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Cancer Vaccine, tailor-made for each patient, advances to Stage 1 clinical trial (wgrz.com)
230 points by checoivan on Jan 25, 2012 | hide | past | web | favorite | 40 comments



Disclaimer: I am not an expert and basically just some random internet person. I've read several recently-published books on cancer, including "The Emperor of all Maladies," (http://amzn.to/xr2Mx1) which I highly recommend.

We keep thinking we have a lock on curing cancer, but it continues to be very elusive.

As I understand it, using automation to "debug" individual cancers is scalable. That is, reading a cancer, adapting to it, and creating a vaccine is something that can be done with increasing levels of detail as automation increases.

So if they only show a 1% improvement, it's a strategy definitely worth continuing. This is very much like the hacker who keeps playing around with a broken method until it works -- only it's all automated. It very well may be that we "learn" how to contain/control many cancers without having a traditional understanding of them at all. Fascinating approach, and much different from previous forays. Watch this space. Given the history, my money says it's still going to be a long, hard slog -- perhaps decades, but still, a promising approach.


I would hope we eventually start to put money towards prevention to reduce cancer to begin with. Prevention will always be less cost and less suffering.


Trouble is, preventing cancer is hard when we don't even know what causes cancer. Obviously smoking is a big one and people have been working hard to great success to eliminate it. How about cooked vegetables? Raw vegetables? Processed sugar? Burnt pieces of meat? Cell phones/wifi? Sunlight? Artificial light?

The reason it seems like everything causes cancer is because everyone is at risk for cancer. Living is a cancer risk. A lot of people don't die from cancer because they don't live long enough, but prevention will never happen. Cancer is inevitable.


> A lot of people don't die from cancer because they don't live long enough, but prevention will never happen. Cancer is inevitable.

Except of course for all those that do live long enough, I don't think the centenarians and beyond die of cancer http://biomedgerontology.oxfordjournals.org/content/60/7/862...

From what I can see at FastStats http://seer.cancer.gov/faststats/selections.php?series=age incidence does go up with age, but there's still plenty of cancers that happen at relatively young ages, and if you look at the trend, going back to 1975 which is not that much really, you can see a marked increase towards 1990 and then a stabilization, which to me suggests it's quite likely that environmental and lifestyle factors do come in play, as similar trends occur in other health related issues (metabolic syndrome). Markedly lower Vit-D levels, our increased consumption of n-6 poly-unsaturated fatty acids and processed foods, all likely play a role.

I short, I agree with gp in that there is surely a bigger payoff in prevention, but that doesn't mean that cures wouldn't be welcome too. I can't agree that cancer is inevitable.

Edited to add links, formatting.


>Except of course for all those that do live long enough, I don't think the centenarians and beyond die of cancer

There are people immune to AIDS as well. These are the outliers. Just because people die of disease before they get cancer doesn't mean they wouldn't have gotten cancer otherwise.

>it's quite likely that environmental and lifestyle factors do come in play

Yes, I accepted that in my post. There are ways to increase your risk of cancer. My opinion was that there is never a statistically relevant zero risk for cancer. Prevention of cancer will never completely stop cancer from forming unless we know and can avoid all possible risk factors of cancer (impossible). Prevention is a good step, but finding a way to reverse cancer is the only way to keep people from dying from it.


Yep, my understanding is that DNA damage is unavoidable and will eventually lead to cancer. The repair mechanisms for DNA are eventually outdone by the damage mechanisms. Improving the efficacy of the repair mechanisms for DNA could end up being a fruitful approach, but I'm not sure where the state of the art is on improving DNA repair.


Everyone has cancerous cells all the time, and the body is able to deal with them. The issue is when there is too much cancer at once or the body's healing systems aren't functioning well. Being proactive by keeping the body healthy, eating fresh food without chemicals, having clean air, doing fitness/yoga to have regular bloodflow and oxygen going through your system and mind will keep your body where it needs to be to better at killing off cancer cells -- a lot of other benefits too of course.


Roswell Park employees also man the phones for the NYS Smokers Quitline.

http://www.nysmokefree.com/

An ounce of prevention is worth a pound of cure.


this is the most pervasive myth in health care. standard economic analysis shows this is wrong and that we would save significant money with more people using emergency room care vs preventative care.


