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The most effective drugs for lung cancer approved in the last few years are PD-1 and PD-L1 inhibitors. The leading drug is mercks pembrolizumab Here are some o

The most effective drugs for lung cancer approved in the last few years are PD-1 and PD-L1 inhibitors. The leading drug is mercks pembrolizumab Here are some of the most widely cited studies of pembro in lung cancer that illustrate its clinical benefit: Open label pembro vs chemo in first line non small cell lung cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa1606774 https://www.nejm.org/doi/full/10.1056/NEJMoa1606774 Development of PD-L1 biomarkers in 495 patient phase 1 study: https://www.nejm.org/doi/full/10.1056/nejmoa1501824 https://www.nejm.org/doi/full/10.1056/nejmoa1501824 Pembro + chemo in lung cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa1801005 https://www.nejm.org/doi/full/10.1056/NEJMoa1801005 Pembro + docetaxel for previously treated lung cancer: https://mdanderson.elsevierpure.com/en/publications/pembrolizumab-versus-docetaxel-for-previously-treated-pd-l1-posit https://mdanderson.elsevierpure.com/en/publications/pembroli...

semi-extrinsic 7y ago
Fun fact: you can identify these drugs as Monoclonal AntiBodies due to the suffix -mab. This category has been incredibly successful against a wide variety of debilitating illnesses like autoimmune, cancer etc. My doctor told me that surgery for arthritis is a dying specialisation in medicine, because the new drugs like infliximab are so effective. The discovery of how to produce them got the Nobel Prize in Medicine in 1984, and the more recent discovery of how to tailor them via directed evolution got the Nobel Prize in Chemistry in 2018.
- acidburnNSA 7y ago
  Apparently that's true for rheumatoid arthritis but osteoarthritis still gets a lot of surgery. Source: my SO the MD.
  - ekianjo 7y ago
    There is no cure for osteoarthritis because it is purely mechanical degradation of joints with aging. You get a lot of pain as your joints disappear. Most of the treatments are symptomatic (strong painkillers) or surgery (replacing joints with prosthetic ones). Very different from RA as a condition.
    - loceng 7y ago
      There is a solution for osteoarthritis, joint degeneration - it's by injecting your bone marrow, stem cells into the joint. A company in the US, Regenexx, has been doing research on stem cell treatments for 18 years now. Other places in the world have been doing stem cell research for 30+ years, it just hasn't become mainstream or widespread yet - so the knowledge isn't distributed well yet.
      - dm319 7y ago
        The evidence isn't strong for it either. The randomised controlled trials have very small n-numbers, are unblinded, have subjective primary outcomes. Needs a big trial to convince people it works.
        loceng 7y ago
        You can see before and after MRI imaging of areas with injury and then healed. Obviously we have to define the process of what is being talked about when saying "stem cell treatment" and determining degeneration level of tissues, along with health of the individual - and therefore the health and potency of their own stem cells, are other factors to consider. I'd say the bigger issue is filtering out the bad-greedy actors who jump into this space, who are piggybacking on the excitement generated from of word of mouth from patients who have benefit greatly - from clinics who have protocols they follow for what they know works and what won't work. I have been getting stem cell treatments from a clinic in the US for a few years now to treat many different areas of injury (limited number of areas they can treat due to limited amount of fluid they have to use after aspiration and post-processing) and from my own experience, and that of speaking with other patients in waiting rooms (and even hotel lobby) who have returned for additional treatments - it certainly works, heals, regenerates tissues with the right protocol and condition. The most painful injection spot I had was a ruptured, torn disk, in my low back - I am doing that area again on the 16th of this month, as part of a number of areas, because it helped permanently reduce radiating pain from that area greatly; I plan to do an MRI of area a few months after this next treatment to have post imaging.
  - odiroot 7y ago
    Yep, had my shoulder surgery exactly because of that, ~4 years ago. Few courses of various drugs didn't help at all. And I wasn't even 30 by then. I use strength training now to keep my shoulder in check.
- mrfusion 7y ago
  Anyone have an eli5 for how infliximab affects arthritis? I couldn’t make sense of the Wikipedia article.
- stenl 7y ago
  More importantly, the specific and incredibly successful class of immune checkpoint inhibitors(PD-1 inhibition is one example) got the Nobel Prize in medicine 2018, awarded to Tasuko Honjo and James Allison. See https://www.nobelprize.org/uploads/2018/10/advanced-medicineprize2018.pdf https://www.nobelprize.org/uploads/2018/10/advanced-medicine...
- teekert 7y ago
  PD-(L)1 inhibitors are a special class though and help the immune system in becoming sensitive to tumor cells and start killing them around the body. Other MAbs like Bevacizumab (an angiogenesis inhibitor, prevents formation of new blood vessels) or Herceptin (Trastuzumab, targets the HER2 membrane protein often over-expressed in certain types of breast cancer) have been on the market for much longer and fall under so called "targeted treatments". The targeted drugs hardly ever lead to a cure, whereas the new immune drugs may even cure people from metastasized cancer (in 30 to 60% of cases in some tumor types). Be aware that the side effects of the new immune drugs may also be severe and mimic auto-immune disease-like symptoms, essentially you are forcing your immune system into higher gear (higher sensitivity, less specificity). [0] https://en.wikipedia.org/wiki/Bevacizumab https://en.wikipedia.org/wiki/Bevacizumab

