11 ms·
A cure for cancer: how to kill a killer
- homero 8y agoI'm worried about these treatments for people with autoimmune diseases. One, they might be on immunosuppressants, two, immune activation can then kill you through the autoimmune disease. I have ulcerative colitis and am on immunosuppressants. So I'm more likely to get cancer and can't get that treatment.
- qaq 8y agoOne would imagine they will not be used in these cases
- doctoring 8y agoAt our hospital we routinely use many of these therapies even in patients with a variety of autoimmune conditions. In about a third of patients, they'll have an exacerbation of their underlying autoimmune condition, which fortunately only rarely necessitates cessation of the immunotherapy. One of several studies we reference when we treat these patients: https://www.ncbi.nlm.nih.gov/pubmed?term=27687304 https://www.ncbi.nlm.nih.gov/pubmed?term=27687304 What's interesting (and increasingly being studied) is the higher risk of developing an autoimmune condition after treatment with some of these immunotherapies. The absolute risk doesn't seem to be huge, but it's an interesting window into how these conditions might develop in the first place.
- homero 8y agoThat's good to hear. Would you stop, say Humira before treatment?
- chopin 8y agoWhat the article unfortunately not explains: as far as I understand the medication suppresses ways the immune system can identify healthy/own cells of the body. If that is suppressed I'd expect more severe side effects, up to death, no less. Why isn't this the case? Imho it could work only if cancerous cells are more affected than healthy ones (like they are more affected by cytostatic drugs because they divide faster). Can anyone chime in with an explanation?
- jcims 8y agoSome additional info here - https://www.quora.com/How-does-PD-L1-checkpoint-inhibition-selectively-target-cancer-cells-but-not-healthy-cells https://www.quora.com/How-does-PD-L1-checkpoint-inhibition-s...
- yk 8y agoThe article follows the standard convention of newspapers to hide any qualifiers in the last few paragraphs, in particular the second to last paragraph starts: > Hype can be dangerous, just as false hope can be cruel. I would therefore suggest reading the last two paragraphs carefully.
- jm__87 8y agoThey aren't hidden, they are just at the end of the article. To me this seems like fairly honest reporting, as opposed to ommitting this info entirely.
- darkerside 8y agoPeople seem to be disturbed by the indiscriminate nature of this cure. The immune system, unleashed, will target not only cancer cells but healthy ones as well. If this feels somehow aesthetically displeasing to you, ask yourself whether it feels more or less clumsy to shoot radiation in your tumor's general direction and literally poison yourself. Immunotherapy seems positively elegant in comparison.
- bsder 8y agoUm, actually, radiation is MUCH better than most of the chemical options unless you are one of the very fortunate few that has a particular receptor than can be targeted. Radiation has gotten extremely good at being far more targeted. The doctors actually model the absorption curves and let computers target the specific areas to make sure that the specific area gets the necessary dose while keeping the dose down in the surrounding tissue. If you can do radiation, it is by far the best option nowadays. Sadly, you can't always use it--sometime surrounding tissue is too sensitive to radiation (intestines) and sometimes things are simply too large. Chemotherapy, though, just really, really, sucks. Almost anything is better.
- darkerside 8y agoYeah I hesitated at putting radiation therapy in there because I didn't know how targeted it was. Thanks for an informative response.
- jobigoud 8y agoPardon my naïveté. Has a honey-pot strategy been tried for Cancer? Like maybe we can't kill it but we can lure it to develop in a very localized place, like a cyst growing on the back of your hand or something, and then we remove the cyst.
- ryanwaggoner 8y agoJust as naive as you about this, but why would cancer developing in one place mean that it can't develop somewhere else?
- Udik 8y agoOk, following with the totally naive speculation. What if it were not a place, but a specific environmental factor or a specific trait? Cancers mutate quickly, and resources are limited, so cells that are more successful might starve those which lag behind, as it happens in animal populations. And once the cancer has "fallen into the trap" of specializing for something, that something could be targeted, or the favouring environmental conditions removed.
- asdff 8y agoThis is the clonal evolution model of cancer, and is how many solid tumors are comprised and treated. The danger is that the selective advantage for the cancer cell is often by masking itself as a healthy cell to the immune system, which complicates treatments but this interaction can still be targeted (see PD-1).
- Udik 8y agoYes, the idle speculation about a "honeypot" method was of artificially encouraging the cancer to evolve in a certain direction, even boosting its growth, until it has reliably mutated in a way that makes it susceptible to some other intervention, like being starved or targeted by some particular marker.
- asdff 8y ago
- vectorEQ 8y agokilling things is bad mkay. prevent instead of cure. solve the root cause. " “The tidal wave of data is still teaching us fundamental concepts about the interaction of the human immune system and human cancer.” " So, if they still learning fundamentals. -> impact of actions based on inaccurate or incomplete knowledge, is unknown. in programming this kind of practice would lead to bugs / undefined behaviour etc. - imagine what kind of shit that would mean for human health... It'd be nice if they had cancer prevention studies instead of cancer cure studies. kthx
- AnimalMuppet 8y agoWhile we're still trying to sort out the root causes, a lot of people are dying. So we're trying to stop them from dying, even while trying to find root causes. (Society as a whole can work on more than one thing at once.)
