I’m now 5.5 years post-treatment with immunotherapy for Stage IV melanoma and have had no evidence of disease for over four years. When immunotherapy works, it can be impressive.
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.
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
I'm a radiation oncologist specializing in lung cancer. Here's my take:
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.
This is truly exciting and only just the beginning.
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.
Yes, this news is exciting. But right now we're a very long way from curing cancer.
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.
> After a median follow-up of 10.5 months, the estimated rate of overall survival at 12 months was 69.2% in the pembrolizumab-combination group versus 49.4% in the placebo-combination group.
Seriously groundbreaking. This is a once-in-a-decade paper. [1]
There have been lots of similar 'groundbreaking' data from the various anti-PD1/-PDL1s over the pest few years. This is great, but not greater than lots of others.
Haven't there been fairly significant advances in using specialized chemotherapies for specific forms of cancer? This at least has been my impression from a few books I've read.
My Father is currently on a trial in Australia which combines Immune Therapy with traditional chemo treatment. The results can only be described as a miracle. He has gone from being inoperable stage IV melanoma (with the disease first being spotted in his lung, not his skin) to showing next to no evidence of the disease.
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.
Not to be dismissive, but those other media stories often had someone incredibly improve their condition too and that someone would have had children to go around saying "this is the real deal" but it's still only an anecdote and it still only works on some patients. Even quack therapies have people recovering naturally sometimes. Not so say immunotherapy is quackery.
This is a really significant public health advance.
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
Thanks for sharing. I wish that instead of building destructive weapons, there was more focus was on building cures for the many diseases and fighting hunger and poverty..
I remember reading this recent Financial Times article[0] about how China is innovating in the area of providing immunotherapy and other breakthrough treatments.
Right now China is playing fast-follower in general with this work, but rapidly becoming more innovative.
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
Someone close passed away from lung cancer last year. He received immune therapy (keytruda), and while it may work wonders for others, it comes with drawbacks; My main issue was that it takes 4 to 5 treatments (with weeks between each treatment) before you even really know if it worked or not. This is valuable time that could be used to treat the cancer with chemo (which admittedly has way worse side effects than keytruda, but still).
Went to a talk about immunotherapy last year, toxicity of these class of therapeutics was way better than the best other available treatment. Sadly still too nascent, but don't forget to ask for it if you can.
Check out the cancer.gov page[1], which does a decent job of giving an overview. The drug in question, pembrolizumab, is a monoclonal antibody (you can tell because the name ends with '-mab'), and you can read more about how those work on this page[2].
Immunotherapy is not new. My mom went to Greece in 1980’s and received it. It was illegal in the US then. She would go to Mexico for booster shots. I believe it really extended her life w quality. She passed in 1990 but looked good... not a bag of bones like chemo patients.
Odd they don't mention the cuban work on this field.
"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.
It will be cheaper in the future. Right now there are only ~4 PD-1 or PD-L1 inhibitors on the market, so it is an oligopoly. In a few years there will be a wave of competing drugs (many developed in China) and prices will fall
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
Cuba has a lung cancer vaccine for $2. Peer reviewed. You don't hear about it.
Edit: I don't even know why I go here if this site is so toxic I get downvoted for pointing out something. Enjoy your guys toxic conformation bias
The "vaccine" you refer to here is racotumomab. It's not a vaccine in the common-parlance sense ("prevents disease"), but a different immunotherapy treatment which is only approved for use in Cuba and Argentina. I'm mildly curious why it doesn't exist in the US. All of the clinical trials in the USA which I can find on that drug are either incomplete[1] or completed-but-without-results[2][3][4]. For all of those trials, "Laboratorio Elea" is the sponsor or a collaborator, so I presume they have the rights to the drug in the USA. That's apparently a company out of Argentina[5]. I don't know why they seem to have given up on getting the drug approved in USA, but wikipedia says "[a study] is underway in Argentina, Brazil, Cuba, Indonesia, Philippines, Singapore, Thailand and Uruguay", though the citation for that seems incredibly suspect[6].
The prohibitively expensive nature of any immunotherapy leaves me profoundly skeptical of its practical usefulness. $100,000/year? That's more than twice the median income in this country.
Is it simply that expensive to get mabs from animals, is drug development disgustingly expensive, or is there unbounded greed in pharmaceutical companies?
It's way more than $100,000 a year too. My treatment alone (Keytruda, every 3 weeks) is around $300,000 a year; about double the price the company will quote you if you ask, because they don't estimate the cost it takes to get blood work, get seen by an oncologist, and then get the treatment administrated to you safely by a trained nurse ready to respond to any adverse events that may spontaneously occur during infusion. However, thanks to current health care law in the US there are caps on the amount of out-of-pocket expenses your insurance can charge you. I have run of the mill bigco health insurance and my personal max out-of-pocket cost (after premiums, deductibles, etc.) is at least two orders of magnitude less than the cost to insurance.
