6 ms·

Ethanol: A Lethal Injection for Tumors

76 points by cdvonstinkpot 9y ago

HillaryBriss 9y ago
If this cancer therapy ever makes it into US healthcare I will be amazed. There's too little profit to fund clinical trials and FDA approval. US residents could perhaps travel abroad for the treatment. Maybe it will be offered in Mexico some day.
- microcolonel 9y ago
  > There's too little profit to fund clinical trials and FDA approval. People think they can have their cake and eat it too with the FDA. The administration likely kills many people through opportunity cost. People really need to ask themselves if the FDA are the ones who should be making the decision whether something is risky enough that you shouldn't have access to it. In my eyes, if drug companies had standard product liability, then drugs would be safer and cheaper.
  - cgb223 9y ago
    Wasn't there a law passed fairly recently that allows otherwise terminal patients to try risky not-yet-approved treatments?
  - falcolas 9y ago
    Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. For every potentially legitimate treatment held back, a hundred illegitimate - if not harmful - treatments are also stopped. I won't claim this excuses the costs and time associated with getting FDA approval, but it's one more thing to consider when judging them.
    - microcolonel 9y ago
      > Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. Who cares? Homeopathy is largely harmless, the vast majority of people who practice it are not actually treating anything. Unless something goes seriously wrong, an extreme dilution is not going to have the same devastating effect as an untreated serious condition, unless the patient sticks it out like a fool, in which case can anyone except the charlatan who convinced them really be blamed?
      - MaulingMonkey 9y ago
        > Who cares? Homeopathy is largely harmless, Not if someone is relying on it (or other 'harmless' cures like faith healing) to treat their cancer, or their children's cancer, instead of something that will actually work it's not. Nor is it harmless if they have a contagious condition that they spread around (and you catch!) under the assumption that they've already been 'cured'. Nor is it harmless even if it's just emptying their wallet. > Unless something goes seriously wrong, an extreme dilution is not going to have the same devastating effect as an untreated serious condition Which I'd wager you'd agree happens more often than homeopathy goes seriously right, even ignoring the fool patients, parents, and caregivers who might leave serious conditions effectively untreated on account of believing in snake oil. Not ignoring them, this was reported two days ago: https://arstechnica.com/science/2017/09/cdc-homeopathic-healing-bracelet-poisons-baby-with-high-levels-of-lead/ https://arstechnica.com/science/2017/09/cdc-homeopathic-heal... > in which case can anyone except the charlatan who convinced them really be blamed? Some would argue that the society which stood idly by and refused to oppose such charlatans, if not to blame, is at least some kind of low trust, everyone for themselves, shitty kind of society. Especially if it can identify who is to blame, and still does nothing. Government regulation is not the only tool of opposition. James Randi has given some good talks to help fight the ignorance they exploit with knowledge. (EDIT: His TED talk: https://www.youtube.com/watch?v=c0Z7KeNCi7g https://www.youtube.com/watch?v=c0Z7KeNCi7g .) And there's some arguments that can be made that true freedom requires freedom to do stupid, counterproductive, self harming shit (although that's not the argument you're making.) TL;DR: I disagree with you on your stance of how harmless homeopathy supposedly is.
      - 9y ago
    - inimino 9y ago
      Is the ban on marketing really changing anyone's mind? I don't think anyone interested in homeopathy is likely to be put off by the fact that the FDA doesn't approve of it.
      - Sacho 9y ago
        It's stopping desperate people who have never heard of homeopathy from trying it, getting the placebo effect and becoming true believers.
    - u801e 9y ago
      > Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. On a related note, why are pharmaceutical companies allowed to market drugs through television and print advertisements? Clearly, most of the target population doesn't have the necessary knowledge or resources to make an informed decision regarding whether or not they should be on the advertised drug as part of their treatment.
      - refurb 9y ago
        DTC is allowed because the FDA has found the benefits outweigh the risk. Here is one positive data point of many in the physician survey: DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.[1] [1]https://www.fda.gov/drugs/resourcesforyou/consumers/ucm143562.htm https://www.fda.gov/drugs/resourcesforyou/consumers/ucm14356...
        falcolas 9y ago
        I won't disagree that this could be an upside, but it's interesting that the US is one of two countries which allow this kind of advertisement.
