
Cancer 'vaccine' that remembers and fights disease is developed by scientists - tempestn
http://www.telegraph.co.uk/news/science/science-news/12157788/Cancer-vaccine-that-remembers-disease-and-fights-it-years-later-is-developed-by-scientists.html
======
marckemil
As was pointed out before, those are unpublished results. We cannot extract
any significant information from this article. For example, in many early
phase trials, the standard treatment is often given WITH the new drug (or
vaccine), so we'd have to know the response rate of the control group.

As other pointed out, blood cancers are very different than solid tumors --
they've historically been easier to treat. That's probably due to the tumor
micro environnement that makes solid tumor a very different process. To put
simply, I would not assume for a second that outcomes for blood cancers can be
replicated for solid tumors.

Immunotherapy is all the rage in the cancer world right now. It resonates with
patient that "their own bodies can destroy cancer". It's almost romantic.
Kinda like when anti-angiogenesis drugs were all the rage a few years ago...

The "cancer vaccine" has been tried many times before. Pretty much every time
the cancer finds a way around it. Sipuleucel-T is a commercially available
cancer vaccine for prostate cancer. It adds a few months for $$$, but newer,
non-vaccine treatments are now doing better.

We're unlikely to find "a" cure for cancer; we'll eventually find "cures" for
cancer, but it will be small, incremental steps. In the meantime I'll go back
to my clinic and continue to enrol patients on clinical trials

~~~
petra
What about extremely early and accurate diagnostic screening , which can offer
0% or very close to 0% false negatives(and ~30% false positives, like
quanterix talks about), followed by a full panel of the relevant proteins
,guiding to the correct,low dose highly targeted chemo therapies ?

Considering that some results of treating early(by today's standards <2-3mm
tumor) we can get to something like 95%-98% 5-years cancer free rates(while
suffering some side effects), in breast cancer - it seems possible to make
cancer a low-risk ,low-pain disease - as long as you do your regular checkups.
Right ?

~~~
marckemil
Cancer research is not an easy field and many are better than me in that
regard. But food for thoughts:

A screening test with 30% false positive is not a great test. One in three
test takers would be positive, requiring more investigations (likely many
more). Let's say 1000 asymptomatic person take the test, 300 will test
positive. Physicians then have to investigate thoroughly those patients. $$$
for those tests, hours of work missed, and very importantly patient anxiety
and potential harm (a prostate biopsy, for example, is not trivial and people
can die from that)

of those 1000 people screened, 1 has the disease. With a 0% false negative
rate, we catch it. Because of the test, it was caught early. Have we really
changed his outcomes? would he have discovered it by himself a few weeks
later, not impacting any of his treatments? The convention of "catching cancer
early will make it easier to cure" is not always true.

In the meantime, we've had to put 300 people through useless agressive
investigations...

Moreover, 0% false negative would be revolutionary. -- 0% and 100% are
extremely rare in medicine.

Anyhow, screening, especially its drawbacks is one of the most complex concept
to explain.

For genotyping and targeted treatments: it's been tried but we're still not
there yet. The papers coming out are disappointing in that regard.

------
teekert
I really appreciate the down-to-earth-ness of this interview, this man is
being very honest. It's good not to create false hope and present cancer
immunotherapy (yet perhaps) as the thing that will cure any cancer.

However, it is the only real curative treatment next to surgery and really the
only treatment that can cure metastatic cancer. At the moment though, only in
small percentage of people with specific cancers (mostly melanoma, skin
cancers.) So there certainly is reason to be excited, the cancer field is all
over this at the moment so advances in the near future can be expected.

~~~
iolothebard
My mother in law is in this therapy right now. The doctors were surprised it
isn't working (prior chemo worked pretty well giving her another year of life,
once it stopped they switched her to this treatment). They're looking at
hospice care right now.

When the cancer gets to stage 4, you're looking at when not if the cancer is
going to kill you. So to everyone you know that doesn't get regular checkups,
encourage them to do so. Both my parents have had cancer but it was caught
early, my mother in law never went to a doctor after having her last kid ~25
years ago.

