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A vaccine for pancreatic cancer treatment?
- JumpCrisscross 3y ago> after years of work, BioNTech says that they can get it down to less than $100,000/dose. I'm sure it can be driven down further, but this is highly unlikely to ever be cheap. They also got an anti-PD-L1 antibody and a four-component chemotherapy cocktail (those last two have already been tried in PDAC therapy without the vaccine dose, to unimpressive effect). The vaccine was administered across nine doses Wow, $1mm to save a life. (This math works in the rich world.)
- mbiondi 3y agoIf it's your life, it might be worth it.
- JumpCrisscross 3y ago> it might be worth it It’s absolutely worth it if you can afford it, which the rich world can. But personalised medicine forces us to face, in stark and dollarised terms, the inequity of healthcare access across the world.
- melling 3y agoNot to worry, it’ll be 1000x cheaper in 10 years.
- JumpCrisscross 3y ago> it’ll be 1000x cheaper in 10 years Personalised medicine has high cost floors. The factors which would enable a triple order-of-magnitude reduction in its cost would sooner realise massive savings elsewhere, which means it’s unlikely a niche cancer treatment would be prioritised.
- a-user-you-like 3y agoThen give it 50 years, have to start somewhere
- kulahan 3y agoMy plan is to get it via a hospital which accepts public funds. This requires them (by law) to offer a payment plan that works for my income level. I'm fine with """paying $1M dollars""" via a monthly bill of $50 or whatever until I die and the rest of the debt evaporates.
- JumpCrisscross 3y ago> requires them (by law) to offer a payment plan that works for my income level Which is a rich-world perk. (That, to be clear, we absolutely should offer our people.) Side note: do you have a link to more on this law? Currently dealing with an uninsured friend for whom we’re pooling resources for a medical treatment.
- kulahan 3y agoCertainly - here's the CFPB's page on it: https://www.consumerfinance.gov/data-research/research-reports/understanding-required-financial-assistance-in-medical-care/ https://www.consumerfinance.gov/data-research/research-repor... Note that this is for lower-income households
- pkaye 3y agoIs your friend in the US? If their income is low enough they would qualify for expanded Medicaid or ACA subsidy.
- wing-_-nuts 3y agoI always wonder if they take assets into account with this?
- elicash 3y agoI wouldn't want to burden my family with the debt. Especially if it might not ultimately work. That said, I appreciate that costs will go down over time--even if only somewhat, if the author is correct.
- xwdv 3y agoIf it doesn’t work you get your money back. The worst case scenario is it works but you die in a car crash anyway.
- RobotToaster 3y agoStand and deliver, your money or your life.
- hprotagonist 3y agoi happen to know that this is the lupin express!
- a-user-you-like 3y agoYeah, best to just not have developed it, or to wait until a more equitable country like Norway develops it. Then it will be fair.
- carlmr 3y agoNorway and Germany aren't that different I'd say.
- throwaway743 3y agoDamn haven't thought of Adam Ant in years. Nice
- screwturner68 3y agoIt's cheaper than cancer, the loss of work and the tens if not hundreds of thousands of dollars spent on treatment, $100K is totally reasonalble.
- hprotagonist 3y agopersonalized medicine of this form is one case where at least for now the cost makes obvious sense. You’re paying like 8 FTE PhDs to hand-build you a therapy from your own body. It’s not even close to automated. but: if it doesn’t work, sometimes you get your money back! (novartis has never had to pay out) https://www.fastcompany.com/40461214/how-novartis-is-defending-the-record-475000-price-of-its-pioneering-gene-therapy-cancer-drug-car-t-kymriah https://www.fastcompany.com/40461214/how-novartis-is-defendi...
- pmarreck 3y agoMaybe there's a possible job in helping them automate this?
- hprotagonist 3y agosafe bet people are working real hard on it; it’s just like, cell cultures are fussy and biology doesn’t care about you, so it’s very much an uphill fight.
