15 ms·
Skin cancer: Half of people surviving advanced melanoma
- breck 7y ago> The findings of the study will be presented at the European Society for Medical Oncology meeting in Barcelona, Spain, and published in The New England Journal of Medicine. Anyone have a link to a preprint? Can't find one anywhere. Hard to comment without seeing the actual source.
- oldgradstudent 7y agoMaybe this one? https://www.nejm.org/doi/full/10.1056/NEJMoa1910836 https://www.nejm.org/doi/full/10.1056/NEJMoa1910836
- breck 7y agoThat's it, thanks! For people without university or other access: https://sci-hub.tw/https://www.nejm.org/doi/full/10.1056/NEJMoa1910836 https://sci-hub.tw/https://www.nejm.org/doi/full/10.1056/NEJ...
- stuartbman 7y agoIts worth saying that some of the side effects of the newer immunotherapies are bizarre, idiosyncratic, and unpleasant, in a different way from chemotherapies. This is definitely good news, but patients undergoing treatment for melanoma are still extremely complex to manage.
- kaybe 7y agoCould you elaborate please?
- 01100011 7y agoMy buddy had bad GI symptoms(throwing up, diarrhea). He also lost his adrenals and thyroid. His thyroid may come back, but he'll be on pills for the rest of his life. IIRC, the treatment lasted about 2 years. He had the advantage of being a guitarist by trade who lived at home anyway. I'm not sure how someone with a normal life would have made it through it. He was the only patient who made it all the way through the trial. He also smoked cigarettes and marijuana, and had a opioid habit. That said, he still managed to keep hiking a couple times a week except on his roughest chemo weeks.
- yread 7y agoBoosting immune system can cause all kinds of issues if one has an auto immune condition.
- jquery 7y agoEven if you don’t, it can cause such a condition. My immune system “boosted” itself into erathyma multiforme during a nasty cold and that particular issue persisted for years even after the cold was long gone. Our immune systems are fantastically complicated, probably more complex a defense system than the entire US military with hundreds of millions of years of evolutionary pressure.
- pflats 7y agoAs the article says, this immunotherapy essentially works by turning off some of the immune system's "don't attack your own body" safeties. This frees the immune system to attack the cancer (provided it can identify it). One big advantage of immunotherapy is that the therapy causes a long-term (permanent? I'm not sure anyone knows; the drugs are less than a decade old) change to the immune system - the body continues to attack the cancer even after the drug treatment has ceased. If you put these two things together, however, you might see why the side effects can be so bizarre. Your immune system might decide that the liver looked at it funny one day, but then decide that the GI tract is actually the real troublemaker a few days later. And since the immune system change persists post-treatment, so do the side effects. These side effects can (usually) be controlled with corticosteroids (hydrocortisone/prednisone/etc.), which have an immunosuppressant effect. Of course, long-term corticosteroid use has its own severe side effects (plus severe dependency issues). And if you're suppressing the immune system, then you're suppressing the mechanism that the immunotherapy uses to fight the cancer in the first place. The treatment and the side effects are two sides of the same coin.
- metiscus 7y agoThis video is an excellent presentation on the subject by Dr. Allison. https://youtu.be/r1Fp6C1xx6Q https://youtu.be/r1Fp6C1xx6Q
- klipt 7y ago> this immunotherapy essentially works by turning off some of the immune system's "don't attack your own body" safeties That sounds like checkpoint inhibitor immunotherapy. Others like CAR-T may have fewer side effects, since they're just augmenting your T cells with a manufactured supply that is primed to attack a specific target. CAR-T is a lot more expensive for now but over time such "precision" immunotherapies may become mass produced and cheaper and we'll be able to make the immune system do what we want with fewer side effects.
- pflats 7y ago> That sounds like checkpoint inhibitor immunotherapy. You are correct. That is because the article is about checkpoint inhibitor immunotherapy (specifically yervoy/ipilimumab and opdivo/nivolumab).
