach than just dealing
with the issue of smoking, it would require us to admit that stress and mental
illness are becoming increasing factors in our modern urban lives but not
everybody is equally equipped to deal with that, sadly it feels like we are a
long way off from that point.

------
nonbel
>"Mismatch-repair deficiency predicts response of solid tumors to PD-1
blockade"

I looked in the paper [1] and didn't see any plot of "mismatch-repair
deficiency" vs "response of solid tumors". Neither did I see any plot like
"model predicted response" vs "actual response". I'm not really motivated to
look into it any further, but be careful with this one.

[1]
[http://science.sciencemag.org/content/early/2017/06/07/scien...](http://science.sciencemag.org/content/early/2017/06/07/science.aan6733)

------
epmaybe
I'm between two sides on this. Access to new life saving medications is
fantastic and therefore should be celebrated. On the other hand, cost of the
drug makes it inaccessible to a wide range of people.

Maybe someone more knowledgeable than me can explain: do we as a society aim
to improve public health on the cheap, or go headfirst into personalized
medicine, knowing that we will be spending way more?

~~~
JBReefer
I'm pretty sure people dying of cancer suddenly stop caring about
philosophical questions about resource allocation. This is an unequivocally
good thing - like that other expensive miracle drug, Harvoni.

~~~
frugalmail
To save the time of others looking this up:

> Harvoni is used to treat hepatitis C genotypes 1, 4, 5, or 6. This medicine
> is for use in adults and children who are at least 12 years old or who weigh
> at least 77 pounds (35 kilograms).

source:
[https://www.drugs.com/harvoni.html](https://www.drugs.com/harvoni.html)

~~~
JBReefer
It cures Hep C, works faster and better than the current, horrible treatment,
and because of that, costs $100,000 for a course of treatment.

It's​ a fucking miracle.

~~~
maxerickson
Current US cash price is $33,000.

([https://www.goodrx.com/harvonihttps://www.goodrx.com/harvoni](https://www.goodrx.com/harvonihttps://www.goodrx.com/harvoni)
)

There is also increasingly coverage from Medicaid programs.

------
StavrosK
Wait, does this mean that these cancers were cured? If this drug makes the
cancer completely visible to the immune system, wouldn't that mean that every
last cancer cell would eventually be destroyed?

~~~
jessriedel
We don't know that "this drug makes the cancer completely visible to the
immune system". It could easily be that, say, 0.1% of the cancer cells don't
become visible for some weird reason, or they accidentally develop a
protection against the immune response. It would look like complete
elimination of the cancer on scans and in blood markers, but could come back
in a few years.

Only way to know for sure is to wait.

~~~
StavrosK
Ah, that makes sense, thank you.

------
agumonkey
I asked repeatedly about these mines of treatment for my uncle. No doctor
listened. I'm voided now.

~~~
sgit
You don't talk to random doctor. You talk directly/contact docs running the
trails. They will tell you what is possible. If isn't possible in the US for
brain-dead/financial/bureaucratic reasons, once you get the details look for
reputed cancer centers abroad who are willing to do it. You will be surprised
how many docs will respond to you over email.

~~~
agumonkey
The doctors in charge of my uncle didn't and that is the largest issue.

Other researchers did, a good percentage did, some didn't but I can't expect
100% time spending for my email so that's ok. I was surprised but you're right
they do answer a few times.

Back to the issue: if first medical caretakers don't listen, then your family
won't listen, because they trust the hospital religiously, albeit
schizophrenically too [1]. Which means someone will die sooner than necessary.

[1] scary disease put everything back to primitive human emotions. My family,
and even I, were constantly dancing between "they don't do enough" "thank you
so much". My aunt even thought nurses would poison her husband if she rubbed
them the wrong way. But in the end, hospital gets the vote, and somehow when
death wins.. doesn't matter who was right or not.

~~~
dghughes
My dad was lucky to get a drug for his lungs he has an uncommon deadly disease
called IPF (and also COPD). It was a combination of doctor, insurance and drug
company but in the end he was approved and was given the drug. People
networking is as important in health as IT it's who you know.

I know I was "researching" (Internet, I'm not a doctor) everything you get
desperate when you hear your family member only has a few years. You even
consider alternative mumbo jumbo think well maybe it may work.

Studies and trials are rare in my small town and region but if you can I'd
search, ask, impose, network do whatever it takes have no shame!

You didn't mention if your uncle was still living if so I wish you and your
uncle good luck and good health.

~~~
agumonkey
Well, I wasn't clear above, but sadly nature reclaimed my uncle, he's now
ashes. I thank you very very much for asking and wish you the best of luck.
It's a very weird and sensitive subject.

About your comment:

1) indeed networking is massively important. You talk to someone out of the
blue, it's hard; you say you've been directed by <acquaintance> and the
discussion is now relaxed and open.

2) indeed, you have to forget about shame. Just insist politely. It's hard at
first but with time it goes.

3) I feared becoming too emotional and trusting things that would reinforce my
belief. So I stuck on the usual venues: pubmed, nih, nci, etc etc. And even
then, every topic or paper, I would check citation, publication date, previous
or more recent validation/invalidation. Research lacks counter studies and
sample so one academic paper is not enough.

After this screening, I then pinged various people about these findings and
what they thought about it, to again, not pursue my own dreams. The issue is,
10 doctors ~= 10 point of views.

3) clinical studies were barely starting in my uncle case (one doctor told me
about israel), he was against this because he thought he would be a guinea pig
suffering for their profit. Which isn't false but we could have delayed death
a bit. We all felt it was way too quick.

ps: all of this just gives hint about the complexity of the real world. So
many pieces working at the same time, politics, economy, research, companies,
doctors, networks .. nothing fits perfectly, and if you have to turns the
gears on your own it takes deep faith to never stop. I wish I did more, but
since it's the first time, I couldn't know if I was crazy and foolish or if I
should harass doctors a bit more. My opinion is now clear: never stop; be
sensitive, but never stop. (that's also the quality of a leader.. which is as
old as important in human groups)

