As was pointed out before, those are unpublished results. We cannot extract any significant information from this article. For example, in many early phase trials, the standard treatment is often given WITH the new drug (or vaccine), so we'd have to know the response rate of the control group.
As other pointed out, blood cancers are very different than solid tumors -- they've historically been easier to treat. That's probably due to the tumor micro environnement that makes solid tumor a very different process. To put simply, I would not assume for a second that outcomes for blood cancers can be replicated for solid tumors.
Immunotherapy is all the rage in the cancer world right now. It resonates with patient that "their own bodies can destroy cancer". It's almost romantic. Kinda like when anti-angiogenesis drugs were all the rage a few years ago...
The "cancer vaccine" has been tried many times before. Pretty much every time the cancer finds a way around it. Sipuleucel-T is a commercially available cancer vaccine for prostate cancer. It adds a few months for $$$, but newer, non-vaccine treatments are now doing better.
We're unlikely to find "a" cure for cancer; we'll eventually find "cures" for cancer, but it will be small, incremental steps. In the meantime I'll go back to my clinic and continue to enrol patients on clinical trials
What about extremely early and accurate diagnostic screening , which can offer 0% or very close to 0% false negatives(and ~30% false positives, like quanterix talks about), followed by a full panel of the relevant proteins ,guiding to the correct,low dose highly targeted chemo therapies ?
Considering that some results of treating early(by today's standards <2-3mm tumor) we can get to something like 95%-98% 5-years cancer free rates(while suffering some side effects), in breast cancer - it seems possible to make cancer a low-risk ,low-pain disease - as long as you do your regular checkups. Right ?
Cancer research is not an easy field and many are better than me in that regard. But food for thoughts:
A screening test with 30% false positive is not a great test. One in three test takers would be positive, requiring more investigations (likely many more). Let's say 1000 asymptomatic person take the test, 300 will test positive. Physicians then have to investigate thoroughly those patients. $$$ for those tests, hours of work missed, and very importantly patient anxiety and potential harm (a prostate biopsy, for example, is not trivial and people can die from that)
of those 1000 people screened, 1 has the disease. With a 0% false negative rate, we catch it. Because of the test, it was caught early. Have we really changed his outcomes? would he have discovered it by himself a few weeks later, not impacting any of his treatments? The convention of "catching cancer early will make it easier to cure" is not always true.
In the meantime, we've had to put 300 people through useless agressive investigations...
Moreover, 0% false negative would be revolutionary. -- 0% and 100% are extremely rare in medicine.
Anyhow, screening, especially its drawbacks is one of the most complex concept to explain.
For genotyping and targeted treatments: it's been tried but we're still not there yet. The papers coming out are disappointing in that regard.
Summary:
Cytotropic Heterogeneous Molecular Lipids (CHML) are used to treat patients with multiple cancers. Numerous studies have been conducted in cellular, animal, pre-clinical and clinical trials. Results showed that CHML, as a biological molecular missile, can easily penetrate through the target cancerous cells to perform programmed cancer cell death (cancer apoptosis). Furthermore, CHML has produced anti-cancer angiogenesis and induced immune function increase. CHML was used to treat 592 patients with cancers in clinical trials. Results confirmed the following advantages of CHML treatment: non-toxicity, high response rate, high quality of life, and high survival rate for these patients. The protocols include local injection, arterial drip and intravenous drip to treat cancers of liver, lung, skin, breast, brain glioma, colon and rectum, stomach, head and neck, leukemia, malignant lymphoma, sarcoma, malignant melanoma, myeloma, and metastasis cancers, etc.
Response rates (CR+PR) were as follows: liver cancer 77%, lung cancer 68%, skin cancer 94%, breast cancer 83%, brain glioma 78%, colon and rectum cancer 80%, stomach cancer 50%, head and neck cancer 78%, leukemia 83%, malignant lymphoma 71%, sarcoma 43%, malignant melanoma 67%, and myeloma 50%. No (0) episodes of grade II or above adverse reactions were observed.
Never heard of it before. That group seems to have published a phase II trial so I would assume they'd be looking at a phase III.
I always look at "promising results" with skepticism, especially when the authors have a direct financial interest in the project.