- bananadonkey 8y agoWhen dealing with a software bug you have to reproduce the issue before you can definitively "fix" it.
- Koshkin 8y agoNot true. (It is often possible to understand the cause by just looking at the damn code.)
- qubax 8y agoMaybe for superficial bugs in small toy programs. But a real bug in any sophisticated program requires a bit more than looking at the code most of the time. User feedback, log/trace data, performance data, system events data, memory dumps, etc. Of course the bug could be in proprietary software your code is using. How would you fix that by purely looking at your own code?
- barry-cotter 8y agoHumans, and every other life form have an undocumented, undesigned self executing specification that consists entirely of the most reticulated, self referential spaghetti code compatible with successful reproduction and it’s not just riddled with Heisenbugs, they’re core parts of the machinery of how everything works. We’ll get there eventually but it’s going to take an exceedingly long time.
- doctoring 8y agoI work in oncology and with some of the people interviewed in the article. I want to emphasize just how exciting this stuff is and how wild it is to have patients who have a belly full of innumerable metastases, for whom 5-10 years ago we'd quote a few months' survival at best, and now on these new fancy drugs their tumors just disappear. It's incredible and up until now unimaginable for these late stage solid cancers. Similarly, to have people with leukemias who previously we use essentially 40 year old drugs, now we can fight and fight to keep alive long enough to get their T-cells harvested and re-engineered and re-infused and then (after nursing them through a cytokine storm) they emerge... with their cancer wiped out completely. (The article blithely says "remissions measured not in extra weeks or months of life, but in lifetimes". It's a little over-reaching since we just don't have that much long term data yet; these therapies haven't been around for "lifetimes". As a result we often prefer the term "durable remission" to "cure".) I also want to emphasize how few patients have this outcome. It sucks. It sucks to have ads on bus stops and TVs that say, "Ask your doctor about Keytruda", but when they ask me, I know it has such a tiny chance of turning them into that laughing family playing in the grass. We test for and hope for the genetic markers that indicate certain immunotherapies are more likely to work spectacularly, but the vast majority of patients don't have those markers. Similarly, most patients with leukemias or lymphomas do not respond to CAR-Ts. We still try these immunotherapies, though, because there's often evidence of some modest better outcomes, and also sometimes you get lucky. I think I mentioned this on HN in some other context, but one of the breakthrough discoveries around pembrolizumab was because of a "Hail Mary" in late stage colorectal cancer; all the patients progressed & died in the study except for one, and she held the key to the genetic derangement that made that subset of cancer particularly sensitive to checkpoint blockade -- leading to FDA approval for pembro for all cancers with that derangement. As this article mentions, there is now a massive number of trials studying these therapies in various subsets of patients, or in various combinations and permutations with traditional therapy, because short of "cure" there's still improved survival which can often be very meaningful. It's exciting. It's inspiring. It's frustrating & heartbreaking.
- Eli_P 8y agoCould that tech of re-engineering T-cells be a step to cure psoriasis? AFAIK psoriasis is caused by T-cells erroneously targeted to kill epidermis.
- ryanackley 8y agoSlightly off-topic but one thing that I've always been honestly curious about is that literally billions of dollars are donated to cancer research each year...but then the practical results of the research are sold to oncology patients at bankrupting sums. So my question is when we donate to cancer research, are we donating to public research or are we handing our money to a for-profit corporation. What is the path from donation to six figure cancer treatments? I would be very interested in how that works.
- Uberphallus 8y ago> the practical results of the research are sold to oncology patients at bankrupting sums. In the US. [0] [0] https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-on-average-other-wealthy-countries-spend-half-as-much-per-person-on-healthcare-than-the-u-s https://www.healthsystemtracker.org/chart-collection/how-do-...
- kokey 8y agoThe rest of the world can thank people in the US for spending rather large sums on certain treatments. In the UK the treatments are covered by the state at no cost to the patient, but it's only a limited set of available treatments which are considered cost effective. In the US there are plenty more options, if you can pay for it. People may decide to bankrupt themselves or sell their house for these treatments that could enable them to survive or not, but either way they are contributing to real world data that informs the rest of the world of the efficiency and cost effectiveness of a particular treatment.
- refurb 8y agoDonations likely contribute to the body of knowledge about cancer. Then someone takes that and develops a new drug, charging a high price along with it. An interesting approach is the cystic fibrosis association in the US that directly invested in a new CF drug. They made a ton of money and rolled it back into research.
- barry-cotter 8y ago
- salex89 8y agoNot directly connected to the article, but the 40% chance of getting diagnosed with cancer in my lifetime really sets of my anxiety...