- pmarreck 3y agoone dream job of mine would possibly be working on the data side of this though
- deleted 3y ago[deleted]
- hanniabu 3y agoThat won't lower costs, only increase profits
- pmarreck 3y agoThat's bullshit, because it can do both. Increasing the amount that can be made by 10x could both reduce unit costs by 8.5x and increase unit profit by 1.5x. Get outta here with your pessimistic external-locus-of-control communism
- yieldcrv 3y agoI’m glad there are options in development! Let’s hope there are parts of this that can be reduced in cost with scale
- jrussino 3y ago> $100,000/dose I really wish I could see a transparent breakdown of that number. How much of that is the amortized cost of R&D, marketing costs, salaries for the executives and management, etc? How much of it is actual production costs, and what do those look like (raw materials, equipment, labor)? How much of it is profit? What else could be baked into that price? Does anybody here know of any publicly available reports that detail cost breakdowns for pharmaceuticals like this?
- peteradio 3y agoI think you are probably right that this is some sort of Hollywood style accounting.
- chrisamiller 3y agoThat's not far off from the rates for producing custom order medical-grade peptides and/or mRNA vaccines, coupled with the expertise needed to design, administer, and monitor them. It's certainly not a case where they produce it for 100 dollars and sell it for 100k. The market for this stuff is beginning to develop, and I hope that we'll see new innovative companies begin to produce them more cheaply.
- epgui 3y agoThis is absolutely not surprising. When I was doing my MSc, I'd often use up about 5000$ just in single-use plastic consumables in a day. There were zero profit incentives related to my project, it was pure fundamental research. Wet labs are insanely expensive to run.
- ugh123 3y agoDo you think it will be that price forever?
- remote_phone 3y agoFor as long as the biotech company can keep it there
- chrisamiller 3y agoI'm as critical of pharma pricing as the next guy, but this really is a case where you're getting a custom vaccine design just for you, and the profit margins probably aren't very high. I certainly do think it'll come down eventually, but there are lots of factors slowing that down.
- tjpnz 3y agoPresumably even less in countries with socialized medicine where the government buys in bulk.
- jdminhbg 3y agoIn this case it looks like probably not, at least in the short term, because it's all extremely personalized.
- pastor_bob 3y agoPerhaps at some point, a 'generic' neoantigen profile vaccine can be produced that is somewhat effective. How much variance can there be amongst 500,000 cancer patients?
- chrisamiller 3y agoThere is a lot of great work going on thinking about this very problem. One common theory goes like this: There are lots of tumor "driver mutations" that are causative and occur in lots and lots of patients. These would make great targets for a vaccine like this, in theory. But - Tumors have to evade the immune system in order to gain a foothold. (We have all had many cancerous cells that were cleared away without anyone ever knowing!). If a mutation is particularly good at activating the immune system, it's unlikely to survive long enough to cause cancer. So one of the features that a mutation has to have in order to become a driver is that it's bad at being recognized by the immune system! That means the most common mutations that we'd like to target with cheap, mass-produced vaccines may not work very well. There's some evidence on both sides at this point, with lots more data being collected, but it's certainly something that us folks researching the problem are keenly following!
- screwturner68 3y agoThe Hep-B vaccine used to cost $100K and now it's about $4000 (in the US where we get screwed). Honestly a $20K vaccine that would protect me from the big killer cancers would be a check I'd write in a second and I'm not a rich man.
- touisteur 3y agoIsn't hep-b integrated in the penta/hexa-valent doses for kids? (expensive compared to the old boring individual or tetravalent ones, but subsidized in France at least, so I guess French social security has more negociation power than little me? right?).
- chrisamiller 3y agoThis isn't a preventative vaccine like that. It's something that has to be developed after you have cancer to target your tumor's specific mutational profile. So mass production (just churning out the same thing in bulk) isn't really an option! Costs will probably come down eventually, but it's going to take research, technology development, and hard work to make that happen.
- polishdude20 3y agoIs it possible that there is only a relative handful of these profiles and we can have these vaccines already on hand for each of them?
- ben_w 3y agoHuh. I had Twinrix (Hep A+B combo vaccine) at least twice because I'd forgotten I'd had it, and only found out later when I put my medical notes into a spreadsheet. Just had to ask and the NHS did it for free.
- pkaye 3y agoMaybe they meant the Hep-C treatment?