~~~
greggman
I have a dumb question but ... how do you know when to check? I suppose I
should google that. AFAIK doctors don't generally check until you show some
kind of symptom (no idea what those symptoms are)

I also remember a Ted talk about a high school student who designed a way to
test for any cancer for $0.01 per test with 99.9% accuracy. No idea whatever
happened to that

[https://www.ted.com/talks/jack_andraka_a_promising_test_for_...](https://www.ted.com/talks/jack_andraka_a_promising_test_for_pancreatic_cancer_from_a_teenager)

~~~
mikekchar
Blood tests can detect a lot of cancers. I've been working in Japan for many
years now. It is normal for people to get blood work done every year here.
After age 40 they also do a barium test for stomach cancer. I think every year
for that is a bit much, so I skipped it this year... They also usually do a
chest X-ray every year which can catch tuberculosis as well as lung cancer.
And for women obviously yearly pap smears and mamograms. Over 35 for men, I
think you are supposed to get yearly prostate exams. I have not done this and
I am planning to get an exam as soon as I can manage it.

Don't wait for symptoms. It's sounds like a lot, but doing the above is really
fairly straight forward and not expensive.

------
nonbel
"The findings are yet to be published and reviewed."

Are people really ok with this practice of researchers talking about their
discoveries without having shared the methods and data (I don't care so much
about the review aspect)? I'm certainly not, but apparently many think this is
acceptable for some reason because I don't see any pushback.

~~~
tominous
I'm biased. My wife was diagnosed with metastatic cancer 6 months ago. With
current standard treatments there is a 3-year survival rate of practically
zero, so to me the most important thing is getting new effective treatments
developed and brought into clinical practice as soon as possible.

I haven't seen the presentation about the study (a related news briefing is
here [1]) so I don't know whether you're correct to say that the researchers
haven't shared their methods and data. They seem quite happy to share
technical details at the news briefing.

However, regardless of that, I still think it is a good thing if researchers
talk about their findings at an early stage, especially if the findings are as
dramatic and positive as these. If a treatment is available and you have
patients out there dying with no other options, then it is just wrong to hide
that away.

In my opinion we treat these things far too cautiously. It is not optimal for
the individual and it is not optimal for society. By sharing /and/ opening up
options like this to terminally ill patients we can (a) save individual lives
and (b) speed up development and refinement of new treatments to benefit
everyone.

The problem is that the incentives we have in place treat a cancer death as
acceptable, while a treatment-related death is unacceptable for researchers,
doctors and drug companies (unless they are shielded by layers of clinical-
trial bureaucracy or years of standard practice). The result is that the
course of treatment doesn't properly weigh the different sources of risk.
Whether the goal is quality-adjusted life years for an individual patient or
faster development of effective and safe treatments, the current system is way
too conservative.

[1]
[http://www.eurekalert.org/aaasnewsroom/2016/webcast/?b=38](http://www.eurekalert.org/aaasnewsroom/2016/webcast/?b=38)

~~~
nonbel
For what it's worth, I used to say I would take some experimental treatment
when the time came. Not after doing research myself and seeing first hand what
"experimental" really means when it comes to medicine. It means: no one has
any way of really knowing what is going on. For example,

1) There will be some studies where a measurement was higher in the treatment
group compared to controls, but it is not 100% clear what combination of
things is actually being measured.

2) There will be other studies you hear about that got different results, but
didn't get published because publishing "negative results" is discouraged and
bad for careers.

3) The criteria for publishing a positive result is a p-value below an
arbitrary threshold, and most people researching medical treatments really do
not understand the meaning of a p-value to begin with. There are all sorts of
myths like it is the probability the treatment didn't work, etc. So (at least
the implementation of) the basic criteria used to judge success is fatally
flawed.

It is quite scary and I don't see anything I can do about it but make people
aware there is a problem here.

~~~
tominous
From a sociology point of view, yes you should distrust any signs of p-hacking
or selective reporting, especially when there is a low effect size.

From a technology point of view, I think we are already well past "no one..
really knowing what is going on." Take the current study. Past researchers had
identified the CD19 antigen found (often exclusively) on B cells, and others
had found that autologous T-cells could persist in a patient for many years,
potentially providing a durable response. The current researchers built on
this knowledge to design and engineer T-cells that could wipe out a patient's
B cells.

So it's a very planned, targeted approach, more akin to engineering than the
old approach of testing thousands of random molecules as potential treatments.
When the targeted approach works, and especially when it has a large and
consistent effect on patients as in this case, then you can be very confident
at an early stage.

