4 ms·

We need to see a much faster ramp in the pace of innovation in this space. We’re eeking out tiny wins over decades, like Rituximab and this agent. Feels like th

We need to see a much faster ramp in the pace of innovation in this space. We’re eeking out tiny wins over decades, like Rituximab and this agent. Feels like there’s an ossification of this entire sector that happened years ago and there’s no sense of urgency - just businesses as usual with the occasional modest win to show. 80 years since chemo was discovered, our most successful treatment across the board continues to be poison that kills fast growing cells faster than it kills the host. We are oncological troglodytes.

echelon 3y ago
Molecular solutions are punch card science. I really want to do whole-body clonal work. Our bodies and genes are machines, yet we still haven't put them to work. We're plastering over the breaks with crude tools that feel like modern day bloodletting. The blast radius in the transduction pathways is huge and imprecise. I've written extensively about this topic on HN. Give me a minute and I'll dig up some references. Edit: https://news.ycombinator.com/item?id=35321368 https://news.ycombinator.com/item?id=35321368 https://news.ycombinator.com/item?id=32379247 https://news.ycombinator.com/item?id=32379247 https://news.ycombinator.com/item?id=30407908 https://news.ycombinator.com/item?id=30407908
- slibhb 3y ago
  We're nowhere near "head transplants" or "creating braindead clones" (not to mention keeping them alive and healthy for decades). This is science fiction. Actual cancer treatments are moving forward at a good pace. Immunotherapies are a good example. Cancer treatment is an example of medical research working well.
  - Apocryphon 3y ago
    Yeah, if we're going to talk sci-fi, at least nanomachines are much less ghoulish than the implications of legalized human cloning.
  - deleted 3y ago
    [deleted]
- Ralfp 3y ago
  This is not only a morally ambiguous sci-fi, it also skips on issue that we have no 100% proof way to make sure the blood used in the procedures you proposed will not contain cancer cells that will then invade the transplanted organ. Not to mention issue of patient being weakened by, say, organ failure, to even survive such procedure.
  - jart 3y ago
    echelon is proposing head or body transplants. It's not sci-fi because doctors have been able to do it with limited success since 1970. Yes it will cure cancer, assuming the tumors haven't spread to your brain. No, cancer is not HIV it is not contagious in the way that you think. https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/is-cancer-contagious.html https://www.cancer.org/cancer/risk-prevention/understanding-...
- CyberDildonics 3y ago
  Your comments are basically "what if we had clones guys, why has no one thought of this?" You didn't "write extensively", you put science fiction plots ideas that have already been done a dozen times into comments. I'm going to go out on a limb and say that execution might be a bigger factor than ideas here.
  - echelon 3y ago
    You're my biggest repeat critic on HN, CyberDildonics. I originally posted a follow-up message, but I revealed to much of the path gradient to build this and so I deleted it. There are so many low-hanging fruit markets, but I have to hold my tongue. It needs the right leadership and angle of attack. I bet my reputation that none of this is science fiction, though, and I can't wait to prove you wrong about everything you doubt me on. Give me ten years on this one. I'll show you. The Hollywood thread you keep doubting me on is going to be extremely obvious in about six months. I really want to see you eat your hat on that one. I'm sleeping on the floor every night to make it happen, and we're getting there.
    - CyberDildonics 3y ago
      Are you now claiming that you know how to clone and grow people for spare organs?
      - echelon 3y ago
        I've cloned and modified genes in eukaryotes. I think I know where to get started.
        CyberDildonics 3y ago
        That's something people have been able to do for decades. How are you planning on growing a headless clone of a person for spare organs?
        ceejayoz 3y ago
        I mean, by that standard, I know how to perform a heart transplant, because I can use a scalpel.
bglazer 3y ago
There are a ton of challenges to better oncology treatments. First, as many have noted, cancer is a constellation of diseases. Often a single tumor will contain multiple different, but related groups of cells. So most treatments will only work for a subset of cancers, and then only until the cancer evolves to be resistant. So any advance, will be necessarily “modest”, the reality of the situation is that there will never be a silver bullet. The closest we’ve come is immunotherapies, the class of treatment described in the article. These are a legitimately incredible advance, completely curing many people without the side effects of chemo. That said, theyre limited because cancer can evolve to defeat the immune response, and occasionally the immune system either under or over-reacts. Also if you think there’s no sense of urgency, you haven’t talked to anyone actually in the field. Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients?
- s1artibartfast 3y ago
  Plus there is the existing financial incentive. If an individual or company comes up with a revolutionary treatment, it would be an absolute money printer. Even historic improvements for large demographics have massive returns. Keytruda (major oncology improvement) had more than $20 billion sales in 2023. It is hard to think of a stronger market incentive to improve drugs as much as possible.
- mmaunder 3y ago
  > Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients? Don’t be bloody ridiculous.
  - bglazer 3y ago
    > Feels like there’s an ossification of this entire sector that happened years ago and there’s no sense of urgency Ok, can you explain what you meant by this?
DrScientist 3y ago
While I agree there wasn't much progress for years - actually now is quite an exciting time in cancer - new effective treatments are coming on stream all the time, with many more in the works - not to mention much better diagnostic tools.
refurb 3y ago
As someone in the industry you're 100% wrong. These aren't "tiny wins". These are massive advancements in cancer treatment. And they're happening every decade or so, and added together is drastically changing outcomes. This is one study. "Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population." https://jamanetwork.com/journals/jama/fullarticle/2598772 https://jamanetwork.com/journals/jama/fullarticle/2598772
- andrenotgiant 3y ago
  This has been my experience firsthand in the system too. Childhood cancer (mostly Leukemia) treatment in the USA is a well-organized country-wide clinical study aimed, at this point, at carefully reducing the amount of high-intensity chemo via replacing it with drugs like the one in the article, Blina. They have gotten so good at treating Leukemia that they are now optimizing for reducing the long-term negative health impacts that come as a result of the treatment. There are still tragic cases where the patients systems don't respond well, or there are complications as a result of compromised immune systems, but everything I have experienced points to major advancements and continued progress towards improving outcomes.
im3w1l 3y ago
My pet idea is that rather than targetting cancer, we should be trying to find and correct DNA-errors before they become cancerous. Otherwise we are just playing whack-a-mole with a slowly degenerating cell population.
- adamredwoods 3y ago
  Most cells that divide will eventually have DNA errors over time, but will not always become cancerous. If we could find and repair DNA errors in normal cells, we could do it in cancerous cells as well. I don't think there's much of a difference.
dennis_jeeves2 3y ago
>We’re eeking out tiny wins over decades, I glean from many non-main stream sources (who are generally labeled quacks or naysayers, I have lost track of sources) : - There have been almost no improvements in cancer treatments especially chemotherapy for _several_decades. Some sleight of hand involving some statistics and the fact that cancer can now be diagnosed in an at an earlier stage, means that the survival rate that is calculated by the survival of people Beyond 5 years of the first diagnosis, is higher. - The primary approach to treating cancer (especially with chemotherapy and radiation) appears flawed. Cancer is a systemic disease so even if you destroy the tumor, you will have more of those propping up, because the body is already predisposed to creating them. - It's a money making scam ( just like any other industry) that thrives in keeping a patient as sick as possible for as long as possible -A lot of naive, but well intention people fall for the above three points mentioned. Of course any attempt to even mention that people could be wrong would be retaliated with: you don't-care-for-people-dying response. Heroics generally trumps common sense