To keep in mind: complete remissions and partial remissions are good, but they're "softer" outcomes. What we want to see is an impact on "harder" outcomes, mainly overall survival. Cause-specific survival is another good one.
We like to associate tumor shrinkage with better survival but it's not that simple (unfortunately). Do we kill people with our treatment? It shrinks the tumors, but for how long? Is the treatment convenient? How did they define "partial response"? What tool did they use? -- the list goes on.
>We're unlikely to find "a" cure for cancer; we'll eventually find "cures" for cancer, but it will be small, incremental steps.
I completely disagree. There will be a "cure", but it'll be a while, and it won't resemble current medicinal methods at all. I predict that in another century or so (assuming civilization doesn't collapse like the Roman Empire and send us into another Dark Age, but on a global scale), we'll basically become cyborgs, with nanites implanted in us to augment our natural bodily functions. These nanites, basically being nanoscale robots, would improve on or replace our immune systems, eliminating cancer, as well as most aging effects.
I really appreciate the down-to-earth-ness of this interview, this man is being very honest. It's good not to create false hope and present cancer immunotherapy (yet perhaps) as the thing that will cure any cancer.
However, it is the only real curative treatment next to surgery and really the only treatment that can cure metastatic cancer. At the moment though, only in small percentage of people with specific cancers (mostly melanoma, skin cancers.) So there certainly is reason to be excited, the cancer field is all over this at the moment so advances in the near future can be expected.
My mother in law is in this therapy right now. The doctors were surprised it isn't working (prior chemo worked pretty well giving her another year of life, once it stopped they switched her to this treatment). They're looking at hospice care right now.
When the cancer gets to stage 4, you're looking at when not if the cancer is going to kill you. So to everyone you know that doesn't get regular checkups, encourage them to do so. Both my parents have had cancer but it was caught early, my mother in law never went to a doctor after having her last kid ~25 years ago.
I have a dumb question but ... how do you know when to check? I suppose I should google that. AFAIK doctors don't generally check until you show some kind of symptom (no idea what those symptoms are)
I also remember a Ted talk about a high school student who designed a way to test for any cancer for $0.01 per test with 99.9% accuracy. No idea whatever happened to that
Blood tests can detect a lot of cancers. I've been working in Japan for many years now. It is normal for people to get blood work done every year here. After age 40 they also do a barium test for stomach cancer. I think every year for that is a bit much, so I skipped it this year... They also usually do a chest X-ray every year which can catch tuberculosis as well as lung cancer. And for women obviously yearly pap smears and mamograms. Over 35 for men, I think you are supposed to get yearly prostate exams. I have not done this and I am planning to get an exam as soon as I can manage it.
Don't wait for symptoms. It's sounds like a lot, but doing the above is really fairly straight forward and not expensive.
Immunotherapy CAN cure any one case of cancer just not all cases. As it stands, immunotherapy has risen to 10% of success in many trials outside of even melanoma/leukemia. That's 10% of cases that are were previously out of options. Heck, I saw an ad of Opdivo (nivolumab) just the other day for lung cancer.
People don't realize the significance but 10% is a lot. Simply because there's so many cancer cases, 10% can already save millions.
The method by which vaccinations work is immunological. I think the most exciting frontier in cancer biology is prophylactic (preventative) vaccination. If we are able to develop effective vaccines against cancers, that will very much change the game.
This is currently a research frontiers area--but in 10-20 years, I believe that we will have made significant inroads on it.
Since every cancer is different in the markers it displays, I think that is unlikely to happen. It would mean an insane amount of vaccinations and the assumption that they have none to acceptable side effects.
Sure--you won't be able to get every tumor. But there are certain markers that are more common than others, so if you can get the top ~10 done within reasonable measures of safety, you could prevent a nontrivial number of cancers.
There are a handful of embryonic proteins that are normally expressed during development but are absent in the adult that are particularly promising. One of the hallmarks of cancer is dedifferentiation--losing specific markers and function and looking more and more like a stem cell that can continue to replicate, and these embryonic proteins are known to be reexpressed in many tumors.
Not to mention the risk for an auto-immune complication... because the cancer is just slightly different from "self", any immune response will have a very high risk for auto-immune recognition.
