For me, my treatment (adoptive cell therapy using tumor infiltrating lymphocytes) used my own white blood cells (130 billion in lab-selected and expanded form) to overwhelm the mutated cancer cells.
It was a one-time treatment (over 3-4 weeks in the hospital) with no further meds or other treatments required.
Immunotherapy has become an important tool in the future of fighting cancer, for sure.
Note: IL-2 was administered after I received my lab-grown white blood cells. It acts as signal to one's immune system to activate. It was used to jumpstart my immune system after it had been replaced.
Also I don't think I'd be eligible, I have ulcerative colitis which is autoimmune.
I hope all patients that would benefit from this treatment will have access to it, to save their lives and to validate and improve the therapy for all those to come
Immunotherapy is really revolutionizing the treatment of locally advanced and metastatic lung cancer. However, a "revolution" in our world is improving 5-year survival by 10-15% in absolute value. It's not outstanding, but when your baseline is around 10%, improving it by 10% means doubling it. That's why immunotherapy is being adopted so quickly despite its price.
A poster mentioned $100 000 is not a lot if it adds 10 years. It's not as simple. Right now we don't really know if we can stop the treatment. So people often receive the treatment until they progress. If it's 4 years, we're looking at $400k... The cost on society in general will have to be dealt with (and debated) at some point. I doubt insurance companies will continue paying for those treatments "forever", especially considering how prevalent lung cancer is.
Immunotherapy benefits from a great "romantic" story, which helps with its marketing like no other drug. It's your own immune system, your army, waking up and attacking the greatest villain of all; cancer. The alternative, chemotherapy, is often seen as poison. Granted, it has fewer side effects, but it has some, and they can be nasty. Basically, the immune system is in a constant state of equilibrium. You stimulate it too much and it starts attacking your own body. We're seeing some cases of thyroid problems, lung inflammation (pneumonitis), skin problems... Generally speaking though, it's better than most chemos.
Overall, it’s a great treatment but obviously not perfect, crazy expensive to a point that it’s likely not sustainable in the long run. Despite all of the drawbacks, it’s a really exciting time for oncologists as we can finally offer more hope to our lung cancer patients.
There is a host of bio-tech startups following this initial wave - with two main goals:
1., Improve the treatments to become 100% cures
2., Lower the price
This is very similar to tech and, say, the storage space. Went from 100k for a few GBs to peanuts for TBs on AWS pretty quickly. That's what momentum in a crowded space will do.
Healthcare systems around the globe will have to figure out the effects of this, similar to autonomous driving. And it is not just simple cost of treatment.
What if cancer becomes curable?
What to do with all the cancer wards? Specialists in Oncology? Chemo/Radio/Surgery? The spider-web effect here is gigantic.
Sticker price for the drug vs. long term treatment (multiple chemo rounds, surgery, palliative care) if its 100k is NOTHING.
In 50% of the full range of cancer types treated so far by the drug in question, immunotherapy does absolutely nothing. And for another 25% it helps only a little. Only about 25% see a game-changing response. Even then, among high responders, most are not cured. They do live longer than if treated only with chemo. (In this study announcement, there's a 51% better survival rate after one year. That's great for those who are near death. But it offers them additional months of life, not decades.)
As of today, the fraction of patients who are fully cured of cancer by immunotherapy is unhappily small. It's also important to remember that these therapies are too new for us to know how long the positive effects will last. Will the lucky ones add months or years to their lives? We don't know. As of today it's just too soon to tell.
I do agree that the potential of treating cancer using the immune system is exciting. Certainly. But right now we're nowhere near able to declare victory or start worrying about the implications of ending cancer. That's not fair to the unlucky majority of cancer patients.
Personally, I always wonder why people go through the pain and expenses to add a few more months. Years/cure - yes, go for it. A few months? I'll take the painkillers and anti anxiety drugs, thanks - it was a good run.
a lot of immuno-onco is currently only approved for late-stage cancer patients. basically once you're near death and chemo/radio is done, you get the new stuff. and even within those groups you get people that are cancer-free within weeks. astonishing.
long term survival is unknown - sure. no one has been treated ten years ago with this stuff. besides a time machine there is no way of knowing, just waiting.
watching companies like https://www.modernatx.com/ building whole platforms is super exciting though. as someone who has lost family and young colleagues to cancer, this shit cannot come soon enough.
