5 ms·

It really is remarkable how far cancer treatment has progressed, even in the last few years. I'm one of the unfortunate people who, through a close family encou

• bongoman37 4y ago
  This. A close friend of mine was diagnosed with stage III stomach cancer. He lost massive amounts of weight and I almost thought he was not going to make it. And a year later he is back at work and doing pretty well.
• harmmonica 4y ago
  Would you be willing to share the type of cancer? Also, was the person you're referring to (can't tell if it was a relative) able to bypass traditional chemotherapy and go straight to the immunotherapy given the prognosis? Or did the oncologists require chemo first and only then your contact was able to receive the immunotherapy? Thanks for sharing anything you can. If more comfortable sharing in private, I can be reached at asuela1 at yahoo's email service (it's my spam account, but I'll check it if you tell me you wrote back there).
  • nyx 4y ago
    Stage IIIC NSCLC, specifically a superior sulcus tumor, advanced enough to be considered inoperable. Standard of care in this case was induction radiotherapy, followed by a single course of combination chemotherapy consisting of carboplatin, pemetrexed, and pembrolizumab (the last of which is the cutting-edge immunotherapy I'm talking about; brand name Keytruda.) After that, patients are prescribed the pemetrexed and immunotherapy alone for a long 2-year "maintenance" course, at which point treatment options will be reassessed. Surgery was not an option here because of the size and location of the mass, but after the initial course of chemo a PET-CT showed an 80% reduction in size. After some time on pembrolizumab, symptoms continue to improve and surgery may be back on the table soon. (edited for a more accurate picture of maintenance treatment; thanks to borbulon for refreshing my memory)
    • harmmonica 4y ago
      Thank you for pointing out the standard of care in this case, given inability to resect, was the immunotherapy from the start. Obviously very specific for that type of lung cancer and the state of your contact's tumor, but I've been learning more and more about this and have been told by multiple oncologists that immunotherapy is typically only given after more conventional treatments are first attempted and fail to stop progression or shrink the mass(es). Needless to say that's far from categorical so in my next conversations I can be a bit more educated in my questioning. And 80% reduction after that first course... Amazing. How long after the first course did they do the scan that showed that reduction? Btw, very happy for you (and even moreso for your contact). Great news.
      • clokar 4y ago
        Not sure about lung cancer, but there's positive results in other cancers for earlier immunotherapy ! https://oncologypro.esmo.org/meeting-resources/esmo-congress/neoadjuvant-immune-checkpoint-inhibition-in-locally-advanced-mmr-deficient-colon-cancer-the-niche-2-study https://oncologypro.esmo.org/meeting-resources/esmo-congress...
      • nyx 4y ago
        The scan that indicated the 80% reduction was after just a couple of weeks, if I recall correctly. Since you're talking about immunotherapy not typically being a first-line treatment, I'll share a morbidly interesting fact that underscores some of the, er... quirks of the US medical system. The oncologist treating my relative initially staged my relative's cancer in the electronic health records as stage IV, despite no evidence of metastasis (the usual criterion)--he explained that he did this specifically in order to pursue first-line Keytruda (which is indicated for stage IV but not stage IIIC) and have it be covered by insurance.
  • mcbain 4y ago
    Of course it varies by cancer. Look up "adjuvant immunotherapy". It is now standard of care for melanoma, for one, but it isn't successful for all cancers, (or even all melanoma mutations).
• dominotw 4y ago
  > in recent years, a very effective checkpoint inhibitor immunotherapy has been developed for the cancer in question. ~2x the success rates of traditional chemo > I think they've been saying this for a long time now, but it's truer than ever that a real cure for cancer is right around the corner. I think thats quite a leap. For prostate cancer( most common cancer among men), top line therapies are still androgen blockage that was discover 70 yrs ago, chemo and radiation. Keytruda failed to deliver any significant survival benefits[1]. Yes we've gotten better at slash, burn , poison methods. Radiation is more trageted and sophisticated. Diagnostics are more precise. Chemo drugs have better safety profiles. But these are all marginal improvements. None of which indicate anything that we are close to a cure. Only hope we still have is to catch it earlier and go ham on it. Most of the slash,burn, poison methods are being FDA approved for earlier use. The other two things(one of which you've mentioned) are immune checkpoint blockade if you have MSI-hi/dMMR or PARP inhibition if you have BRCA2+. Even if you are lucky to have these mutations these drugs are a hit or miss[1]. I don't feel optimistic about a cure at all. 1. https://www.businesswire.com/news/home/20220803005334/en/Merck-Provides-Update-on-Phase-3-KEYNOTE-921-Trial-Evaluating-KEYTRUDA%C2%AE-pembrolizumab-Plus-Chemotherapy-in-Patients-With-Metastatic-Castration-Resistant-Prostate-Cancer https://www.businesswire.com/news/home/20220803005334/en/Mer...
