from the seems-better-then-what-we-are-doing-now dept.
Arthur T Knackerbracket has found the following story:
An immunotherapy drug has been described as a potential "game-changer" in promising results presented at the European Cancer Congress.
In a study of head and neck cancer, more patients taking nivolumab survived for longer compared with those who were treated with chemotherapy. In another study, combining nivolumab with another drug shrank tumours in advanced kidney cancer patients.
Immunotherapy works by harnessing the immune system to destroy cancer cells.
Advanced head and neck cancer has very poor survival rates.
In a trial of more than 350 patients, published in the New England Journal of Medicine, 36% treated with the immunotherapy drug nivolumab were alive after one year compared with 17% who received chemotherapy. Patients also experienced fewer side effects from immunotherapy.
The benefits were more pronounced in patients whose tumours had tested positive for HPV (human papillomavirus). These patients survived an average of 9.1 months with nivolumab and 4.4 months with chemotherapy.
Normally, this group of patients, with advanced or treatment-resistant tumours, are expected to live less than six months.
Early data from a study of 94 patients with advanced kidney cancer showed that the double hit of nivolumab and ipilimumab resulted in a significant reduction in the size of tumours in 40% of patients. Of these patients, one in 10 had no sign of cancer remaining. This compares with 5% of patients showing tumour reduction after standard therapy.
[...] As yet, nivolumab has only been approved for treating skin cancer and in June it became one of the fastest medicines ever approved for NHS use, in combination with ipilimumab, for the same cancer. Nivolumab and ipilimumab both work by interrupting the chemical signals that cancers use to convince the immune system they are healthy tissue.
(Score: 3, Informative) by fadrian on Tuesday October 11 2016, @02:45PM
Nivolumab is the generic name for Opdivo. Opdivo's been tanking in the field compared to Keytruda. So much so that Bristol-Meyers Squib stock sank about 10% today due to this. So they're trotting out anything they have that this drug might stick to. And, who knows - it might actually fight kidney cancer tolerably well. However, this was the same kind of "miracle drug" talk that came out when Opdivo came out for lung cancer. Just sayin'.
That is all.
(Score: 2) by weeds on Tuesday October 11 2016, @02:56PM
Right. Game changer for Bristol-Meyers Squib if enough people buy into the hype.
Get money out of politics! [mayday.us]
(Score: 3, Insightful) by VLM on Tuesday October 11 2016, @03:11PM
I googled up the cost and its roughly 4000x as expensive as gold per unit mass. Of course in bulk production and use it might eventually be cheaper. Although, "hey you gonna die without this" "I'll pay anything not to die" "Good because you get one guess how much it gonna cost?"
Right now that 5 months of life (average) costs $295000 which sounds like a beancounter trying to keep it under some insurance limit of $300K. Five months as an engineering estimate is about 3600 hours so that's only eighty bucks per hour (to one sig fig in my head) to keep someone alive.
My point isn't the cheapness or expensiveness of life, but the stupidity of waiting to spend money until the last couple months of life.
Surely, there are some cancers that are a genetic cause and nothing can stop them. But of the ones that can be stopped, surely its cheaper to stop them 10 years ago for pennies on the dollar rather than waiting to spend $300K after the death sentence is pronounced.
So you'd break even if you spent $300K per person preventative, but lets go a tenth, $30K/person is a hell of a lot of dough to convince people that suntanning isn't cool or smoking crack isn't cool or dipping tobacco isn't cool or WTF causes this kind of cancer to begin with.
Well we can't afford to make a seawall taller so we'll just wait till the nuclear plant washes away into the ocean and then spend trillions cleaning it up, because that's "cheaper" or some damn fool accounting thing.
Just seems a very stupid allocation of resources. Find a way to reduce the incidence of this type of cancer to 1% or less of its current rate for $3K/person and I'll be impressed, but this is just some weird frankensteinian experiment on terminally ill people, screwed up and creepy and wasteful of money.
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @03:57PM
> I googled up the cost and its roughly 4000x as expensive as gold per unit mass.
What you missed is that nivolumab is under patent protection.
When it goes generic, it won't be crazy expensive any more.
BTW, that's a crap metric anyway.
I googled up the cost of a morning after pill - Altavera: [drugs.com]
30 mcg for 90 cents == $30,000 per gram.
Market price for gold is $40.55 per gram.
(Score: 2) by sjames on Tuesday October 11 2016, @04:40PM
Actually, it's a great metric if you want to know how crazy overpriced something is. In the case of Altavera, it just happens that you need so little it's affordable in spite of being marked up to crazy heights.