        sitharus 9y ago
        And the other doesn't get in to it anywhere near as much as the US because most of the time you get what is subsidised.
      - dboreham 9y ago
        Because: money (Very, very large quantities of it)
  - adrianN 9y ago
    I don't think the average person has the time or the skill to make an accurate assesment of the level of risk that taking some experimental drug means for them. Especially if you get rid of the need to have long and expensive studies to prove safety. How is a patient supposed to make an informed decision?
    - SAI_Peregrinus 9y ago
      Also keep in mind that the studies to prove safety are the short and cheap ones (phases 1 & 2), the long and expensive one (phase 3) is to prove efficacy. Of course sometimes safety issues show up only in phase 3, but its primary purpose is to show that the drug actually works and isn't just a scam.
      - wbl 9y ago
        Safety is related to effacity. Have an oncology drug that makes you go deaf but extends life for melanoma patients by a lot? Great! Oh, it's for acne? Probably not going to pass muster.
    - gozur88 9y ago
      Just because the government doesn't make the decision for you doesn't mean you won't have information. There's no reason the FDA couldn't still exist as an advisory body.
damnfine 9y ago
I can already smell the breath of the alternative (read: fake) medicine version of this as I type. Is the liquortarian diet more effective than the fruitatarian diet? You betcha! Just look at this study!
- tyingq 9y ago
  It's simple enough that I worry a bit about unqualified people offering it as a service.
jszymborski 9y ago
The article is available here[0] and is open-access. [0] https://www.nature.com/articles/s41598-017-09371-2 https://www.nature.com/articles/s41598-017-09371-2
jszymborski 9y ago
This is a really neat and elegant study. All they're missing is a long-term survival curve. You're probably wondering what the catch is if you haven't spotted it yet. Ethanol ablation is usually used for carcinomas of the liver, although it sometimes sees use in some very rare cancers. So, this falls under the "extremely effective but with limited application" category. That doesn't mean it doesn't have great value, but you also don't want folk to think it's a "lethal injection for all tumours".
- hanklazard 9y ago
  Right. And would not be useful for tumors with poor accessibility for injection, small multifocal tumors or those with small mets, or tumors of the blood. Still, plenty of early stage cancers involve a single accessible mass and I could imagine this technique being safer and easier than full excision in some cases. This is elegant and, importantly, should be inexpensive (vs the many personalized therapies being developed)
- Pica_soO 9y ago
  The unique thing about this approach was that is is a gel- not being limited to encapsulated tumors?
  - jszymborski 9y ago
    This article is just a proof-of-concept, and unfortunately we can't make the claim that this means we can effectively use EtOH+Gel to treat tumours that are not encapsulated; particularly because it isn't clear to me whether the cancer model used is a good model of those "hard-to-treat-w/-EtOH-ablation" cancers. There is also a very honest list of caveats in the discussion, "Although we have demonstrated the efficacy of enhanced ethanol ablation in the treatment of squamous cell carcinomas in the hamster cheek pouch, there are several limitations to this study. First, the use of a chemically-induced tumor model (in which spontaneous tumors arising in sites adjacent to a treated site would be indistinguishable from the original tumor) precluded the possibility of any long-term monitoring of tumor recurrence. Second, a single animal tumor model was utilized. Further study in other tumor models is needed to investigate such recurrence, and demonstrate therapeutic efficacy more broadly. Since this study was a proof-of-concept, sample sizes were relatively low. Although other studies have shown systemic safety of ethanol ablation in a variety of applications, more research is needed to investigate the possibility of damage to surrounding tissue. Leakage of ethanol and nearby necrosis should be minimized, and details may be specific to tumor types. Although ethyl cellulose-ethanol has been used in the treatment of venous malformations, further safety evaluations of injections to tumors are clearly necessary. The ethanol-ethyl cellulose-water system has shown promise; but its more complete characterization will inform optimization. For example, better understand- ing of physicochemical details of the sol-gel transition, e.g. involving pressure and temperature, will benefit from improved discrimination between the sol and gel phases. The mechanical phantoms proved helpful in this initial study. Follow up use of them can improve details of their poroelastic structures and properties, and thus improve their role in the design process for enhanced ethanol ablation."
jeffdavis 9y ago
"Alcohol: the cause of, and solution to, all of life's problems." -- Homer Simpson