- scarmig 3y agoNapkin math: the typical estimate for the statistical economic value of a human life (in the US) is $1M-$10M. So if each vaccine course can be targeted such that it saves a life with 25% likelihood, it's likely a net positive. Future iterations and new technologies based on it would hopefully drive the cost down further.
- epgui 3y agoIn the US it was on the order of 10M$, not adjusted for inflation, a decade or two ago (source: publicly available DOT documents).
- inglor_cz 3y agoTo be more precise, the rich world can afford to spend money on developing such treatments. It is entirely possible that 30 years from now, the same therapy will cost 1000 USD per dose, with most of the expensive stuff automated away.
- georgeburdell 3y agoVaccine seems like the wrong term as I think of it as preventative. Perhaps there is no precise term for a treatment that uses the immune system to fight an existing disease in the body
- nappingbat 3y agoThere are two types of vaccines: prophylactic (to prevent or ameliorate the effects of a future infection by a pathogen) and therapeutic (to fight a disease that has already occurred, such as cancer).
- stronglikedan 3y ago[flagged]
- nathan_compton 3y agoHardly. One typically receives a rabies vaccine (for example) after infection.
- pmarreck 3y ago[flagged]
- cesnja 3y agoRabies vaccine is also given after infection.
- tiahura 3y agoPerhaps there is no precise term for a treatment that uses the immune system to fight an existing disease in the body Immunotherapy?
- jtlienwis 3y agoYou need to think of the cost of this kind of treatment at this stage as R&D. If it works thousands of people will benefit, have longer lives and contribute back more than the lifesaving treatment will cost.
- yieldcrv 3y agowe can justify having an option for people’s self preservation instincts without having to make up that fairy tale, more elderly humans will probably be a net negative
- UberFly 3y agoPlease explain your "fairy tale" descriptor, I don't understand what your are trying to say here.
- killjoywashere 3y agoI think he’s implying that everyone dies, everyone will ultimately live through some life arc, and letting people survive a fatal illness invariably causes the average age of the population to rise and at some point the costs outweigh the benefits. So what’s the point of a longer arc of life? My personal counterpoint: pancreatic cancers tend to strike anywhere in adulthood, so survival could yet lead to many years of productive life. Also, having grandparents is good, even if they’ve retired. Maybe especially if they’ve retired.
- joshuahedlund 3y agoI think you are all in agreement; I interpreted the above comment as implying the exact opposite - don't make economic arguments that people saved will contribute more, because elderly people may not actually do that, but that doesn't mean it's not worth it on other grounds, precisely as you are doing here.
- peteradio 3y ago
- up2isomorphism 3y agoYeah, every normal US people is paying 10x for the basic medical treatment compared to other developed countries in order to fund this treatment for the super rich.
- dang 3y ago"Eschew flamebait. Avoid generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- jjtheblunt 3y agoBioNTech is German, not US.
- valine 3y agoHow do we get to the point where this therapy doesn’t require a team of scientists to manufacture? Is there a future where every cancer center has a DNA sequencer and mRNA synthesizer?
- malfist 3y agoBy doing research like this. Universities prove it's viable, then companys productionize it, sometimes with incentives from the government
- pixl97 3y agoAlso, how do we get there without effectively creating bioweapons lab capable of immense damage in the wrong hands?
- elric 3y agoGoogling the cost of DNA sequencing suggests that "human genome sequencing cost decreased from $1 million in 2007, to $1000 in 2014". That's pretty amazing.
- voisin 3y agoIt’s been 9.5 years since 2014. Wonder how far down it’s come since then.
- mikeyouse 3y agoThe $1,000 'cost' was the actual lab cost previously, we're now at a point where consumers can buy WGS for under $400, so the equivalent supplies/materials cost must be well below that; https://sequencing.com/products/purchase-kit https://sequencing.com/products/purchase-kit
- gww 3y agoWith the Novaseq X the cost is approximately $200 a genome. One the current challenges is storing the hundreds of gigabytes of data per genome.
- fwungy 3y ago[flagged]
- jjtheblunt 3y agoI'm guessing from your tone that your grandmother wasn't crippled by poliovirus years before the vaccine. mine was. to your probable point, it's a disservice that marketing of vaccine boosters has clearly made vaccines seem tied to corporate profiteering, but there DO exist useful vaccines.