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @04:59PM
Get back to us when there is a standard dose for gold medication.
(Score: 2) by sjames on Wednesday October 12 2016, @04:00AM
OK [wikipedia.org]
(Score: 1, Insightful) by Anonymous Coward on Tuesday October 11 2016, @04:05PM
The math is not nearly that obvious or clean. I'm going to be making up numbers, but consider the following.
Cost to treat disease is $10000
Cost to prevent the disease is $1
Cost to diagnose somebody potentially has the disease is $1 (say it has a 90% accuracy rate)
Percentage of the population which gets the disease is 1/100000
So yes, for a person who has the disease it would have been substantially cheaper to get the preventative treatment. However, for society as a whole, there are so many false-positives, cost for diagnosis, and costs of treatment it is actually not worth it to do. This is not including the side-effects of the preventative treatments (chances of complications, people feeling bad from the medicine, etc.)
Likewise for the power plants, if somebody told the power plant company that a disaster would occur, I guarantee they'd have built the wall. However, there are thousands (?) of power plants, almost all of which never have a problem. You need to draw a line somewhere where to accept risk. The world is a dangerous place, and if you try for a 100% perfectly safe world, you'll end up spending far too much expense.
For an example, see the efforts of the TSA, the attempts of the government to install backdoors into all systems, etc. After all, "if we can save just one life, it's worth it"... isn't it?
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @06:28PM
"For an example, see the efforts of the TSA, the attempts of the government to install backdoors into all systems, etc. After all, "if we can save just one life, it's worth it"... isn't it?"
Those are... outrageously bad examples. The security theater has absolutely nothing to do with (attempts to get) actual security and absolutely everything to do with money, control and the appearance of "doing something". You can't use those as examples of excessive spending for almost no benefits if the benefits weren't in the plans to begin with.
I do agree with your general point though - it's just that your example was bad. You should've used a car metaphor.
(Score: 0) by Anonymous Coward on Wednesday October 12 2016, @03:35AM
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @04:06PM
I agree with your line of reasoning, but this kind of biological research broadens our body of knowledge and will certainly be useful in many yet unknown ways and in treatment of non lethal and other diseases which are not in oncology domain. Besides, isn't it applicable in early cancer treatment as well?
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @05:19PM
Surely you're not implying that all cancer types have a direct cause, and are thus preventable...?
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @05:23PM
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @05:33PM
Haven't you heard? If you were virtuous enough, you'd live forever.
(Score: 5, Informative) by Joe on Tuesday October 11 2016, @03:19PM
The drugs mentioned in TFA are antibodies that neutralize the immune checkpoint proteins PD-1 and CTLA-4. Both proteins are involved in down-regulating the immune response in order to prevent excessive damage to healthy tissue ("friendly fire") as an infection is being cleared or to prevent unwarranted attack of healthy tissue by the immune system (e.g. autoimmunity). Because the antibodies target the proteins on healthy T cells instead of the cancer cells, classical drug resistance (mutation that prevents binding of a drug) is not possible.
Since the immune system will normally kill any cell that is becoming cancerous, there is strong selective pressure for cancer to hide (immunoediting) from or to suppress the immune system. The selective pressure of the immune system is something all cancer has to deal with and many different types of cancer take advantage of the PD-1, CTLA-4, and other immune checkpoint pathways by either producing immunosuppressive proteins themselves or by inducing their production by non-cancer cells (in the tumor microenvironment).
The reason why the effect was more pronounced in HPV-positive tumors is because those tumors are not as good at hiding (HPV antigens are more immunogenic). I expect that the combination of a cancer vaccine (to increase immunogenicity) with these therapies will greatly improve the percentages of patients that have a favorable outcome.
https://en.wikipedia.org/wiki/Nivolumab [wikipedia.org]
https://en.wikipedia.org/wiki/Ipilimumab [wikipedia.org]
https://en.wikipedia.org/wiki/Immunoediting0 [wikipedia.org]
https://en.wikipedia.org/wiki/Tumor_microenvironment [wikipedia.org]
https://en.wikipedia.org/wiki/Immunogenicity [wikipedia.org]
https://en.wikipedia.org/wiki/Cancer_vaccine [wikipedia.org]
- Joe
(Score: 5, Insightful) by fishybell on Tuesday October 11 2016, @03:54PM
Thank you. I feel like sometimes I'm the only one who comes here for this and not the "exuberant editorials" (see comments above, or really, every SN comment section).