I doubt this is a full and accurate analysis you're mentioning. Is it calculating productivity losses? What about emotional costs? Quality of life? Etc. etc. And at the same time - sure, if you just let people get sick and put a bandaid on them and get them out of system without actually being healthy - then I'm sure you can make it cheaper ... but not with the same results of health.


Wait, really? That's surprising to me. A very cursory search seemed to indicate that prevention is better. Do you have sources? I'm interested.


quick ref: http://www.overcomingbias.com/2008/04/prevention-cost.html http://www.overcomingbias.com/2008/10/preventive-heal.html

I'll look for some underlying data once I get out of class.

AFAIK the problem isn't necessarily "best practices prevention" per se but the fact that we massively over-consume health care because of bad incentives.


But of course as one of your links points out: The term "preventive medicine" no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach. But the medical model for prevention has become less about health promotion and more about early diagnosis.

I'm pretty sure the original comment you replied to assumes the same meaning, that of promoting healthy behavior _before_ you become ill, not the newer and distorted meaning of "early detection".


IME experience people usually mean the actual preventative medicine and not promoting healthy lifestyles. Otherwise it wouldnt be such a big deal for how much of GDP is spent on medicine.


I hope we use Genuine Progress Index (GPI) instead of GDP in the future. GPI takes into account more than just money spent and hard productivity.


Yup - nice to find out the term was highjacked to mean something different. :)


I'd also highly recommend "The Emperor of all Maladies." Even if you have only a passing interest in the topic of cancer, it's consistently surprising and interesting.


> This is very much like the hacker who keeps playing around with a broken method until it works

There's a huge downside to that: "Lets see if drop tables works... oops."

I'm not sure if this thinking is only something from mixed metaphors or is applicable to what they're doing.


Then a bunch of mice die, and we move on to the next iteration.


My life partner has grade III brain tumor. Recently diagnosed and operated. She took surgery well. Apart from slightly higher chance of mispronunciation she feels as good as ever. It's interesting that you can live unchanged without the part of your brain. Her brain had time to adjust while her tumor was growing. She'll be starting irradiation and chemo next month.

I really hope this vaccine will be available and effective when her tumor grows back.


I'm proud to say that I work at Roswell Park. I'm one of five web developers in the IT dept. I write internal applications focused on supporting the many clinical trials happening here.

There is definitely a huge buzz going through Roswell's campus regarding this.

Here is the publicly available information regarding this particular Phase I study.

http://www.roswellpark.org/clinical-trials/list/191511


I'm curious, how do you like working there?

I'm a programmer in Buffalo, NY. I always check Roswell's "Available Careers" and they always have to same two Programmer Analyst postings.

Do you have a chance to use cool technologies there? The postings mention JSP/VB/blah.

I'd love to send in a resume to support meaningful work.


I've been at Roswell nine years. I intend to retire from here. I'm also a Buffalo native and I can't think of anywhere else in the city I'd rather work.

Roswell is run similarly to a college campus (I've had previous experience supporting NY State colleges), meaning there are many departments, each run fairly independently of each other and each with different technical needs.

The departments usually fall in one of three categories: there is an educational group that works with UB's medical campus, a clinical component that treats patients, and obviously a heavy research component. During my time here, there have been at least four startups/companies that have formed as a result of research I've helped support.

Roswell currently has about 3,300+ employees. The Programmer/Analyst positions you have seen are an attempt to fill needed positions in various departments.

Everyone's version of "cool technologies" is different. I'm of the opinion, for the most part, whatever gets the job done thoroughly and accurately works.

In the past nine years I've written and maintain about 20+ applications in VBscript, C#, Actionscript, PHP, Ruby, etc with the various associated frameworks. Since every department requires something slightly different I've had to adapt as needed. However, recently we've been running with an inhouse PHP framework called Surebert which was/is written by a co-worker.

http://www.surebert.com

https://github.com/surebert

Interestingly enough for me, I've never written anything professionally in Java, but a lot of my co-workers have.