- hestipod 7y agoI went through immunotherapy several years ago, for an iatrogenically induced issue which angers me more, and I think it permanently damaged me. I was quite sick for a while after and have never felt "the same" as before. I know that's vague and easily dismissed but it's as if the side effects of the treatment never went away. I also just spent months and a LOT of money on multiple biopsies apropos of the post's title, one of which got infected and created a whole other level of pain, stress, and cost, for a misdiagnoses. I never needed to be cut up and infected. This happened to me long ago in a more severe way with surgery as well that disabled me. Misdiagnosed by multiple doctors, spent tens of thousands, worse off. I would have had a much higher quality of life overall had I never gone to a doctor in this country. They have never gotten it right from small to big issues, and ruined my life in the process. I guess I need to just learn my lesson that the system can never be trusted here. But it's hard when you have pain or problems and want a solution. In my professional and personal experience the potential negative outcomes are always massively underplayed to patients. Medical errors/misdiagnoses are the THIRD leading cause of death in the USA. If I had been properly informed about any of the big issues I suffered I would have never agreed to "treatment" and better off for it.
- jquery 7y agoAll too common. I’m still dependent on a drug which was meant to be temporary but I was given such a high dose it permanently altered me. I’ve spent years tapering down and looking at another year to finally get off it, with no underlying issue anymore. Painfully slow, tedious, and maddening at times. I’m sorry you had to go through that.
- hestipod 7y agoI understand what you are going through and am sorry I cannot solve it for all of us in this boat. I try my best not to dwell in the past and be angry, but its so hard when the past's errors and slights affect your quality of life every day.
- erikpukinskis 7y ago> I guess I need to just learn my lesson that the system can never be trusted here. I made a similar generalization about dentists a number of years back. I regret making that generalization now. I wish I had instead decided “that one can’t be trusted, let me try another”.
- clircle 7y agoThe title says half of people survive advanced melanoma, but the article says 52% of patients live for 5 years. Are these medically the same?
- inetsee 7y ago5 Year survival rate is one of the standard measures for the effectiveness of a medical treatment.
- anovikov 7y agoThat's what always bugged me: after a 5-year survival, what is the typical probability of cancer ever returning? I.e. to what extent 5-year survival == "cure"?
- huherto 7y agoMuy guess is that you have 52% of surviving another 5 years. But as the xkcd lanes comic linked explains you are never really cured.
- _Microft 7y agoIf you want a display that imo really hits home for some reason, see xkcd "Lanes". The uncertainty that patients are going through in the years after a cancer diagnosis/treatment must be brutal. https://www.xkcd.com/931/ https://www.xkcd.com/931/
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- melling 7y agoWe could greatly increase the survival for most cancers if we could detect them much earlier. “ If it is caught in the early stages then the chances of survival are good, but as the cancer becomes more aggressive and spreads throughout the body (known as metastatic cancer) then survival plummets” Craig Venter: https://youtu.be/iUqgTYbkHP8?t=15m37s https://youtu.be/iUqgTYbkHP8?t=15m37s
- toomuchtodo 7y agoHow do we detect it earlier? And how do you scale that up?
- akiselev 7y agoWe need tests with lower false positive rates. The problem with catching cancer early is confirming whether you actually have cancer or not. This most often requires invasive biopsies which exposes the patient to significant postop risks and the early detection tests' false positive rates mean that blanket tests of all patients would do far more harm than good. For example, mammograms have a false positive rate of something like 50% and complications happen in something like 30% of surgeries. Multiply that by every possible common cancer and you've got a no-win scenario. All of our early detection tools are pretty terrible and we can't ethically test everyone for everything so it's all about educating the patients to take a proactive role.
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- afarrell 7y ago> mammograms have a false positive rate of something like 50% This is pretty astounding to me. Where should I read more about this?