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @07:00PM
As one of the originals to this site, and one who threw one of the first fuckBeta on the day of revolution, I can say I've been let down by this community. This is not a troll. There are good people here, but there are too few regular posters that really want to say something interesting or informative.
Now days I more or less live at Y-combinator Hacker News https://news.ycombinator.com/ [ycombinator.com]
The moderations there is good. There is a ton of talent, and signal to noise is very high. The articles are timely, but also older but interesting stories make it to the top fairly often--which is great.
If Soylent News has a future over the long-term, it will need to grow...and to do that they need to avoid flame wars and attract expertise. --buswolley
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @09:18PM
I left ycombinator over shadow-banning before Soylent even existed. Shadow-banning is the most heartless and inhumane 'fix' for spam that I have ever seen. I saw one guy who had been posting for months without any idea that no one else could see what he had to say. Apparently he got shadow-banned because just one of his posts was about his own project. I read it (you can tell what post the admins don't like because all of the prior posts stay visible even without "show hidden posts" enabled) and it sure didn't stand out to me and I hate duplicitous self-promotion), but he got no warning or any kind of notification at all. Just silently censored. It doesn't get more arbitrary than that.
The guy had literally put in days of man-hours making a positive contribution to the site before I told him he was being censored. Even worse, if you should figure out that you are shadow-banned (by deleting cookies and then trying to read stories in which you've posted comments and noticing they aren't there) there is no process to remedy it. You have to get in contact with the admins via a poorly publicised email address (hope you message doesn't go in their spam folder) and beg them to reconsider.
There are a fuckton of loud idiots on soylentnews that get up-modded because there are too many other credulous idiots here. But at least the place isn't run by autistic robots. I keep thinking about walking away from here, but no way in hell would I go back to ycombinator.
(Score: 2) by SubiculumHammer on Tuesday October 11 2016, @09:49PM
I am fairly new to that site, so I haven't heard of the banhammering. I'll keep it in mind.
Thanks
(Score: 0, Disagree) by Anonymous Coward on Tuesday October 11 2016, @07:29PM
You are talking about a 36% success rate for $300,000. Most people wouldn't take those odds.
The few immunotherapy drugs I'm familiar with have insane side effects, are tricky to administer, and as such are usually used as a hail marry on the way to the grave.
It maybe a step forward with further development, but as of now it is an insanely expensive beta.
(Score: 2) by Joe on Tuesday October 11 2016, @08:51PM
In this trial, there were less severe and life-threatening (grade 3 and 4) adverse events in the immunotherapy treatment group (13%) compared to standard therapy (35%). One of the reasons why immunotherapy drugs are being used in patients "on the way to the grave" is because they've been shown to still work after standard therapy has failed.
Most people wouldn't take those odds
Do you have a reference?
You are projecting a dispassionate and rational perspective on people who are dealing with a very emotional topic. People often disproportionally value their own life and the lives of their friends/family, lack an understanding of odds/statistics, and have not prepared for these types of decisions.
http://www.nejm.org/doi/full/10.1056/NEJMoa1602252#t=article [nejm.org]
- Joe
(Score: 0) by Anonymous Coward on Tuesday October 11 2016, @09:51PM
And how successful were the treatments to those adverse reactions comparatively? Standard chemo has more side effects, but can be treated usually.
You are projecting a dispassionate and rational perspective on people who are dealing with a very emotional topic.
As it should be since there isn't unlimited resources to treat everyone, someone has to be the voice of reason asking if the cost/benefit analysis adds up.
If people are paying this out-of-pocket, fine.
But increasingly these types of treatments are being spotlighted as a gap between the rich and poor, and are heavily subsidized for very little benefit. $300,000 a pop pays for a ton of prenatal care or some of the very best hospice care.
And if the average life increase is under a year, someone should be questioning the value.
(Score: 2) by Joe on Tuesday October 11 2016, @10:48PM
I fully agree that there should be more reason involved in healthcare decisions, but I recognize that many people are not very rational about it or do not fully understand the cost/benefit of these decisions.
And how successful were the treatments to those adverse reactions comparatively?
Table 3 from the linked paper shows that the immunotherapy treatment had the same adverse reactions (with the exception of mild itchy skin) with a lower percentage in everything except mild rash.
It is also worth noting that the average life expectancy is not the full picture because there is a large variation in the treatment effectiveness across individuals. While everyone hopes that they would be part of the 10% of responders that completely clear the cancer, I expect that we will be able to better understand what accounts for the variation and better choose which patients it is a realistic option for or how to modify treatment strategies to increase their effectiveness.
- Joe