echelon 3y ago

Molecular solutions are punch card science. I really want to do whole-body clonal work. Our bodies and genes are machines, yet we still haven't put them to work. We're plastering over the breaks with crude tools that feel like modern day bloodletting. The blast radius in the transduction pathways is huge and imprecise. I've written extensively about this topic on HN. Give me a minute and I'll dig up some references. Edit: https://news.ycombinator.com/item?id=35321368 https://news.ycombinator.com/item?id=35321368 https://news.ycombinator.com/item?id=32379247 https://news.ycombinator.com/item?id=32379247 https://news.ycombinator.com/item?id=30407908 https://news.ycombinator.com/item?id=30407908

slibhb 3y ago
We're nowhere near "head transplants" or "creating braindead clones" (not to mention keeping them alive and healthy for decades). This is science fiction. Actual cancer treatments are moving forward at a good pace. Immunotherapies are a good example. Cancer treatment is an example of medical research working well.
- Apocryphon 3y ago
  Yeah, if we're going to talk sci-fi, at least nanomachines are much less ghoulish than the implications of legalized human cloning.
- deleted 3y ago
  [deleted]
Ralfp 3y ago
This is not only a morally ambiguous sci-fi, it also skips on issue that we have no 100% proof way to make sure the blood used in the procedures you proposed will not contain cancer cells that will then invade the transplanted organ. Not to mention issue of patient being weakened by, say, organ failure, to even survive such procedure.
- jart 3y ago
  echelon is proposing head or body transplants. It's not sci-fi because doctors have been able to do it with limited success since 1970. Yes it will cure cancer, assuming the tumors haven't spread to your brain. No, cancer is not HIV it is not contagious in the way that you think. https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/is-cancer-contagious.html https://www.cancer.org/cancer/risk-prevention/understanding-...
CyberDildonics 3y ago
Your comments are basically "what if we had clones guys, why has no one thought of this?" You didn't "write extensively", you put science fiction plots ideas that have already been done a dozen times into comments. I'm going to go out on a limb and say that execution might be a bigger factor than ideas here.
- echelon 3y ago
  You're my biggest repeat critic on HN, CyberDildonics. I originally posted a follow-up message, but I revealed to much of the path gradient to build this and so I deleted it. There are so many low-hanging fruit markets, but I have to hold my tongue. It needs the right leadership and angle of attack. I bet my reputation that none of this is science fiction, though, and I can't wait to prove you wrong about everything you doubt me on. Give me ten years on this one. I'll show you. The Hollywood thread you keep doubting me on is going to be extremely obvious in about six months. I really want to see you eat your hat on that one. I'm sleeping on the floor every night to make it happen, and we're getting there.
  - CyberDildonics 3y ago
    Are you now claiming that you know how to clone and grow people for spare organs?
    - echelon 3y ago
      I've cloned and modified genes in eukaryotes. I think I know where to get started.
      - CyberDildonics 3y ago
        That's something people have been able to do for decades. How are you planning on growing a headless clone of a person for spare organs?
      - ceejayoz 3y ago
        I mean, by that standard, I know how to perform a heart transplant, because I can use a scalpel.

