
'Living drug' offers hope to terminal blood cancer patients - lifeisstillgood
https://www.bbc.co.uk/news/health-48706822
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apathy
Not mentioned here: the same results can in many cases be had from BiTEs at
lower cost and without having to ship leukapheresis samples to the US in
liquid nitrogen

Having seen both ALL and AML patients relapsing through CAR-T, I don’t think
people appreciate either the systemic load or the possibility of treatment
failure that exists in real patient populations. Neither was elderly; 26yo
female ALL and 5yo female AML. Both dead, both crushing disappointments after
the initial excitement.

(For CAR-T therapy, the common remark is “you know it’s working when the
patient goes to the ICU” from tumor lysis; but in both cases the patient’s
disease outran their engineered T cells)

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dannykwells
It's not really fair to compare BiTEs to first gen CAR. Bispecific (or
tri/quad specific) CAR have a greatly reduced rate of relapse due to antigen
loss (likely what is causing most relapse in these diseases).

Re: BiTEs, it's not clear they'll produce durable cures like CAR does. They're
just antibodies, and will eventually be cleared. With CAR, if you can get a
response, you can generate memory T-cells and control any relapse far down the
road.

~~~
lliamander
Immunotherapy is really fascinating, I know someone going through it right now
and it seems to be helping (early days yet, of course).

I was very curious to read that it had such severe side-effects, especially
the neurotoxicity. Why such a severe reaction? Does the neurotoxicity have
developmental impacts for children that receive immunotherapy?

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dannykwells
The origin of CNS toxicity is still a topic of research. I believe it can
occur in children as well (I am not an MD and specialize more in the
checkpoint inhibitor side of things).

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NotSammyHagar
This is the way it will work in the future, so many diseases will one by one
get treatments that are individualized genetic treatments. They will gradually
get cheaper. You will hope to survive till a treatment for your problems get
cheap.

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lifeisstillgood
Thank you

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GeekyBear
Vice on HBO did an episode back in 2015 looking at several different
experimental (at the time) cancer treatments which included a segment on the
fourth patient to receive CAR-T.

[https://www.youtube.com/watch?v=FlK-
PeCfezM](https://www.youtube.com/watch?v=FlK-PeCfezM)

The CAR-T segment starts at 27:30.

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ImaCake
When I first heard about this I thought it would be another failed wonderdrug.
But I am very excited to see it's adoption in mainstream medicine, even if for
just the most extreme patients. Treatments like this, and other less audacious
immunotherapies give me a lot of hope for the future of decreasing human
suffering.

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milofeynman
They don't mention it in the article but I believe this is the first big
treatment to use CRISPR/Cas9

[https://www.ncbi.nlm.nih.gov/m/pubmed/30261221/](https://www.ncbi.nlm.nih.gov/m/pubmed/30261221/)

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dannykwells
This is not true. The treatment they are getting uses a lentivirus transduced
T-cell. CRISPR will eventually be used but in the approved products, not yet.

~~~
milofeynman
Oh I see, sorry about the confusion.

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gaspoweredcat
kind of a good and bad thing to call it really though, obviously even though
they are dying no one wants a "Dying drug" but likewise "Living Drug" seems to
offer a little too much, "Anti-Dying Drug" maybe? :P

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tialaramex
It's a living drug because it's a drug which is in some sense alive. It's made
up of T-cells, from the patient's body, but modified.

We also distinguish "live vaccine" from "inactivated" or "killed" vaccines,
for example OPV the cheapest way to prevent polio is a live vaccine, it's a
version of the Polio virus that has adapted to a slow life in a cold medium,
and then you eat it (literally, it was traditionally given by adding one drop
to a sugar cube, the patient eats the sugar cube, delicious) and your gut goes
"What? This is alien - kill it" and you become immune to Polio before it spins
back up and causes any harm.

Live vaccines are dangerous (which is why we don't use OPV in countries with
no polio and plenty of money, even though it is more effective than any
alternative) and no doubt this drug is also dangerous, but hey, it's for
people with a terminal disease so what's the worst that could happen?

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aiyodev
> They are frozen in liquid nitrogen and sent to laboratories in the United
> States.

Why do you need to send your blood to an “inferior” healthcare system?

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sapilla
This reads like the prelude to 90% of all zombie movies - cheating death by
injecting virusses, starting in the UK. It even includes a fever and
neurotoxicity as side effects.

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WalterBright
I wouldn't worry about zombies. They violate conservation of energy laws, for
one.

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dhimes
_They violate conservation of energy laws_

Now I'm even more worried! How can the _do_ that?

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sslayer
So gene therapy with extra steps.

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Circuits
If cancer was a dude I would punch him in face.