  • nyx 4y ago
    I agree that my original comment is very optimistic--for what it's worth, Keytruda has thus far been very effective in the case I'm talking about, so I have some bias here. I concede that even in my "double the effectiveness" example, we're talking about doubling something like a 20% 5-year OS. By "around the corner" I'm really talking about, like, 20-30 years out, which I think is fairly soon in terms of cancer treatment progress. You're right that it reads like a leap in the context of my comment.
    • bnjemian 4y ago
      Not to be too pessimistic, but 600,000 people died of cancer in 2019, so 20-30 years is hardly "round the corner" when you extrapolate to the, let's say conservatively, 10 million families in the US losing loved ones in that time period. The history of cancer (The Emperor of All Maladies is a good book covering the history) is full of promising adjuvants, drugs, protocols that fail to generalize well. There are a lot of reasons for this. With drugs, one is that Phase 3 clinical trials often have patients who are selected on the basis of them being likely to be among the best responders. But once the drug is approved and made available to all patients within a given indication – a fundamentally different population – an overwhelming positive response may be significantly more modest. In many cases, this has to do with a patient's tolerance of the side effects or the interaction of the drug with known or underlying comorbidities. While I'm encouraged by the research in this article and could see the drug being part of a combination protocol, I'm hesitant that it will be "universal". And the mechanism, candidly, is downright scary – if I were running a Phase 3 for this (seems the trial cited was a Phase 2 demonstrating baseline safety in humans), I would want a very detailed articulation of how the technology ensures with a high margin of safety that the drug delivery is targeted to the tumor and no other tissues. The permeability of blood vessels in tumors would not be sufficient (and also does not seem "universal"). On a more personal note, I'm actually a computational biologist and have done quite a bit of work in cancer research (masters thesis, portion of my dissertation). My Mother was also diagnosed with a highly aggressive cancer of unknown primary (CUP) origin in her lung late last year (estimated stage IIIb for NSCLC, stage 4 for CUP/melanoma). Its location and heart involvement made it inoperable. Turned out is was a melanoma, which to be frank I quickly recognized down to the subtype upon reviewing the pathology reports. The lung oncologists were much more conservative; given the location, they weren't especially well-versed in melanoma, and presumed it was an adenocarcinoma with a rare presentation despite the staining for carcinomas being negative across the board. Luckily, we managed to convince them to split the difference on the standard of care – CarboTaxol (carboplatin + taxol) combination and immunotherapy (nivolumab and ipilimumab), all at once. The immunotherapy surely saved her life; unlike with carcinomas, chemo is roughly 5% effective (as in, any response whatsoever) for melanomas. About 70% of melanoma diagnoses respond to combination immunotherapy with about 15% going into full remission (memory is shaky on that last number, may be slightly higher). With >95 PDL-1 expression, she was one of the lucky ones – she had a full response on both imaging and pathological endpoints. That also made her tumor (or what was left of it) operable. She's two lobes and a chunk of heart lighter, but she's alive, healthy, and recovering well. And while I cringed when he did it, one of her oncologists dropped the "c word" after surgery in discussing her case. Knowing the foe, I'm much more cautious in contemplating whether any of this represents a cure. Psychologically, the uncertainty around the future maintains a heavy burden over her and our family. A 70% response rate sounds really good, but it's a very different calculus when you're living it. But as you said, her path towards a cure wouldn't have been possible not too long ago – in her case, 10-15 years; ipilimumab was approved in 2011 and nivolumab in 2014. But 30% of people with melanoma are still non-responders to combination immunotherapy. And, while a handful of other (generally less effective) options exist, non-responses in melanoma are deadly, often within a year or two of diagnosis, and for most all cancers have an incredibly high opportunity cost.