That's why CAR-T treatments are considered only in the cases where all other options have been exhausted.
"The findings are yet to be published and reviewed."
Are people really ok with this practice of researchers talking about their discoveries without having shared the methods and data (I don't care so much about the review aspect)? I'm certainly not, but apparently many think this is acceptable for some reason because I don't see any pushback.
I'm biased. My wife was diagnosed with metastatic cancer 6 months ago. With current standard treatments there is a 3-year survival rate of practically zero, so to me the most important thing is getting new effective treatments developed and brought into clinical practice as soon as possible.
I haven't seen the presentation about the study (a related news briefing is here [1]) so I don't know whether you're correct to say that the researchers haven't shared their methods and data. They seem quite happy to share technical details at the news briefing.
However, regardless of that, I still think it is a good thing if researchers talk about their findings at an early stage, especially if the findings are as dramatic and positive as these. If a treatment is available and you have patients out there dying with no other options, then it is just wrong to hide that away.
In my opinion we treat these things far too cautiously. It is not optimal for the individual and it is not optimal for society. By sharing /and/ opening up options like this to terminally ill patients we can (a) save individual lives and (b) speed up development and refinement of new treatments to benefit everyone.
The problem is that the incentives we have in place treat a cancer death as acceptable, while a treatment-related death is unacceptable for researchers, doctors and drug companies (unless they are shielded by layers of clinical-trial bureaucracy or years of standard practice). The result is that the course of treatment doesn't properly weigh the different sources of risk. Whether the goal is quality-adjusted life years for an individual patient or faster development of effective and safe treatments, the current system is way too conservative.
For what it's worth, I used to say I would take some experimental treatment when the time came. Not after doing research myself and seeing first hand what "experimental" really means when it comes to medicine. It means: no one has any way of really knowing what is going on. For example,
1) There will be some studies where a measurement was higher in the treatment group compared to controls, but it is not 100% clear what combination of things is actually being measured.
2) There will be other studies you hear about that got different results, but didn't get published because publishing "negative results" is discouraged and bad for careers.
3) The criteria for publishing a positive result is a p-value below an arbitrary threshold, and most people researching medical treatments really do not understand the meaning of a p-value to begin with. There are all sorts of myths like it is the probability the treatment didn't work, etc. So (at least the implementation of) the basic criteria used to judge success is fatally flawed.
It is quite scary and I don't see anything I can do about it but make people aware there is a problem here.
From a sociology point of view, yes you should distrust any signs of p-hacking or selective reporting, especially when there is a low effect size.
From a technology point of view, I think we are already well past "no one.. really knowing what is going on." Take the current study. Past researchers had identified the CD19 antigen found (often exclusively) on B cells, and others had found that autologous T-cells could persist in a patient for many years, potentially providing a durable response. The current researchers built on this knowledge to design and engineer T-cells that could wipe out a patient's B cells.
So it's a very planned, targeted approach, more akin to engineering than the old approach of testing thousands of random molecules as potential treatments. When the targeted approach works, and especially when it has a large and consistent effect on patients as in this case, then you can be very confident at an early stage.
This needs to be recognized and medical practice needs to change as a result. We're entering an era of incredibly detailed knowledge and precision tools for research and development. The pace of development will continue to increase and treatments will become more patient-specific as individual targets are identified.
You could consider the large, slow, blunt clinical trials as being like optimization for a particular treatment. When new drugs are rare or not well understood it makes sense to spend time to optimize their use. But when new drugs come frequently and are well targeted this premature optimization costs lives.
>"Past researchers had identified the CD19 antigen found (often exclusively) on B cells, and others had found that autologous T-cells could persist in a patient for many years, potentially providing a durable response."
I didn't watch the video, so I'm not sure where this info is coming from, but providing such references is one reason why they should write a paper up before talking to the media.
Also, I am fairly certain if we do follow up on these claims (I know nothing about them specifically) we will find the actual evidence is much more ambiguous, there has been no direct replication attempted, the references do not actually contain the evidence claimed, etc.
See the problem? I can claim anything I want about this, be it optimistic or pessimistic, and no one can check. There is no paper (or equivalent source of information), so no way to assess the evidence.