This needs to be recognized and medical practice needs to change as a result.
We're entering an era of incredibly detailed knowledge and precision tools for
research and development. The pace of development will continue to increase
and treatments will become more patient-specific as individual targets are
identified.

You could consider the large, slow, blunt clinical trials as being like
optimization for a particular treatment. When new drugs are rare or not well
understood it makes sense to spend time to optimize their use. But when new
drugs come frequently and are well targeted this premature optimization costs
lives.

~~~
nonbel
>"Past researchers had identified the CD19 antigen found (often exclusively)
on B cells, and others had found that autologous T-cells could persist in a
patient for many years, potentially providing a durable response."

I didn't watch the video, so I'm not sure where this info is coming from, but
providing such references is one reason why they should write a paper up
before talking to the media.

Also, I am fairly certain if we do follow up on these claims (I know nothing
about them specifically) we will find the actual evidence is much more
ambiguous, there has been no direct replication attempted, the references do
not actually contain the evidence claimed, etc.

~~~
nonbel
See the problem? I can claim anything I want about this, be it optimistic or
pessimistic, and no one can check. There is no paper (or equivalent source of
information), so no way to assess the evidence.

~~~
tominous
One way to approach an announcement like this is to wait until everything is
wrapped up nicely in a neat paper.

Another approach is to investigate further using the tools available: look up
the authors' past work on Google Scholar, check clinicaltrials.gov, look for
third party opinions, even ask the authors directly. I'd argue that the
scientists and journalists at the AAAS conference where this was presented are
capable of this second approach, and so are many participants on HN.

~~~
nonbel
I think if you try it out, after a few you'll find this is naive. Further, you
are doing the job of the person making the claim!

It is too time consuming to research a claim indirectly like that. That is
what you do after reading the paper which contains (usually most of) the
required information and (usually a biased sample of) citations to the other
research that were found relevant.

Reading the paper is only a first filtering step to evaluating a claim, a
conference presentation simply doesn't merit that effort because it contains
far too little information. A conference presentation is more like "hey, check
out what I'm working on".

Now, that doesn't mean people don't try to do this, it is one of the primary
uses for misinterpretation of p-values.

------
mchahn
Why are all the gene-based cancer breakthroughs I've seen in the news for
blood diseases? Is it easier to manipulate genes in blood?

~~~
teekert
I think it is because in blood drugs and gene based treatments are the only
option, surgery is simply not an option. This has always spurred the blood
cancer field to take greater risks, the all or nothing approach.

~~~
pacap
From what I remember, these blood cancer have an antigen, CD13 or something,
which is unique to them - no other body part has it, making it easy to target
them.

Otherwise, you get the side effect of destroying your own body, the case of a
woman a few years ago, who died having her lungs destroyed by immunotherapy.
Lungs had the same antigen.

This morning I read something hopeful in this direction - UCSF researchers
designed an AND gate, so now they could trigger a T cell attack only when 2
specific antigens are present, making it much more reliable. And I could
imagine these can be chained, further narrowing it down. It needs genetic
sequencing to isolate.

[https://www.ucsf.edu/news/2016/01/401471/tricked-out-
immune-...](https://www.ucsf.edu/news/2016/01/401471/tricked-out-immune-cells-
could-attack-cancer-spare-healthy-cells)

At the moment this is a terrible manual and time consuming process, so it is
expensive.

~~~
erkkie
This is also why a combination of engineered T-cells and immune checkpoint
inhibitors is a really winning combo.
[http://www.theguardian.com/society/2015/jun/01/paradigm-
shif...](http://www.theguardian.com/society/2015/jun/01/paradigm-shift-hailed-
in-treatment-of-lung-cancer)

~~~
AstralStorm
Immune checkpoint (fancy name that, you probably mean anti-autoimmune system)
inhibitors main problem is the very high risk of autoimmune disorders that are
hard or impossible to treat. Just toggling the suppressor will not kill clonal
cells already in circulation, and those can last a long, long time, or even a
lifetime. If you're unlucky, you will also get "broken" immune memory cells -
which also last for life.

Trading cancer for SLE or rheumatoidal arthritis etc.

------
dschiptsov
Theory holds that mutations are random and each cancer process is different.