- fwungy 3y agoThe CDC Red Book used to list the chances of a permanent or fatal response to polio as being < 0.5%. They took that out a while ago when people started citing it. Oftentimes you find that a bad outcome to an illness, especially when rare, is associated with an extenuating circumstance. Covid, for example, isn't all that dangerous to young people with healthy BMIs. OTOH it is very dangerous to the elderly with multiple comorbidities, i.e. people who are in danger under any condition and need careful care. Medicines and vaccines can be wonderful and life saving, but speaking as someone who has professionally reviewed trial data, they needed to be treated with great care. The potential for unintended consequences is always high with powerful new medications. Techno philia and corporate greed can often get in the way of good science.
- temptemptemp111 3y ago[dead]
- treeman79 3y agoSo the Covid MRNA vaccine requires many boosters and doesn’t provide protection for long. What are the odds this will be the same?
- Retric 3y agoIn this specific case boosters are likely unnecessary because pancreatic cancer isn’t contagious and if it works all the persons current cancer cells are dead. As to the need for boosters, it’s more a question what benefit a booster provides vs its risks and costs. Frequent measles boosters aren’t recommended in the US in large part because the disease is already rare here. COVID is however still very common which changes the exposure risks part of the equation. This is also why vaccine boosters for measles are recommended when you travel to specific countries. https://wwwnc.cdc.gov/travel/page/travel-vaccines https://wwwnc.cdc.gov/travel/page/travel-vaccines
- peteradio 3y agoCovid MRNA vaccines short lived effect was more to do with the characteristics of the virus and the way our immune systems generally function, IMO.
- ben_w 3y agoI'd be fine with spending €100 per year on each of ten vaccines that each need annual boosting, if that reduced by merely 10% my risks from each of the top ten likely causes of death and QALY reduction at whatever my age is in any given year of my life. This isn't that cheap, not yet at least, but I think "what's the cost?" is a much more important question than "does it need boosters?"
- fsociety999 3y agoI am not entirely sure why you are getting downvoted. It says right in the study > Vaccine-expanded T cells were durable, persisting up to 2 years despite post-vaccination mFOLFIRINOX treatment So yes, that seems to suggest you may have to keep going back every couple years for more boosters.
- remote_phone 3y agoPancreatic cancer terrifies me and keeps me up at night. It has virtually no symptoms until it’s too late. My friends dad was diagnosed with pancreatic cancer and died 6 weeks later. Every time a celebrity dies of cancer I always hope that it’s not pancreatic but the numbers keep increasing. Patrick Swayze, Steve Jobs, Alex Trebek, Aretha Franklin, now Jerry Springer. As someone with type 2 diabetes it’s something I worry about very often.
- gww 3y agoThere are lots of other tumours that are just as deadly as pancreatic adenocarcinoma. Steve Jobs died of a pancreatic neuroendocrine Tumour. It should not be grouped with pancreatic adenocarcinoma. The former is approximately 7-8% of all pancreatic tumors and has a much better prognosis of almost 90% at 5 years if it's caught early. In Jobs case it was. Pancreatic adenocarcinoma has a dismal prognosis of <10% at 5 years. Edit. My Pancreatic cancer knowledge is a bit outdated but I recall type 2 diabetes being a risk factor for pancreatic cancer. I believe in some cases pancreatic cancer can cause diabetes because of the damage it does to the pancreas.
- 01100011 3y agoYep. Ex-wife has neuroendocrine carcinoid tumors in her liver and pancreas, with the main tumor removed from her lung aroun 18-19 years of age. Unless your tumors are functional(i.e. they are neuroendocrine tissue and can secrete hormones) or rapidly growing, it's not a very severe disease and there are treatments available. After 6 years of monitoring by a leading oncologist, she was told she would live a long life and die of something else. That doesn't stop me from needing to pay her huge amounts of money for alimony, but it is what it is. Steve Jobs died because he was an idiot who tried quack therapies.
- cdelsolar 3y agoit's still very rare especially for young people. as someone with a degree of health anxiety, I sympathize, though.