One way to approach an announcement like this is to wait until everything is wrapped up nicely in a neat paper.
Another approach is to investigate further using the tools available: look up the authors' past work on Google Scholar, check clinicaltrials.gov, look for third party opinions, even ask the authors directly. I'd argue that the scientists and journalists at the AAAS conference where this was presented are capable of this second approach, and so are many participants on HN.
I think if you try it out, after a few you'll find this is naive. Further, you are doing the job of the person making the claim!
It is too time consuming to research a claim indirectly like that. That is what you do after reading the paper which contains (usually most of) the required information and (usually a biased sample of) citations to the other research that were found relevant.
Reading the paper is only a first filtering step to evaluating a claim, a conference presentation simply doesn't merit that effort because it contains far too little information. A conference presentation is more like "hey, check out what I'm working on".
Now, that doesn't mean people don't try to do this, it is one of the primary uses for misinterpretation of p-values.
> I'm biased. My wife was diagnosed with metastatic cancer 6 months ago
My sincerest condolences. Even attempting to imagine what that must be like is beyond painful; my mind refuses to contemplate it for more than a few moments.
I hope that you're able to find something that works out.
If you know the experimental drug\treatment you want to try check overseas. Don't wait for local (I'm assuming) docs to give you the info. Contact centers with a known rep. Good luck!
Thanks, I certainly have my eyes peeled for news about metastatic ACUP (or any related diagnoses) but as far as I'm aware there's no silver bullet anywhere yet.
Right now the strategy is to kick the can down the road until there is a solution: traditional chemo, then the blunt immunotherapy of ipilimumab + nivolumab/pembrolizumab.
Also (with oncologist's knowledge) adding in very speculative but reasonably safe extras like a COX-2 inhibitor, anti-histamine, and melatonin. (Certainly not the well-targeted approach I talk about in my other comment, unfortunately!)
These results were presented at a meeting. The final results will be eventually published in a peer-reviewed journal.
This technique is actually fairly well known and other groups are running similar trials. So this isn't some black box. There is a long history of peer-reviewed publications that got us to this point. The basic science behind these techniques has already been published. This is just the next step - presenting the clinical trial data for these studies.
"These results were presented at a meeting. The final results will be eventually published in a peer-reviewed journal."
They could put the information on their own webpage for all I care, as long as they are willing to stake their reputations on it.
The point is that we, the audience, do not have access to the requisite information (methods, data, background refs they trust) to even start attempting to judge the claims. Even if a conference talk/poster/abstract is available somewhere, that is an extremely limited format of communication.
With all due respect, in all likelihood, you are not the audience for this talk (I honestly don't know). For those who are in the field, who were at the talk, I'm sure there was more than enough information presented for them to judge the claims (one way or the other).
Think of this as a preprint for the paper. It's just a talk.
If you want to blame anyone here, you could blame the media for reporting on a talk. But then again, the public likes to hear good news about cancer research, so I think the media is okay on this one.
>"For those who are in the field, who were at the talk, I'm sure there was more than enough information presented for them to judge the claims (one way or the other)."
I can assure you 100% this is not the case. Perhaps they could get that info by extensively talking to the presenter afterwards (which will not be recorded), but no way you can fit it into a 15-60 min talk or onto a poster, or any way that will be shared later. Not physically possible.
Edit:
Ok, I imagined a bunch of androids like Data (star trek character), and believe it may be physically possible but would require superhuman capabilities to transmit and process information.
What I think is getting glossed over is that this wasn't a lay audience they are talking to... it's an audience who knows the field and prior research. There is a lot that the presenter doesn't have to go over, since it's already assumed that the audience already knows it. So in this case, they need to present only what is new and novel. There is more than enough time for this.
If you're not in that field, then no, you're not going to walk away with a good understanding of the work. Talks are always tailored to the audience.
My issue is with talking to the media. The people at the conference (should) realize it is just a high level overview (usually with preliminary data) presented to let them know what is going on and get them interested in the topic. It is not taken as a serious venue to make any claims.
Also, did the link change? I can't find the line I originally quoted anymore.
