A cancer treatment has shown astounding results in a small clinical trial. All of the treated patients, who had a specific form of mid-stage rectal cancer, have since experienced complete remission. Though the findings are based on a sample size of just 18 people, they could hold important implications for treating these particular cancers.
The trial enrolled volunteers diagnosed with stage II or III rectal cancer, meaning their tumors had begun to grow larger and spread to nearby parts of the body. Their cancer was also determined to be caused by a particular mechanism known as a deficiency in mismatch repair.
The researchers theorized that their treatment, a lab-made antibody called dostarlimab, might be able to help this subset of patients. It works by inhibiting a protein known as programmed death receptor-1 (PD-1) found in many cancer cells. This inhibition then allows the immune system to recognize the cancer cells as harmful and target them for destruction. [...]
That said, the findings are still very early, and it will take much more research with larger-sized studies to confirm the drug's effectiveness, especially over the long term. [...] And the drug doesn't come cheap, costing $11,000 per dose out of pocket.
At $11,000/pill, from some halfway house in an undisclosed location, Pharma Bro smiles with approval.
Journal Reference:
Andrea Cercek et al., PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer, NEJM, 2022. DOI: 10.1056/NEJMoa2201445
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His early release reflects good behavior and completion of rehabilitation programs
Infamous ex-pharmaceutical executive Martin Shkreli has been released from federal prison after serving less than five years of a seven-year sentence for a securities and wire fraud conviction. He is now moving into a US Bureau of Prisons halfway house at an undisclosed location in New York until September 14, 2022.
Shkreli was convicted in August 2017 on two counts of securities fraud and one count of conspiracy to commit securities fraud in connection to what federal prosecutors called a Ponzi-like scheme involving two hedge funds Shkreli managed. In March 2018, a federal judge sentenced him to seven years, which he was serving in minimum security federal prison in Allenwood, Pennsylvania.
His early release—slightly more than four years after his sentencing—reflects time shaved off for good behavior in prison, plus completion of education and rehabilitation programs, according to CNBC. It also includes a credit for the roughly six months he spent in jail prior to his sentencing.
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Shkreli Stays in Jail; Infamous Ex-Pharma CEO Quickly Loses Appeal
Martin Shkreli Accused of Running Business From Prison With a Smuggled Smartphone
Sobbing Martin Shkreli Sentenced to 7 Years in Prison for Defrauding Investors
Britain Fines Pfizer Record £84.2m for 2600% Drug Price Hike
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(Score: -1, Offtopic) by Anonymous Coward on Friday June 10 2022, @01:41AM
All are dead? All whopping 18? Dang.
(Score: 1, Troll) by JoeMerchant on Friday June 10 2022, @02:09AM (8 children)
18 participants is a really small number. If the treatment has a 50% actual remission rate, there is a 1/250000ish chance of getting this result.
Sounds improbable, but people win less probable lotteries every day.
🌻🌻🌻 [google.com]
(Score: 2) by krishnoid on Friday June 10 2022, @03:42AM (2 children)
But a total remission -- not tumor shrinkage -- in even some patients is kind of a holy grail for cancer.
I'm guessing that the PD-1 is what normal cells that undergo apoptosis [nih.gov] express on their surface. Cancer cells express them too, so they just whistle and go about their business as well, nothing to see here, even though they *don't* intend to behave like a good citizen by eventually terminating, but instead keep multiplying.
If the *presence* of a receptor on a cancerous cell makes immune cells ignore them, I don't understand how an immune cell can identify a cancerous cell by the *absence* of a receptor -- I mean, are the white blood cells checking *every* cell for their travel papers? Seems impossible.
But if the immune system *can* differentially identify cancer cells, then the game is on -- the immune system can treat them like an infection, and any straggler cancer cells that continue to reproduce will eventually be large enough to be detectable and attackable by an immune system that's active through the entire body.
(Score: 5, Informative) by Anonymous Coward on Friday June 10 2022, @06:34AM (1 child)
You are slightly mixed up, which is understandable because the summary is also mixed up. Immune cells have a receptor called PD-1 (think keyhole) and proteins that interact with that receptor on other immune cells called PD-L1 and PD-L2 (think keys). These are important because they help keep the immune system in the most effective range by turning down the immune response. If that kind of immune cell is doing either too much or not enough damage, then the system signals that cell by connecting PD-L1 or PD-L2 to PD-1 receptor. The cell responds by turning down its response, even to the point of killing itself if it determines it necessary due to repeated signaling.
Cancer cells coopt this mechanism, and the drug prevents the hijack. The cancer cells express both PD-1 and PD-L1/2 proteins. When they interact with immune cells, this results in them sending the message "Hey! I'm your supervisor immune cell and you need to knock it off." The immune cell will respond by turning down its response, with enough cancer cells literally killing your immune cells. If the cancer cell has its PD-1 signaled, it ignores it because the pathway isn't intact like it is in real immune cells. The drug, on the other hand, is the equivalent of a key that is the right size for the hole, but the wrong combination and covered in glue. Obviously, this plugs up the PD-1 in both the cancer cells and immune cells.