Seriously groundbreaking. This is a once-in-a-decade paper. 
it’s the first major advance we’ve had in oncology in maybe 25 years.
When I read many medical studies in the media, they often sound too good to be true. In this instance it is the real deal.
I hope access to this treatment becomes readily available for the rest of the public.
In the US, cancer is the second leading cause of death, and lung cancer is one of the largest causes of cancer death. Curing this disease, even in a subset of patients, is really amazing
[1 non-outlined link]: https://www.ft.com/content/30b5a944-3b57-11e8-b9f9-de94fa33a...
There are quite a few Chinese companies developing their own PD 1, PD L1 and CTLA4 inhibitors (these are the first gen immunotherapy treatments), and a lot of innovation in CAR-T cell therapy (first approved products of this type were US and European, Novartis and KITE pharma). There is less regulation of cell therapy in China, so potential for some breakthroughs.
A company called Legend Biotech in China surprised the biopharma world at a major confreence last year with breakthrough work with a cell therapy targeting BCMA.
However, the amount of US and EU investmnet in immuno-oncology is still greater than in China
I hesitate to assign an exact percentage to the effectiveness since there are so many factors to consider, but I remember Keytruda being reported to shrink tumors in less than a third of patients who took it.
> “Chemotherapy has limitations. Immunotherapy has the ability to cure. I lead the Yale lung team. We have patients on these immunotherapies alive more than eight years.”
"Researchers with Cuba’s Center for Molecular Immunology have developed and approved an immunologic cancer therapy that improves survivability for certain types of cancers in some cases; as of January 2017, the drug has begun clinical trials for the treatment in the United States."
This drug has completed a limited Phase II study in 2014 (71 patients), adding about 5 months of life over the control group (11 mo vs 6 mo). Then it began a large international phase III NSCLC (lung) study which apparently hasn't ended yet.
It's approved for use in Cuba and Argentina, probably only for lung cancer.
Also, these drugs don't just extend life a few years for a few patients. Over 50% of patients are responding to these drugs, and some of these can live 10 full years. Is $10,000 / year too much to spend so a loved one can live a healthy life? $50K / year is generally the threshold used by health economists to determine the value of a quality adjusted life year, and in this case these treatments fall below that threshold
And if you have insurance, it will cover much of that cost
Someone has cancer and their kids are wanting the treatment (of course, it's false hope, we don't want daddy to die) without realizing what they are asking for (lifelong debt). So in addition to cancer, the patient has to grapple with that shit. Anyone with a little financial sense would probably take death, but now they have to explain that to their families why they are denying the treatment (daddy doesn't want to be with us / daddy wants to die?).
Disgusting what this country has become.
Putting caps on prices without doing something about research costs is just going to kill research. All the big pharma companies are laying off scientist every week because even with uncapped prices the returns are so low that it is not worth spending the money to develop new drugs.
A more productive approach might be to look into why drug development has become so expensive. It is certainly not because pharma companies have suddenly become greedier.
European countries pay much lower prices (although still relatively high vs. an average salary) vs. the US. The dirty secret is that the US is generally milked by pharma, because it can be. Until the US gets its act together and fixes this --and how likely is that, with the essentially broken system of government?-- it will continue.
> A more productive approach might be to look into why drug development has become so expensive. It is certainly not because pharma companies have suddenly become greedier.
It's expensive because a) it's a long and hard slog, and b) the regulators set very high standards. You can't affect a), and there is a strong disincentive for regulators to change b): in essence, regulators exist to prevent bad things happening, so are only incentivised to ever-tighten regulations.