More then last 2 than the first one. Getting money from investors is much harder than getting MAbs from animals. Probably more gruesome, too.
Also greed is not just the Pharma. Some Hospitals/physicians use Clinical Trials as a profit center, and see Pharma as a bottomless pit of cash-- its a bit of a vicious circle.
I've been in and out of the hospital a bit lately (broken back). That seems downright cheap. I average about $4,000 an hour when I'm in. The most recent "study" took an hour with one low paid tech using one ultrasound machine and it cost over $2,000. CT Scan? 15 minutes $7K. Heck, they charged nearly $800 to "start an IV" when they didn't even start it, it was the ambulance EMT that put it in (billed separately) they just injected morphine into it. If you don't have good insurance you are one small slip away from bankruptcy.
nothing is “prohibitively expensive” in healthcare unless you can’t afford your out of pocket costs, which is perhaps increasingly the case for a lot of people, but even conventional cancer treatment is still way over out of pocket costs, so I don’t see how the cost of this treatment really makes much of a difference.
if you don’t have health insurance, your floor for “prohibitively expensive” is probably way lower than this already.
PhDs that have dedicated their lives to specializing in specific cancers, failed drugs, research that leads nowhere, failed clinical trials because of XYZ. It's all highly specialized. And if done with a rigorous protocol, it's all expensive.
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?
[+] [-] byteCoder|8 years ago|reply
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.
[+] [-] SteveNuts|8 years ago|reply
[+] [-] eecc|8 years ago|reply
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
[+] [-] marckemil|8 years ago|reply
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.
[+] [-] shadowtree|8 years ago|reply
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.
[+] [-] randcraw|8 years ago|reply
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.
[+] [-] byteCoder|8 years ago|reply
[+] [-] iooi|8 years ago|reply
Seriously groundbreaking. This is a once-in-a-decade paper. [1]
[1] http://www.nejm.org/doi/full/10.1056/NEJMoa1801005?query=fea...
[+] [-] mft_|8 years ago|reply
[+] [-] hprotagonist|8 years ago|reply
it’s the first major advance we’ve had in oncology in maybe 25 years.
[+] [-] DubiousPusher|8 years ago|reply
[+] [-] killjoywashere|8 years ago|reply
[+] [-] killjoywashere|8 years ago|reply
[+] [-] schappim|8 years ago|reply
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.
[+] [-] lopmotr|8 years ago|reply
[+] [-] aaavl2821|8 years ago|reply
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
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
https://jamanetwork.com/journals/jama/fullarticle/2678018
[+] [-] zpatel|8 years ago|reply
[+] [-] kuwze|8 years ago|reply
[0]: https://outline.com/tdDNdd
[1 non-outlined link]: https://www.ft.com/content/30b5a944-3b57-11e8-b9f9-de94fa33a...
[+] [-] aaavl2821|8 years ago|reply
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
[+] [-] hanspragt|8 years ago|reply
[+] [-] wellboy|8 years ago|reply
[+] [-] agumonkey|8 years ago|reply
[+] [-] suyash|8 years ago|reply
[+] [-] leodeid|8 years ago|reply
[1] https://www.cancer.org/treatment/treatments-and-side-effects...
[2] https://www.cancer.org/treatment/treatments-and-side-effects...
[+] [-] waynecochran|8 years ago|reply
[+] [-] keepper|8 years ago|reply
"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."
https://www.usatoday.com/story/news/world/2018/01/09/cuba-ha...
[+] [-] randcraw|8 years ago|reply
https://www.ncbi.nlm.nih.gov/pubmed/25420897
https://www.frontiersin.org/articles/10.3389/fonc.2012.00150...
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.
[+] [-] Clubber|8 years ago|reply
[deleted]
[+] [-] aaavl2821|8 years ago|reply
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
[+] [-] danieltillett|8 years ago|reply
[+] [-] neolefty|8 years ago|reply
[+] [-] delbel|8 years ago|reply
[+] [-] leodeid|8 years ago|reply
[1] https://clinicaltrials.gov/ct2/show/NCT02998983
[2] https://clinicaltrials.gov/ct2/show/NCT01460472
[3] https://clinicaltrials.gov/ct2/show/NCT01598454
[4] https://clinicaltrials.gov/ct2/show/NCT01240447
[5] http://www.elea.com/
[6] https://en.wikipedia.org/wiki/Racotumomab#Clinical_trials
[+] [-] stochastic_monk|8 years ago|reply
Is it simply that expensive to get mabs from animals, is drug development disgustingly expensive, or is there unbounded greed in pharmaceutical companies?
[+] [-] adrianm|8 years ago|reply
[+] [-] vibrio|8 years ago|reply
[+] [-] abarringer|8 years ago|reply
[+] [-] joe5150|8 years ago|reply
if you don’t have health insurance, your floor for “prohibitively expensive” is probably way lower than this already.
[+] [-] firstplacelast|8 years ago|reply
[+] [-] aantix|8 years ago|reply
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?