- nradov 8y agoIf you live long enough you will eventually get some kind of cancer. This is inevitable as DNA damage accumulates. Chances are something else will kill you first, but detailed autopsies of older people frequently turn up small, slow-growing cancer tumors.
- philjohn 8y agoIt's why at a certain age with Prostate cancer "watchful waiting" is often preferable to invasive procedures. In some cases it will be so slow growing you're likely to die of something else first.
- jillesvangurp 8y agoYou have 100% chance of dying of something.
- tcbawo 8y agoThe immune system is so complex, we can't even solve food allergies. We're only scratching the surface, although I am hopeful for the future.
- jmcmichael 8y agoI've been working with a team* on an open-source analysis pipeline tool to assist researchers and oncologists in identifying specific neoantigens used in cancer immunotherapy. Given a patient's sequenced tumor/normal genome, it uses a set of prediction algorithms and the public Immune Epitope Database to produce candidate neoantigens for synthesizing the vaccines used in clinical interventions or research. We just released a browser-based client to assist users not comfortable with constructing the long and complex command-line arguments used with most bioinformatics analysis pipelines. It also provides a REST API that makes it easier to integrate into existing research/clinical pipelines. If you're working in this area of research/treatment please check it out to see if pVACtools can be of use to you! http://pvactools.org http://pvactools.org EDIT: Just received a writeup in GenomeWeb: https://www.genomeweb.com/informatics/wustl-software-offers-automated-option-cancer-variant-review https://www.genomeweb.com/informatics/wustl-software-offers-... * as a user-interface designer/developer
- aaavl2821 8y agoThis is cool. Who is the main target user for this? Biotech companies? Academic researchers?
- jmcmichael 8y agoBoth. It's currently being used mainly by academic researchers, and biotech companies are evaluating it as well.
- aaavl2821 8y agoHow does it perform compared to any in house software at biotech companies? Or are the main users companies that specialize in making cell therapies / peptide vaccines and you just help them figure out which vaccines to make? Am just interested bc i have a few friends involved in neoantigen / shared tumor antigen cell therapy companies, and did some consulting work for a company that had tech for delivering nucleic acid therapies and was considering getting into oncology, but didnt have in-house sequencing or antigen identification expertise. Mostly intellectual interest at this point
- msiyer 8y agoI am honestly curious. What exactly is the root cause of cancer? The article talks about cancerous cells tricking the immune system, but this trickery is the result of something else. Immune system, in a healthy body, eliminates cancer cells continuosly. What enables some cancer cells in some humans to fool the immune system and multiply maliciously? We can "manage" cancer without understanding the root cause. We cannot cure it.
- Symmetry 8y agoJust evolution whispering “kill, consume, multiply, conquer” to the cells in your body in the normal way that evolution does. It's pretty common for small mutations to occur in your cells from time to time. Cancer requires several mutations to line up in ways that allows cells to start multiplying without constraint - evading normal growth controls and apoptosis and the immune system and such. The cells where the mutations don't align and which start multiplying with everything else you never even notice.
- msiyer 8y ago> Cancer requires several mutations to line up in ways that allows cells to start multiplying without constraint - evading normal growth controls and apoptosis and the immune system and such. In that case, either we are engineered badly (genetic) or there are factors that cause cells to go rogue (epigenetic). We still need to find the root cause. I have a hard time believing there are faults in the way we are designed.
- Symmetry 8y agoIt's not that there's a fault in evolution's design so much as that evolution doesn't really care that much that people die of cancer. Whether or not it could be possible to create a non-senescent humanoid species by evolution evolution has a fixed budget of complexity it can work with given germline mutation rates and the selective pressure our species is under. And reducing germline mutation would mean we would evolve more slowly in the face of new selective pressures like new diseases. People are working on ways to end cancer. Aubrey de Grey has a plan[1] which, unlike his others for fighting aging, I think is totally crazy but hey at least someone is working on it. But its certainly not something that could evolve in nature. [1]https://en.wikipedia.org/wiki/Strategies_for_Engineered_Negligible_Senescence#Nuclear_mutations/epimutations%E2%80%94OncoSENS https://en.wikipedia.org/wiki/Strategies_for_Engineered_Negl...
- kareldonk369 8y agoThe cure for cancer already exists. We've had it for ages. It's THC found in the cannabis plants. See research from, among others, Compultense University in Spain.[1] Many people suffering from various forms of cancer have been cured by using cannabis oil made from cannabis with high THC concentrations. [1] https://youtu.be/1miGzTwK28U https://youtu.be/1miGzTwK28U
- rishabhbits038 8y agoMy dad had liver cancer which was detected early. We went with liver transplant and 3 months later, cancer reoccurred in lymph nodes in his lungs. Now, he's on immunosuppressants (tacrolimus and everolimus) for organ rejection. Can immunotherapy still be tried on him?