4 ms·

Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradation. It's a tradeoff that

Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradation. It's a tradeoff that most cancer patients think is worth it. I think that this therapeutic benefit puts us in a grey zone with regard to the definition of poison. The substances would undoubtably be considered poison in other contexts (e.g. mustard gas) but the doses are carefully calibrated to just-barely not kill a patient. Maybe "poison" is a function of usage intent?

Gatsky 11y ago
"Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradataion." This is just not true. I provide you with this list of cases where chemotherapy can cure people (established in phase III double blind randomised controlled trials): Early stage breast cancer Early stage colon cancer Acute myeloid leukaemia Acute lymphoblastic leukaemia Diffuse large B-cell Lymphoma Paediatric neuroblastoma, retinoblastoma, nephroblastoma etc etc Testicular seminoma and non-seminoma Testicular germ cell tumours Note that breast and colon cancer are among the top 3 most common cancers.
- iskander 11y ago
  Let me revise that: for solid tumors, chemotherapy can cure people, but typically doesn't. At one extreme, early stage (solid) cancers are primarily cured by surgery. At the other extreme (metastasis), chemotherapy is a terminal rollercoaster. In between those extremes (e.g. some limited local progression), adjuvant chemotherapy seems to be useful for breast cancer, but has only a very small effect for colon cancer (http://www.sciencedirect.com/science/article/pii/S0140673607618662 http://www.sciencedirect.com/science/article/pii/S0140673607...) and none for lung cancer (http://jnci.oxfordjournals.org/content/95/19/1453.short http://jnci.oxfordjournals.org/content/95/19/1453.short).
  - Gatsky 11y ago
    When you say adjuvant chemotherapy 'seems' to be useful in breast cancer, what exactly do you mean? How does a meta-analysis of 20,000 patients in randomized controlled trials showing a persistent reduction in risk of recurrence and death equate to 'seeming'? http://www.ncbi.nlm.nih.gov/pubmed/25917869 http://www.ncbi.nlm.nih.gov/pubmed/25917869
Ralfp 11y ago
You are talking about chemo provided via infusions. We are seeing increasing number of chemo in pills that are noted for being far more bearable for patients while still being effective.
- agumonkey 11y ago
  I saw 'local delivery' through surgically added path ways (basically planting metal tubes through your skin into the tumor or organ). A bit violent for tissue but I bet a whole lot better for the overall system. I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary.
  - Ralfp 11y ago
    > I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary. But this is the holy grail of oncology, is it not? To reach cancer cells non-invasively with spot-on accuracy so healthy cells are spared?
    - agumonkey 11y ago
      Sure, ability to target a bad cell and only a bad one is. There are many way, membrane markers etc. But they all involve using the main vascular system with potential harmful leaks. Now if you can create your own 'chemo vessel' to reach into a tumor. Erf sounds naive even to me now.
Bluestrike2 11y ago
It seems like a lot of the "chemo = poison" arguments are part of an ill-informed appeal to nature. Which is an especially stupid argument considering cancer is a natural process run amok. The dose makes the poison. Even water can become toxic with a high enough dosage. Calling chemo drugs poisonous isn't really helpful. At best, it's like saying water is wet. At worst, you wind up misinforming people and contributing to decisions that are based on bad information. The side effects of cytotoxics make chemotherapy difficult on the patient, but the alternative is a good deal worse and permanent to boot.
- Mz 11y ago
  Which is an especially stupid argument considering cancer is a natural process run amok. We don't actually know this. We don't really understand what cancer is. We know that in some cases viral infection is the cause of a specific cancer, but we don't really know the exact mechanism behind what makes cancer, cancer. I am not a fan of the idea of "auto-immune disease." I think that's bullshit. I think it basically is an admission we have no fucking clue what we are talking about. The body does things for a reason. Just because we don't understand it does not mean the body has simply lost its mind. We fundamentally need a better mental model of these things.

Gatsky 11y ago

"Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradataion." This is just not true. I provide you with this list of cases where chemotherapy can cure people (established in phase III double blind randomised controlled trials): Early stage breast cancer Early stage colon cancer Acute myeloid leukaemia Acute lymphoblastic leukaemia Diffuse large B-cell Lymphoma Paediatric neuroblastoma, retinoblastoma, nephroblastoma etc etc Testicular seminoma and non-seminoma Testicular germ cell tumours Note that breast and colon cancer are among the top 3 most common cancers.

iskander 11y ago
Let me revise that: for solid tumors, chemotherapy can cure people, but typically doesn't. At one extreme, early stage (solid) cancers are primarily cured by surgery. At the other extreme (metastasis), chemotherapy is a terminal rollercoaster. In between those extremes (e.g. some limited local progression), adjuvant chemotherapy seems to be useful for breast cancer, but has only a very small effect for colon cancer (http://www.sciencedirect.com/science/article/pii/S0140673607618662 http://www.sciencedirect.com/science/article/pii/S0140673607...) and none for lung cancer (http://jnci.oxfordjournals.org/content/95/19/1453.short http://jnci.oxfordjournals.org/content/95/19/1453.short).
- Gatsky 11y ago
  When you say adjuvant chemotherapy 'seems' to be useful in breast cancer, what exactly do you mean? How does a meta-analysis of 20,000 patients in randomized controlled trials showing a persistent reduction in risk of recurrence and death equate to 'seeming'? http://www.ncbi.nlm.nih.gov/pubmed/25917869 http://www.ncbi.nlm.nih.gov/pubmed/25917869

Ralfp 11y ago

You are talking about chemo provided via infusions. We are seeing increasing number of chemo in pills that are noted for being far more bearable for patients while still being effective.

agumonkey 11y ago
I saw 'local delivery' through surgically added path ways (basically planting metal tubes through your skin into the tumor or organ). A bit violent for tissue but I bet a whole lot better for the overall system. I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary.
- Ralfp 11y ago
  > I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary. But this is the holy grail of oncology, is it not? To reach cancer cells non-invasively with spot-on accuracy so healthy cells are spared?
  - agumonkey 11y ago
    Sure, ability to target a bad cell and only a bad one is. There are many way, membrane markers etc. But they all involve using the main vascular system with potential harmful leaks. Now if you can create your own 'chemo vessel' to reach into a tumor. Erf sounds naive even to me now.

Bluestrike2 11y ago

It seems like a lot of the "chemo = poison" arguments are part of an ill-informed appeal to nature. Which is an especially stupid argument considering cancer is a natural process run amok. The dose makes the poison. Even water can become toxic with a high enough dosage. Calling chemo drugs poisonous isn't really helpful. At best, it's like saying water is wet. At worst, you wind up misinforming people and contributing to decisions that are based on bad information. The side effects of cytotoxics make chemotherapy difficult on the patient, but the alternative is a good deal worse and permanent to boot.

Mz 11y ago
Which is an especially stupid argument considering cancer is a natural process run amok. We don't actually know this. We don't really understand what cancer is. We know that in some cases viral infection is the cause of a specific cancer, but we don't really know the exact mechanism behind what makes cancer, cancer. I am not a fan of the idea of "auto-immune disease." I think that's bullshit. I think it basically is an admission we have no fucking clue what we are talking about. The body does things for a reason. Just because we don't understand it does not mean the body has simply lost its mind. We fundamentally need a better mental model of these things.