- tombert 3y ago
- rubicon33 3y agoCall me crazy but I am of a firm belief that the cause of almost all cancers is viral in nature. It is a combination of a viral infection and a failure of the innate immune response to stop the virus. I believe we are stopping these viruses all the time in our daily life and it is only when our immune system is under duress (ex: age, smoking, chemical, etc.) that it fails to stop these viruses. I'm not a virologist, or a medical practitioner, just someone who's interested casually in the subject of cancer and viruses.
- biotechbio 3y agoThis is not true. Some cancers are caused by viruses. Many oncogenes were initially discovered in viruses. But the majority of tumors are definitely not caused by viruses. This was a hypothesis in the field for a number of years, and has been disproven. If you want a good overview of the history of cancer, I recommend “The Emperor of All Maladies” by Siddhartha Mukherjee.
- rubicon33 3y agoThanks, I'll check that out. Bought it on Kindle and will give it a read.
- panabee 3y agowhere we agree: * not all cancers are caused by viruses. * only some cancers are caused by viruses. where we disagree: * that science has proven the majority of tumors are definitely not caused by viruses. could you kindly share a few of the studies disproving the majority case? in particular, i'm interested in the sample size and diversity powering these refutations. to clarify, i'm not saying you're wrong. simply seeking to learn more. my research has uncovered misleading conclusions based on studies with flawed methodology/logic. for example, this study [0] states, "epstein-barr virus plays no role in the tumorigenesis of small-cell carcinoma of the lung." based on a sample size of 23. [0] https://pubmed.ncbi.nlm.nih.gov/14752524 https://pubmed.ncbi.nlm.nih.gov/14752524
- chrisamiller 3y ago
- rodoxcasta 3y agoThey focus the immune system on the tumor by teaching it to identify some "neoantigens" in the tumor. Turns out that tumors express various strange proteins in their cell wall, I suppose because of the inherent genetic instability. Anyone know why this can't be a silver bullet for most tumors? Like, a way to target an intrinsic characteristic of cancers that in theory could be very effective on most of them.. sounds too good to be true. So, what's the catch?
- chrisamiller 3y agoIt's true that the whole problem of cancer therapy is "how do I target these cells over here, while avoiding the rest of your healthy cells, when they look mostly the same" And you're right that this is a really exciting and promising approach! A partial list of the "catches" at present are 1) tumors are really good at down-regulating the immune system. If they weren't, they would have been cleared already 2) we're still fairly bad at knowing which of the many mutations in a tumor are going to be good neoantigens - that is, which ones the immune system will be good at recognizing and ramping up against 3) It's expensive to design personalized therapies for every patient, but may be necessary (see some of my other comments below) 4) Tumors aren't single cells, they're collections of them that can have different characteristics. Just like with other therapies, sometimes immunotherapies kill 99% of the tumor, but leave that 1% to come roaring back. (same idea as antibiotic resistance) So yeah, lots of hurdles to overcome, but overall, I'm genuinely excited about the rapid progress we're making in the area of immunotherapies. It's impossible to overstate the effect that sustained research funding has had on the rate of advances in this field.
- bglazer 3y agoThere are various strategies that cancer cells can use to evade the immune system. They can simply stop expressing the neoantigen. Also tumor cells can express proteins that suppress immune cells. The genetic instability works both ways, the weird neoantigens sometimes get expressed but theres so much heterogeneity in some tumors that the immune resistant cells can get selected for very quickly.
- Maursault 3y agoClumsy headline. It's a vaccine that inoculates against pancreatic cancer. It wouldn't inoculate against the treatment for pancreatic cancer, because why would anyone want to develop a vaccine that prevents a cancer treatment from working? Headline vaguely reminds me of Brain Candy, 1996.[1] [1] https://www.youtube.com/watch?v=xAn-mdS-otE&t=0m15s https://www.youtube.com/watch?v=xAn-mdS-otE&t=0m15s
- jrjarrett 3y agoI love that this is advancing treatment; I was somewhat disappointed that apparently, you must HAVE cancer first in order to create the vaccine. If there was a vaccine that prevented this before it happened, I would be in line.