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- mrosett 7y agoThis is amazing news. Many of the articles about "a cure for cancer" that get posted here and elsewhere don't pan out, but this is the real deal. Obviously the goal isn't 50% survival - it's 100% - but we've come a long way. I was diagnosed with melanoma in 2010. At the time, the standard of care for melanoma was remove it surgically... and then cross your fingers and hope it doesn't come back. During the 3 month interval between when I was first diagnosed and when we learned that the cancer had spread, that changed. The first paper showing an overall survival benefit for melanoma patients (by dosing them with ipilimumab) was published in the NEJM in June 2010. Although ipilimumab (marketed as Yervoy) wasn't approved by the FDA until the next spring, I was able to get access to a very high dose of the drug through a clinical trial. The trial was weird in a couple ways. First, I can get on clinicaltrials.gov, pull up the results of my study, and calculate that if I'd been put in the placebo arm of the trial, there's a 25% chance I wouldn't be here to write these words. That's a strange thing to know. Second, the side effects were really unusual and unpleasant. I didn't have to endure the acute toxicity you get from chemotherapy, so that was a blessing. On the other hand, immunotherapies (like both of the drugs referenced in this study) mess with immune regulation mechanisms that apparently aren't supposed to be messed with. My personal experience ranged from the mundane to the miserable: fatigue, severe acne, absolutely excruciating eye infections, and other stuff I won't get into here. I'm still dealing with some of these issues almost a decade later, but the key point is that I'm here to deal with them! Ipilimumab was the first step; James Allison recently won a Nobel prize for discovering the protein that it targets. Nivolumab (marketed as Opdivo) actually gives even better performance, so nivo is the standard and is sometimes supplemented with Yervoy (or so I understand; I'm not a physician.) I can only imagine what the side effects of the combination therapy are like. Remarkably, both drugs were developed by Bristol-Myers Squibb.
- PhantomGremlin 7y agoif I'd been put in the placebo arm of the trial, there's a 25% chance I wouldn't be here to write these words I think you fared much much better than most. Maybe it's because you received a very high dose of ipilimumab. The people in the article's trial (which I assume wasn't your trial) were less fortunate. Specifically: The results showed: 26% were still alive on ipilimumab alone So 74% of the people in that trial are no longer here.
- aaavl2821 7y agoThese drugs were originally developed by a company called Medarex, based on academic research. Bristol Myers bought Medarex in 2009 I think. From what I understand, Bristol Myers almost didn't develop the drugs. Back then the idea of targeting the immune system to treat cancer wasn't a mainstream idea. It's a very good thing they moved forward with them!
- 01100011 7y agoYeah, my buddy survived it once, then it came back again as stage 4 and he beat it using immune based therapy. Now his adrenals and thyroid are dead. It's better than dying, but it's not free. Edit: also, my buddy was the only guy in the study group who didn't drop out. He just happened to be a massive pill-head(opiates), and smoked a ton of pot, which probably helped get him through the side effects. Immune therapies are worlds better than traditional chemo/rad, which often ended up giving you an entirely different kind of cancer years later, but they are not without side-effects.
- RickJWagner 7y agoFantastic! I've had a few skin-cancer spots removed from my arms. (Failed to use sunscreen in my younger years. Avoid this fate!) I'm very glad to read this article.
- civil_engineer 7y agoI was diagnosed with stage 4 melanoma in Feb 2017. At my fourth treatment (every three weeks) of pembrolizumab, my PET and CAT scans were clear. I continued treatment for 12 months, and still get scanned every four months. Still clear 3 weeks ago. My doctor says he now gets to use the c-word with cancer patients. Minimal side effects for me. I wish for my cohorts that more reliable treatments come soon.
- simonsmithies 7y agoSimilar response with pembrolizumab for my son, diagnosed with stage 4 melanoma in 2015. Side effects really quite trivial for him - more akin to allergy/hay fever than what you see with other treatments. I understand pembro is even better than the drugs mentioned in the article, both in terms of side effects (less) and likelihood of actually working for a particular individual.
- tryitnow 7y agoI'm coming around to the view that treating cancer is mostly a resource allocation issue. I'd be willing to bet if we made even more aggressive investments in finding treatments and cures, we'd be able to achieve both rapid incremental improvements and a handful of breakthroughs with the net results being a radical decline in suffering and deaths due to cancer (not to mention amazing discoveries in science for the sake of science). It's a shame we don't do this.