76 points by cdvonstinkpot 9y ago

If this cancer therapy ever makes it into US healthcare I will be amazed. There's too little profit to fund clinical trials and FDA approval. US residents could perhaps travel abroad for the treatment. Maybe it will be offered in Mexico some day.

microcolonel 9y ago
> There's too little profit to fund clinical trials and FDA approval. People think they can have their cake and eat it too with the FDA. The administration likely kills many people through opportunity cost. People really need to ask themselves if the FDA are the ones who should be making the decision whether something is risky enough that you shouldn't have access to it. In my eyes, if drug companies had standard product liability, then drugs would be safer and cheaper.
- cgb223 9y ago
  Wasn't there a law passed fairly recently that allows otherwise terminal patients to try risky not-yet-approved treatments?
- falcolas 9y ago
  Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. For every potentially legitimate treatment held back, a hundred illegitimate - if not harmful - treatments are also stopped. I won't claim this excuses the costs and time associated with getting FDA approval, but it's one more thing to consider when judging them.
  - microcolonel 9y ago
    > Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. Who cares? Homeopathy is largely harmless, the vast majority of people who practice it are not actually treating anything. Unless something goes seriously wrong, an extreme dilution is not going to have the same devastating effect as an untreated serious condition, unless the patient sticks it out like a fool, in which case can anyone except the charlatan who convinced them really be blamed?
    - MaulingMonkey 9y ago
      > Who cares? Homeopathy is largely harmless, Not if someone is relying on it (or other 'harmless' cures like faith healing) to treat their cancer, or their children's cancer, instead of something that will actually work it's not. Nor is it harmless if they have a contagious condition that they spread around (and you catch!) under the assumption that they've already been 'cured'. Nor is it harmless even if it's just emptying their wallet. > Unless something goes seriously wrong, an extreme dilution is not going to have the same devastating effect as an untreated serious condition Which I'd wager you'd agree happens more often than homeopathy goes seriously right, even ignoring the fool patients, parents, and caregivers who might leave serious conditions effectively untreated on account of believing in snake oil. Not ignoring them, this was reported two days ago: https://arstechnica.com/science/2017/09/cdc-homeopathic-healing-bracelet-poisons-baby-with-high-levels-of-lead/ https://arstechnica.com/science/2017/09/cdc-homeopathic-heal... > in which case can anyone except the charlatan who convinced them really be blamed? Some would argue that the society which stood idly by and refused to oppose such charlatans, if not to blame, is at least some kind of low trust, everyone for themselves, shitty kind of society. Especially if it can identify who is to blame, and still does nothing. Government regulation is not the only tool of opposition. James Randi has given some good talks to help fight the ignorance they exploit with knowledge. (EDIT: His TED talk: https://www.youtube.com/watch?v=c0Z7KeNCi7g https://www.youtube.com/watch?v=c0Z7KeNCi7g .) And there's some arguments that can be made that true freedom requires freedom to do stupid, counterproductive, self harming shit (although that's not the argument you're making.) TL;DR: I disagree with you on your stance of how harmless homeopathy supposedly is.
    - 9y ago
  - inimino 9y ago
    Is the ban on marketing really changing anyone's mind? I don't think anyone interested in homeopathy is likely to be put off by the fact that the FDA doesn't approve of it.
    - Sacho 9y ago
      It's stopping desperate people who have never heard of homeopathy from trying it, getting the placebo effect and becoming true believers.
  - u801e 9y ago
    > Just remember: the FDA is also the organization that keeps homeopathy from marketing itself as legitimate cure to every disease out there. On a related note, why are pharmaceutical companies allowed to market drugs through television and print advertisements? Clearly, most of the target population doesn't have the necessary knowledge or resources to make an informed decision regarding whether or not they should be on the advertised drug as part of their treatment.
    - refurb 9y ago
      DTC is allowed because the FDA has found the benefits outweigh the risk. Here is one positive data point of many in the physician survey: DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.[1] [1]https://www.fda.gov/drugs/resourcesforyou/consumers/ucm143562.htm https://www.fda.gov/drugs/resourcesforyou/consumers/ucm14356...
      - falcolas 9y ago
        I won't disagree that this could be an upside, but it's interesting that the US is one of two countries which allow this kind of advertisement.
        sitharus 9y ago
        And the other doesn't get in to it anywhere near as much as the US because most of the time you get what is subsidised.
    - dboreham 9y ago
      Because: money (Very, very large quantities of it)
- adrianN 9y ago
  I don't think the average person has the time or the skill to make an accurate assesment of the level of risk that taking some experimental drug means for them. Especially if you get rid of the need to have long and expensive studies to prove safety. How is a patient supposed to make an informed decision?
  - SAI_Peregrinus 9y ago
    Also keep in mind that the studies to prove safety are the short and cheap ones (phases 1 & 2), the long and expensive one (phase 3) is to prove efficacy. Of course sometimes safety issues show up only in phase 3, but its primary purpose is to show that the drug actually works and isn't just a scam.
    - wbl 9y ago
      Safety is related to effacity. Have an oncology drug that makes you go deaf but extends life for melanoma patients by a lot? Great! Oh, it's for acne? Probably not going to pass muster.
  - gozur88 9y ago
    Just because the government doesn't make the decision for you doesn't mean you won't have information. There's no reason the FDA couldn't still exist as an advisory body.