• borbulon 4y ago
  As a person who currently has stage IV NSCLC, I can add some context to this: YMMV. One thing to remember is that "Lung Cancer" is not just one thing. There are mutations of different genes, there are overexpressions of different genes. Each one has its own new medicines. Also, some peoples' cancers are more aggressive than others, and while for many they can find the right drug, for some nothing works. Keytruda works wonders for some. It did not for me. I had 4 treatments of the CPP (carboplatin, pemetrexed, and pembrolizumab) triad, which had some success. They then put you on "maintenance," which is the PP without the carboplatin (which is the really old school platinum-based chemo). Maintenance did nothing for me. My main tumor grew more than 50% in 2 months. Last summer I started 9 months on a chemo/immuno that was geared towards my specific mutation. It actually did wonders. It resulted in a 98% shrinkage of my main tumor before I ended up with pneumonitis from it and had to stop. But I've been able to be off treatment for the entire summer. I know there are others who have tried this, and it didn't work. So yeah, I'm really, really glad your relative was able to get some relief from the Keytruda. But I also wish it were the wonder cure for everyone that it was for them.
  • mromanuk 4y ago
    What are your thoughts on Dr. Seyfried and cancer as a metabolic disease?
  • tomcam 4y ago
    Shit. My best to you and yours. Thanks for sharing.
  • nyx 4y ago
    Thanks for sharing your story and treatment details. I should add that my relative's cancer has no particularly interesting mutations, but does have a high PD-L1 expression, which from what I can tell is the reason Keytruda was more likely to work for their situation. > that was geared towards my specific mutation This is actually one of the things that gives me hope for the future: genetic testing on a tissue sample of the patient's cancer is standard, and for many of the specific oncogenes that we know about, there exist therapies targeted to those specific mutations: https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/targeted-therapies.html https://www.cancer.org/cancer/lung-cancer/treating-non-small... One thing I've learned is that even in the face of good news, cancer is a horrible time, and I wouldn't wish it on anyone. But I'm likewise glad to hear about your results from the latest treatment, and hope things stay as positive as they can for you.
• asdff 4y ago
  As others have mentioned it depends. For instance the initial trials with pembrolizumab weren't the silver bullet the media makes them out to be today, until they identified what features might common among patients that did see a response, e.g. mismatch repair deficient cancers, because the tumor needs to be spitting out enough of these tumor-specific neoantigens to be targted by the immune system. That generally happens with highly mutated tumors such as those found in mismatch repair deficient tumors. The reason why the immune system was not targeting the tumors like it should have given the neoantigens until you take the drug is because the tumor cells presents the correct receptors that the immune system expects from healthy cells, which prevents the immune response. When you block that receptor as these drugs do, and also have many of these tumor specific neoantigens being expressed, then the immune system is able to target the tumor cells for death and the drug works well.
• silisili 4y ago
  It's moving so fast even doctors(sans oncologists, perhaps?) can't keep up. Brother's been a doctor about 15 years. Huge extended family is aging, and of course cancer creeps in. Of course family members call to get his opinion, and he's been wrong every single time(thankfully). Usually saying something like 'oh, she'll be dead within 2 years' and them living 6, or 8. And in one case calling something a death sentence that was actually, seemingly at least, cured. It's entirely possible he's just a shit doctor, but I like to think it's that progress has moved a ton since he's studied up on it last.
  • inglor_cz 4y ago
    It is also notable how doctors can get away with not following the progress in their own field. A programmer who would ignore the developments since 2007 would be unusable.
    • thelittleone 4y ago
      This 500x.
    • viraptor 4y ago
      "their field" is a fuzzy concept. For example for a GP their field is "medicine". By definition they need to know just enough about everything to direct you to a specialist when needed, but it's simply impossible to be up to date with everything. On the other hand, there's a huge number of consultants for enterprises which still write .net 4 like it's 2008 and they're both happy and productive. Unless they're sent to a training, why bother learning new stuff?
      • inglor_cz 4y ago
        True, but a GP shouldn't declare death sentences on their relatives if he is out of his depth in oncology.
    • biofox 4y ago
      I'm still programming in Java like it's 2001. No problems here :)