Out of the five of us on the web team, I'm the Apple fanboy. So I'm on a MacBook, iPhone, etc. Another one is on Fedora, another is using a Dell (ugh). To each their own.

And Roswell lets me moonlight on the side. I've had fairly steady freelancing gigs for a couple years now.

Interesting place to work. Good people. Very little complaints (nothing's perfect).


I appreciate this response so much. Thank you.


As a near-border neighbour in Hamilton, it's great to see Roswell Park and Buffalo get some much deserved attention on the biomed front.


Agreed.

Some great things are happening in Buffalo/Roswell, this is just one of the more vocal discoveries worthy of attention. I truly hope this trial continues on successfully as the PIs (principal investigators) envision.

On a personal note, I find it mildly entertaining to say that "I code to cure cancer". It is an honor to support incredibly smart people working to eradicate such a horrible array of diseases.


I'm writing an article that could use some input from you. I'll appreciate if you can contact me (http://www.nilkanth.com/contact) and share some insight.


Hi. Message sent. However, your contact form timed out on me.


Remember, stage 1 clinical trials are just "does this treatment accidentally kill people" trials. They're a long way off from testing to see if the treatment actually works.


Nobel laureate Ralph Steinman had some of this kind of vaccines tested on himself when he got pancreatic tumor. He lived unusually long for this kind of tumor and died of pneumonia.

There's piece about his fight in recent Scientific American. http://www.scientificamerican.com/article.cfm?id=the-patient...


Right, but that's the thing... some of these drugs might work for some and kill other people unexpectedly. The efficacy for one person doesn't mean that it wouldn't kill every other person that takes it, and looking at a sample size of 1 (nobel laureate or not) doesn't make for good science or good medicine.


This is exactly why personalized medicine, bioinformatics, computational pharmacokinetics, etc is key for the future of medicine.

I am not a biologist but I imagine someday soon a scenario like this will be possible: You have a model of the sites and interactions the drug targets, and optimum biology - metabolism, target cells' proteomes etc. Measure these in the patient and you can predict ahead of time the efficacy of the drug and then optimize the drug's chemistry to be more effective for this individual. With a better understanding of protein modelling and such you could do a search for similar structures and compute the expected interactions and optimize for personalized effectiveness.


Some people who have exhausted all other treatment options might opt for it even then, though. At least they can.


While generally speaking, yes, you are totally correct, you have to remember one thing: the FDA has provisions for terminally ill patients to utilize unapproved medicines in highly restricted scenarios.

http://www.cancer.org/Treatment/TreatmentsandSideEffects/Cli...


There is already an FDA-approved therapeutic cancer vaccine that is sold by Dendreon for the treatment of prostate cancer (Provenge). Like this Roswell Park therapy linked to, Provenge also harnesses dendritic cells.

More info on Provenge: http://en.wikipedia.org/wiki/Sipuleucel-T


Soon, everyone can smoke without worry.


Two words: zombie apocalypse


Stage 1 clinical trials take healthy individuals, give them the drug, and wait to see if it kills them. To go from stage 1, through stage 2 (which determines effectiveness), through stage 3 (which determines safety for general distribution) takes 10-15 years.

In other words, this is not news. There are probably hundreds of similar clinical trials every year.


Not quite. Phase I trials often happen in patients with the disease, because otherwise the data you get on toxicity aren't that relevant.

Definitive efficacy is established in a phase III trial, along with safety.

en.wikipedia.org/wiki/Phases_of_clinical_research

This trial is news-worthy for a few reasons. One is that the only documented cases of cure of a disseminated cancer are proabably all due to an immune-mediated attack (exceptions are lymphomas and testicular cancers which can be cured with chemotherapy even if widespread). Vaccines are trying to exploit this mechanism. Another reason is that most of the treatments we use in phase I trials are poorly understood. The treatment employed in this study however utilises a pretty simple and elegant approach - find something that only cancer cells have, then try and bait the immune system with it.


"The purpose of this study is to test the safety of a treatment called DC205 NY ESO 1 vaccine, given with and without sirolimus, and to see what effects (good or bad) it has on you and your type of cancer."

http://www.roswellpark.org/clinical-trials/list/191511




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