damnfine 9y ago

I can already smell the breath of the alternative (read: fake) medicine version of this as I type. Is the liquortarian diet more effective than the fruitatarian diet? You betcha! Just look at this study!

tyingq 9y ago
It's simple enough that I worry a bit about unqualified people offering it as a service.

jszymborski 9y ago

The article is available here[0] and is open-access. [0] https://www.nature.com/articles/s41598-017-09371-2 https://www.nature.com/articles/s41598-017-09371-2

jszymborski 9y ago

This is a really neat and elegant study. All they're missing is a long-term survival curve. You're probably wondering what the catch is if you haven't spotted it yet. Ethanol ablation is usually used for carcinomas of the liver, although it sometimes sees use in some very rare cancers. So, this falls under the "extremely effective but with limited application" category. That doesn't mean it doesn't have great value, but you also don't want folk to think it's a "lethal injection for all tumours".

hanklazard 9y ago
Right. And would not be useful for tumors with poor accessibility for injection, small multifocal tumors or those with small mets, or tumors of the blood. Still, plenty of early stage cancers involve a single accessible mass and I could imagine this technique being safer and easier than full excision in some cases. This is elegant and, importantly, should be inexpensive (vs the many personalized therapies being developed)
Pica_soO 9y ago
The unique thing about this approach was that is is a gel- not being limited to encapsulated tumors?
- jszymborski 9y ago
  This article is just a proof-of-concept, and unfortunately we can't make the claim that this means we can effectively use EtOH+Gel to treat tumours that are not encapsulated; particularly because it isn't clear to me whether the cancer model used is a good model of those "hard-to-treat-w/-EtOH-ablation" cancers. There is also a very honest list of caveats in the discussion, "Although we have demonstrated the efficacy of enhanced ethanol ablation in the treatment of squamous cell carcinomas in the hamster cheek pouch, there are several limitations to this study. First, the use of a chemically-induced tumor model (in which spontaneous tumors arising in sites adjacent to a treated site would be indistinguishable from the original tumor) precluded the possibility of any long-term monitoring of tumor recurrence. Second, a single animal tumor model was utilized. Further study in other tumor models is needed to investigate such recurrence, and demonstrate therapeutic efficacy more broadly. Since this study was a proof-of-concept, sample sizes were relatively low. Although other studies have shown systemic safety of ethanol ablation in a variety of applications, more research is needed to investigate the possibility of damage to surrounding tissue. Leakage of ethanol and nearby necrosis should be minimized, and details may be specific to tumor types. Although ethyl cellulose-ethanol has been used in the treatment of venous malformations, further safety evaluations of injections to tumors are clearly necessary. The ethanol-ethyl cellulose-water system has shown promise; but its more complete characterization will inform optimization. For example, better understand- ing of physicochemical details of the sol-gel transition, e.g. involving pressure and temperature, will benefit from improved discrimination between the sol and gel phases. The mechanical phantoms proved helpful in this initial study. Follow up use of them can improve details of their poroelastic structures and properties, and thus improve their role in the design process for enhanced ethanol ablation."

jeffdavis 9y ago

"Alcohol: the cause of, and solution to, all of life's problems." -- Homer Simpson