To be fair, European big pharma also lives off the US market to plump their margins. That subsidizes their ability to charge lower prices in Europe and elsewhere. They also constantly poach cutting edge biotech & pharma companies out of the US to keep their stables full, such as AveXis, Genzyme, Genentech, etc. Without constantly buying up elite US biotech, Europe would have practically no biotech industry at all.
The US is by far the world's largest drug market. It's heaven for Sanofi, GlaxoSmithKline, Novartis, Roche, AstraZeneca, et al. The US drug market is twice the size of the EU drug market, with ~37% fewer people.
...as I said in my very next sentence? :)
> They also constantly poach cutting edge biotech & pharma companies out of the US to keep their stables full, such as AveXis, Genzyme, Genentech, etc. Without constantly buying up elite US biotech, Europe would have practically no biotech industry at all.
Can I ask, what's the problem with this?
All of the companies you refer to are pretty-much global - they have a presence in many countries, including the US, and by being publicly traded, ownership isn't especially linked to their country of origin. AZ (for example) being based in the UK means little for the UK, apart from that being where it pays some tax, and employs some people in its head office.
To take one of your examples, Roche (Swiss) bought Genentech (US), and still maintains the same huge presence in SF, still employs people in SF, still pays taxes there. And presumably the previous owners of Genentech stock did nicely out of this?
You are 100% right that the problem all comes back to regulation. What is missing from the drug development area is any cost benefit analysis. Regulations are made as if there is no cost to the ever tightening and restrictive regulations.
You paint such a sad, desperate picture, but based on their numbers, it sounds like they are doing it to save a buck. Look at those profit margins. 10-43 percent on billions of investment. I should be so lucky.
Did you know the US government isn't allowed to negotiate drug prices for medicare and medicaid? They (we) just pay whatever the companies want to charge.
I am no defender of pharma companies, but they are doing exactly what the economic incentives encourage them to do. We need to change the incentives, not just rant about high prices and greed.
Edit. Yes I know that the US government is not allowed to negotiate with drug companies over pricing (it is a little more complex than this in practice), but even with pricing uncapped the profit margins don't justify them spending more on R&D.
We agree on the problem, just disagree on the solution. You should also read the part two of the article you quoted . Unfortunately all the solutions provided are little more than a sugar pill for the real problem - R&D costs.
There is a clause in the law establishing Part D that says the government can't interfere with those negotiations, but this is different than the prices not being negotiated at all.
Medicaid prices aren't negotiated, but the government dictates that they get near the lowest prices the manufacturer sells the drug for.
Also, Medicaid does not only get the lowest price ("best price"), they also get another 23% knocked off.
So to be entirely accurate, the US gov't doesn't negotiate drug prices for Medicaid, it creates it's own discounts and tell the company to screw off if they won't accept them.
Is it simply that expensive to get mabs from animals, is drug development disgustingly expensive, or is there unbounded greed in pharmaceutical companies?
https://www.healthcarebluebook.com and a bunch of others are trying to provide price transparency. Sometimes 30 min drive means thousands in savings.
if you don’t have health insurance, your floor for “prohibitively expensive” is probably way lower than this already.
You're not doing a lifetime of cancer research in hopes that you earn an average salary.
For the company, if you finally get somewhere with a drug that is affective, you have to try and recoup your investment. How else do you fund future research?
Looking at just research and eliminating patent dogging efforts, Drug companies don't pay for nearly as much research as you might think.
These numbers certainly aren't risk-free. Even if the company has 10 billion in cash, how many potential research leads can they bring to market? Not many.
Clearly not true. Less than 5% of molecules that drug companies pick up make it to market. Huge failure rate.
In the US, 5% of patients represent over 50% of the cost of healthcare. 1% of patients are 20% of all expenses. The healthiest 50% represent just 3% of the healthcare system's costs - they're the financial offset group.
For downvoters that find facts uncomfortable: that's why the ACA needed to force all people to have insurance, it's a financial necessity to get as many paying healthy people in the system as possible to financially offset the cost of sick people if you want to try to make it work. This is healthcare system 101.
Agree - that's indeed how insurance works. :)
I was referring to high co-pays on vastly expensive new drugs, and was also being slightly facetious.