In general, blood cancers are more accessible than solid tumors. With blood cancers, the majority of the cancer cells are in the blood or in very well perfused tissues (bone marrow, spleen, thymus, etc), meaning that drugs/treatments can get to the targets very easily.
With solid tumors, you have to deal with the complexities of the tumor microenvironment. The tumor microenvironment is the complex environment of the cancer tumor tissue. Of particular note, decreased lymphatic drainage, increased connective tissue, and aberrant angiogenesis (growth of new blood vessels) create very high interstitial fluid pressures within the tumor, limiting the ability of drugs or cells to penetrate within the tumor and "work their magic" by reaching the cells/target molecules of interest, etc.
Blood cancers are a good proof-of-principle for many cancer therapies; translation to solid tumors is difficult (see challenges with CAR-T cell immunotherapy).
As for gene manipulation in blood--yes, it is relatively easy to manipulate genes in blood. Hematopoetic Stem Cells (which differentiate into all different kinds of blood cells) can be withdrawn without too much difficulty, manipulated in the lab, and then reinjected into the patient.
Pardon the naive question, I don't know how localized therapies are today, but hasn't there been research into developing fake foreign capillaries to be implanted non invasively to deliver drugs right on target ?
ps: I remember seeing more 'barbaric' version of the idea, namely metal pipes planted in the patient as a direct path. I was wondering about something more organic.
I'm not an expert, but I think there's been a variety of attempts for vascular renormalization--to restore the normal flow of vessels to allow for drug delivery, etc. Rakesh Jain's lab (at MGH) is a big player in this field and is worth looking up if you're interested.
I'm not personally familiar with work in developing capillary devices, but it wouldn't surprise me at all if this was an approach under development--it certainly makes a lot of sense.
I was more thinking about artificial pathways, not renormalization (which sound very very difficult) but I'm happy to learn it's considered. Thanks a lot for the name too.
I think it is because in blood drugs and gene based treatments are the only option, surgery is simply not an option. This has always spurred the blood cancer field to take greater risks, the all or nothing approach.
From what I remember, these blood cancer have an antigen, CD13 or something, which is unique to them - no other body part has it, making it easy to target them.
Otherwise, you get the side effect of destroying your own body, the case of a woman a few years ago, who died having her lungs destroyed by immunotherapy. Lungs had the same antigen.
This morning I read something hopeful in this direction - UCSF researchers designed an AND gate, so now they could trigger a T cell attack only when 2 specific antigens are present, making it much more reliable. And I could imagine these can be chained, further narrowing it down. It needs genetic sequencing to isolate.
Immune checkpoint (fancy name that, you probably mean anti-autoimmune system) inhibitors main problem is the very high risk of autoimmune disorders that are hard or impossible to treat. Just toggling the suppressor will not kill clonal cells already in circulation, and those can last a long, long time, or even a lifetime.
If you're unlucky, you will also get "broken" immune memory cells - which also last for life.
Trading cancer for SLE or rheumatoidal arthritis etc.
Surgery is an option, namely bone-marrow transplants.
The reason blood cancers are first with these techniques boils down to having better known antigen targets to target compared to solid tumors where known antigens have more cross reactivity to other tissues (so less specificity, more side-effects).
Despite the word "transplant", bone marrow transplants are not done surgically; they are done by infusion of donor cells into the bloodstream. Then, the cells seek out their own niche and engraft.
As other pointed out, blood cancers are very different than solid tumors -- they've historically been easier to treat. That's probably due to the tumor micro environnement that makes solid tumor a very different process. To put simply, I would not assume for a second that outcomes for blood cancers can be replicated for solid tumors.
Immunotherapy is all the rage in the cancer world right now. It resonates with patient that "their own bodies can destroy cancer". It's almost romantic. Kinda like when anti-angiogenesis drugs were all the rage a few years ago...
The "cancer vaccine" has been tried many times before. Pretty much every time the cancer finds a way around it. Sipuleucel-T is a commercially available cancer vaccine for prostate cancer. It adds a few months for $$$, but newer, non-vaccine treatments are now doing better.
We're unlikely to find "a" cure for cancer; we'll eventually find "cures" for cancer, but it will be small, incremental steps. In the meantime I'll go back to my clinic and continue to enrol patients on clinical trials