semi-extrinsic 7y ago

Fun fact: you can identify these drugs as Monoclonal AntiBodies due to the suffix -mab. This category has been incredibly successful against a wide variety of debilitating illnesses like autoimmune, cancer etc. My doctor told me that surgery for arthritis is a dying specialisation in medicine, because the new drugs like infliximab are so effective. The discovery of how to produce them got the Nobel Prize in Medicine in 1984, and the more recent discovery of how to tailor them via directed evolution got the Nobel Prize in Chemistry in 2018.

acidburnNSA 7y ago
Apparently that's true for rheumatoid arthritis but osteoarthritis still gets a lot of surgery. Source: my SO the MD.
- ekianjo 7y ago
  There is no cure for osteoarthritis because it is purely mechanical degradation of joints with aging. You get a lot of pain as your joints disappear. Most of the treatments are symptomatic (strong painkillers) or surgery (replacing joints with prosthetic ones). Very different from RA as a condition.
  - loceng 7y ago
    There is a solution for osteoarthritis, joint degeneration - it's by injecting your bone marrow, stem cells into the joint. A company in the US, Regenexx, has been doing research on stem cell treatments for 18 years now. Other places in the world have been doing stem cell research for 30+ years, it just hasn't become mainstream or widespread yet - so the knowledge isn't distributed well yet.
    - dm319 7y ago
      The evidence isn't strong for it either. The randomised controlled trials have very small n-numbers, are unblinded, have subjective primary outcomes. Needs a big trial to convince people it works.
      - loceng 7y ago
        You can see before and after MRI imaging of areas with injury and then healed. Obviously we have to define the process of what is being talked about when saying "stem cell treatment" and determining degeneration level of tissues, along with health of the individual - and therefore the health and potency of their own stem cells, are other factors to consider. I'd say the bigger issue is filtering out the bad-greedy actors who jump into this space, who are piggybacking on the excitement generated from of word of mouth from patients who have benefit greatly - from clinics who have protocols they follow for what they know works and what won't work. I have been getting stem cell treatments from a clinic in the US for a few years now to treat many different areas of injury (limited number of areas they can treat due to limited amount of fluid they have to use after aspiration and post-processing) and from my own experience, and that of speaking with other patients in waiting rooms (and even hotel lobby) who have returned for additional treatments - it certainly works, heals, regenerates tissues with the right protocol and condition. The most painful injection spot I had was a ruptured, torn disk, in my low back - I am doing that area again on the 16th of this month, as part of a number of areas, because it helped permanently reduce radiating pain from that area greatly; I plan to do an MRI of area a few months after this next treatment to have post imaging.
- odiroot 7y ago
  Yep, had my shoulder surgery exactly because of that, ~4 years ago. Few courses of various drugs didn't help at all. And I wasn't even 30 by then. I use strength training now to keep my shoulder in check.
mrfusion 7y ago
Anyone have an eli5 for how infliximab affects arthritis? I couldn’t make sense of the Wikipedia article.
stenl 7y ago
More importantly, the specific and incredibly successful class of immune checkpoint inhibitors(PD-1 inhibition is one example) got the Nobel Prize in medicine 2018, awarded to Tasuko Honjo and James Allison. See https://www.nobelprize.org/uploads/2018/10/advanced-medicineprize2018.pdf https://www.nobelprize.org/uploads/2018/10/advanced-medicine...
teekert 7y ago
PD-(L)1 inhibitors are a special class though and help the immune system in becoming sensitive to tumor cells and start killing them around the body. Other MAbs like Bevacizumab (an angiogenesis inhibitor, prevents formation of new blood vessels) or Herceptin (Trastuzumab, targets the HER2 membrane protein often over-expressed in certain types of breast cancer) have been on the market for much longer and fall under so called "targeted treatments". The targeted drugs hardly ever lead to a cure, whereas the new immune drugs may even cure people from metastasized cancer (in 30 to 60% of cases in some tumor types). Be aware that the side effects of the new immune drugs may also be severe and mimic auto-immune disease-like symptoms, essentially you are forcing your immune system into higher gear (higher sensitivity, less specificity). [0] https://en.wikipedia.org/wiki/Bevacizumab https://en.wikipedia.org/wiki/Bevacizumab