Because the PD-1 is plugged up on the cancer cell, the immune system will not confuse it for a working immune cell when it encounters it. Because the PD-1 is plugged up on the immune cell, it cannot be told to turn off by the cancer cell. But this result is even worse for the cancer cell for two reasons: 1. because the mechanism doesn't work, the immune cells cannot be turned down by the real immune system as easily (there are other pathways that can be used to prevent autoimmune disease and appears that it doesn't take much antibody to get a good anti-cancer response) so they really go to town; and 2. because the proteins shouldn't be on the cancer cells and there are a lot of them, the immune system targets them more because they act as a giant red flag for those cells to be marked as both high-priority and obvious targets.
(Score: 0) by Anonymous Coward on Friday June 10 2022, @08:22AM
tl dr;
shit fuced up
(Score: 5, Interesting) by Runaway1956 on Friday June 10 2022, @06:13AM (1 child)
Yes, 18 is a small sample size. But, when 100% of your sample shows the same results, then, obviously, you need to investigate further. That's how science works, right?
It would be absolutely crazy if the drug had nothing to do with anything. They just happened to select 18 test subjects who all just whipped the cancer on their own initiatives. In which case, you would want to examine the DNA of all those 18 subjects!! They've got something going on that other cancer patients need.
“I have become friends with many school shooters” - Tampon Tim Walz
(Score: -1, Redundant) by JoeMerchant on Friday June 10 2022, @01:35PM
Depends on the disease, and especially the reimbursement potential for the treatment. Cancer just might support $11K per pill, I'm sure this is getting another round of funding.
For contrast: I became aware of a bulimia treatment study which showed total remission in 8/10 patients, better than best alternative treatment remission in one, and equal to best alternative treatment remission on the last one. 10 patients in the control arm received counseling (then and now accepted as "standard of care") and basically saw little to no improvement. Total cost of the treatment was in the $30K one-time range, but apparently bulimia doesn't have the juice to fund $30K per patient for treatment. In the 20 years since that study has been done, the literature acknowledges its results as promising, to extremely promising, but no followup studies have been done.
🌻🌻🌻 [google.com]
(Score: 2) by maxwell demon on Friday June 10 2022, @07:56AM (1 child)
But there are far more people playing the lottery (think about it: There must be enough people playing to pay for all the wins as well as the operating cost, and still allow the lottery operator to make a profit).
The Tao of math: The numbers you can count are not the real numbers.
(Score: 2) by JoeMerchant on Friday June 10 2022, @01:38PM
The state run lotteries in the US are just about all set at a 50% payout rate, most of them run less than 2% expenses and the remaining 48% of ticket prices are given to the general fund, earmarked for education or whatever, but at least in Florida when education got money from the lottery, the property taxes that (still) fund the majority of education expenses immediately decreased by 110% of the lottery funding amounts.
🌻🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Saturday June 11 2022, @04:22PM
In the accompanying editorial it reads:
> The results of recent phase 3 trials have led to an increase in the intensity of treatment to include multiagent chemotherapy in addition to radiation therapy before proctectomy is performed; such treatment has resulted in a 3-year disease-free survival rate as high as 77%.1,2
https://www.nejm.org/doi/full/10.1056/NEJMe2204282 [nejm.org]
So current treatments have ~77% cure rate lasting three years, while this new one has 100% cure rate lasting at least one year.
If four of the 18 patients relapse in the next two years the treatments will be equally effective. The new one may still be cheaper or have less severe side effects though.
(Score: 0) by Anonymous Coward on Friday June 10 2022, @08:43AM (6 children)
It's a lot of money, but I guess a patient needs only one or two doses max. How does that compare to the costs involved if the patient ins't treated? My guess those costs will be a lot more. In that view $11,000 is cheap.
(Score: 3, Interesting) by pkrasimirov on Friday June 10 2022, @11:50AM
Is that the price for patients or for insurance companies? I've heard there can be quite the difference.
(Score: 0) by Anonymous Coward on Friday June 10 2022, @01:16PM
In this study they were given eight doses.
(Score: 2) by Snotnose on Friday June 10 2022, @02:11PM (1 child)
If memory serves it's 1 injection every 3 weeks for 6 months. So that 11k per dose adds up.
Of course I'm against DEI. Donald, Eric, and Ivanka.
(Score: 2) by DeathMonkey on Friday June 10 2022, @04:53PM
When the alternative is chemo that sounds fucking awesome!
(Score: 0) by Anonymous Coward on Friday June 10 2022, @04:28PM (1 child)
Curious how they can set a price before the drug is even approved
(Score: 2) by Runaway1956 on Saturday June 11 2022, @12:13AM
I think that setting an exorbitant price is part of the approval process. A ten cent pill won't be approved, but a million dollar pill will be.
“I have become friends with many school shooters” - Tampon Tim Walz