bglazer 3y ago

There are a ton of challenges to better oncology treatments. First, as many have noted, cancer is a constellation of diseases. Often a single tumor will contain multiple different, but related groups of cells. So most treatments will only work for a subset of cancers, and then only until the cancer evolves to be resistant. So any advance, will be necessarily “modest”, the reality of the situation is that there will never be a silver bullet. The closest we’ve come is immunotherapies, the class of treatment described in the article. These are a legitimately incredible advance, completely curing many people without the side effects of chemo. That said, theyre limited because cancer can evolve to defeat the immune response, and occasionally the immune system either under or over-reacts. Also if you think there’s no sense of urgency, you haven’t talked to anyone actually in the field. Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients?

s1artibartfast 3y ago
Plus there is the existing financial incentive. If an individual or company comes up with a revolutionary treatment, it would be an absolute money printer. Even historic improvements for large demographics have massive returns. Keytruda (major oncology improvement) had more than $20 billion sales in 2023. It is hard to think of a stronger market incentive to improve drugs as much as possible.
mmaunder 3y ago
> Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients? Don’t be bloody ridiculous.
- bglazer 3y ago
  > Feels like there’s an ossification of this entire sector that happened years ago and there’s no sense of urgency Ok, can you explain what you meant by this?

DrScientist 3y ago

While I agree there wasn't much progress for years - actually now is quite an exciting time in cancer - new effective treatments are coming on stream all the time, with many more in the works - not to mention much better diagnostic tools.

refurb 3y ago

As someone in the industry you're 100% wrong. These aren't "tiny wins". These are massive advancements in cancer treatment. And they're happening every decade or so, and added together is drastically changing outcomes. This is one study. "Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population." https://jamanetwork.com/journals/jama/fullarticle/2598772 https://jamanetwork.com/journals/jama/fullarticle/2598772

andrenotgiant 3y ago
This has been my experience firsthand in the system too. Childhood cancer (mostly Leukemia) treatment in the USA is a well-organized country-wide clinical study aimed, at this point, at carefully reducing the amount of high-intensity chemo via replacing it with drugs like the one in the article, Blina. They have gotten so good at treating Leukemia that they are now optimizing for reducing the long-term negative health impacts that come as a result of the treatment. There are still tragic cases where the patients systems don't respond well, or there are complications as a result of compromised immune systems, but everything I have experienced points to major advancements and continued progress towards improving outcomes.

im3w1l 3y ago

My pet idea is that rather than targetting cancer, we should be trying to find and correct DNA-errors before they become cancerous. Otherwise we are just playing whack-a-mole with a slowly degenerating cell population.

adamredwoods 3y ago
Most cells that divide will eventually have DNA errors over time, but will not always become cancerous. If we could find and repair DNA errors in normal cells, we could do it in cancerous cells as well. I don't think there's much of a difference.

dennis_jeeves2 3y ago

>We’re eeking out tiny wins over decades, I glean from many non-main stream sources (who are generally labeled quacks or naysayers, I have lost track of sources) : - There have been almost no improvements in cancer treatments especially chemotherapy for _several_decades. Some sleight of hand involving some statistics and the fact that cancer can now be diagnosed in an at an earlier stage, means that the survival rate that is calculated by the survival of people Beyond 5 years of the first diagnosis, is higher. - The primary approach to treating cancer (especially with chemotherapy and radiation) appears flawed. Cancer is a systemic disease so even if you destroy the tumor, you will have more of those propping up, because the body is already predisposed to creating them. - It's a money making scam ( just like any other industry) that thrives in keeping a patient as sick as possible for as long as possible -A lot of naive, but well intention people fall for the above three points mentioned. Of course any attempt to even mention that people could be wrong would be retaliated with: you don't-care-for-people-dying response. Heroics generally trumps common sense