9 ms·

Woman who had pioneering cancer treatment 18 years ago still in remission

192 points by ranit 2y ago

adamredwoods 2y ago
Recruiting immune cells for cancer intervention is the future, but it will still take a while to get there. >> Over seven years that followed the therapy, 12 patients died due to relapsed neuroblastoma. Among the seven that survived beyond this point, five were cancer-free when given the CAR T-cell therapy but had previously been treated for neuroblastoma using other approaches and were at high risk of relapse. All five were disease-free at their last follow-up, between 10 and 15 years after the CAR T-cell therapy, although the team note they may already have been cured when the therapy was administered.
- jandrese 2y ago
  The problem is that cancer is your own cells, so immunotherapy solutions are always going to be balanced on a knife point. If you make the tiniest mistake it is Lupus.
  - lr4444lr 2y ago
    Wouldn't that likely have a better prognosis than most cancers?
    - meowfly 2y ago
      A family member of mine is going through keynote 522, which is a clinical trial that combines 3 chemos and an immunotherapy prior to surgery. The five year survival rate for stage 3 triple negative breast cancer is normally about ~60% but the clinical trials show with immunotherapy it exceeds 80%. So the survival rates you see online aren't capturing the progress we are making with these drugs. Hashimotos seems worth the risk. An interesting aside is that the patients in the clinical trials who had adverse reactions to immunotherapy and came off the medication had higher survival rates than patients who stayed on it. The hypothesis is that stimulating an immune system overreaction also means it was also highly effective against the cancer.
      - adamredwoods 2y ago
        Interesting theory, but not in my experience. My wife died of MBC and she had lots of reactions. Anecdotally, the pembro + chemo may have given her an extra year, she did well on it.
    - jandrese 2y ago
      Lupus is not generally associated with "good prognosis".
  - mbil 2y ago
    I wonder if they could do two phases. Like first engineer T cells that mark the target cell but don’t kill it. And then, if the marked cells are sufficiently scoped to cancer cells, use the same targeting mechanism for cancer-destroying T cells.
    - adamredwoods 2y ago
      Marking them is the challenge. Cells have expressions that we can engineer chemicals to bind with, but sometimes the cancer cells have no expression (Triple negative breast cancer for one). It just mutates and divides faster. This is why chemo works well, it is uptaken by cells that divide faster, like cancer, and hair, mouth cells, etc. But chemo is general, it doesn't specialize. So thus, the new chemo called ADCs (anti-body drug conjugates), are really nice. They target AREAS and release generally.
melling 2y ago
A doctor in Australia has been cancer free for almost 2 years after treating his brain cancer with Car-T therapy https://www.bbc.com/news/world-australia-69006713 https://www.bbc.com/news/world-australia-69006713
- apwell23 2y ago
  Every therapy works for someone spectacularly. This has been the case forever. It doesn't really prove anything/ main challenge is figuring out why it worked for this particular person when it fails for most. Cancer treatment has always been primitive throw shit at the wall and see what sticks. Still the case today.
  - dennis_jeeves2 2y ago
    You are partially correct. But here a broader picture - you may have to get in touch with the person(s) who is claiming the cure to draw a conclusion. Sometimes they may have done multiple trials within their own circle, or if it's a physician on his patients. They generally will have documented their patients. They generally will not have the means to do large scale trials. (I heard that it cost about 10 million, and about 10 years to get an FDA approval). When a unknown/non credentialed practitioners or a physician claim something it is generally ignored - as far as I'm concerned the cancer treatment cartel industry is real (As with almost every other industry), if by the rare chance it does get some publicity (as it happened with the Linus Pauling, Nicholas Gonzales), the cartel indulges in accusations of quackery and character assassination. Now I'm not saying that the small time practitioners are always correct, in fact they are mostly wrong. But they deserve some investigation.
  - cjbgkagh 2y ago
    If the therapy had not worked would that be evidence that the therapy is not effective? If so the fact that it did work must be at least some evidence that the therapy is effective. Simple Bayes factor, you can't have one without the other. Additionally, if there is enough similar cancers we can know the rate of spontaneous remission within a particular band of time. This would be much lower than spontaneous remission at any time so that a spontaneous remission at the specific time of treatment could be a rather unlikely event and start to look like decent evidence. Not disagreeing that cancer treatment isn't a shit show but I would suggest that such evidence cannot be easily dismissed due to the lack of the gold standard large scale double blind study.
ackbar03 2y ago
Problem with CAR-T is still too expensive to use... people should be investing a lot more in early stage drug discovery biotechs! A lot more!!! (I'm doing an early stage drug discovery biotech)
- Teever 2y ago
  Why is that a better course of action than investing resources in making the existing and effective treatment more affordable? From what I've heard the bottleneck for CAR-T is the lack of technicians who can do the work and automation it make more effective use of the technicians and their time. It seems like there is a clear path to decreasing the cost of this.
  - DennisP 2y ago
    Why not both? It's not like those are the only two things in the world. Maybe they're both way more useful than a thousand other ways we spend our money.
- fredophile 2y ago
  There are companies pursuing CAR-T for veterinary treatments that are driving the costs down. One example I'm aware of is LEAH Labs (https://leahlabs.com https://leahlabs.com) that is working on using CAR-T to make affordable cancer treatments in dogs. Full Disclosure: I am an investor in LEAH Labs.
- iancmceachern 2y ago
  The problem is Erooms law. Yes we need to invest more, but we also need to figure out why we're getting worse at doing it year over year. My hypothesis, many others, is that the models are flawed. We need better, more fluid models.
mattkrause 2y ago
If you like stuff like this (i.e., beating cancer), badger your reps to get the NIH back up and running! This particular work came out of at least 3 NIH grants and indirectly relies on a whole lot more.
- n4r9 2y ago
  Could be problematic; cancer research relies on a diverse sample set.
  - mattkrause 2y ago
    Ha! I'm afraid to admit how much thought I've put into avoiding words that overlap with the "naughty list", like (statistical) bias and (electrical) polarization. A dead comment says this is all a myth but from somebody in the trenches...it's not. No access to the Federal Register means no meetings to evaluate grants, which means no more grants going out at all.
    - caycep 2y ago
      future of oncological meds might come from PRC institutions, maybe EU; US pipeline will likely dry up
      - firecall 2y ago
        Australian research has also made some excellent contributions!
- monero-xmr 2y ago
  [flagged]
- vkou 2y ago
  My reps can't do anything and the ones that can will laugh at anyone who calls them with such a request.
  - 2y ago
Workaccount2 2y ago
Can someone explain "remission" to me? Perhaps I am missing something because to me, going 18 years without cancer after having cancer and going through treatment is...expected? Does canceer treatment not actually get rid of the cancer or something like that?
- teddyh 2y ago
  Relevant xkcd: <https://xkcd.com/931/ https://xkcd.com/931/>
  - DennisP 2y ago
    I know that's generally true, but apparently sometimes the odds of recurrence are so low they stop worrying about it. I have a relative who was diagnosed with stage 4 melanoma a decade ago. She got three doses of immunotherapy and her tumors immediately shrank by 2/3, and eventually disappeared entirely. For a while they kept scanning her twice a year, but several years ago they told her it was gone and stopped the scans.
    - Out_of_Characte 2y ago
      That's great to hear but, your risk of cancer before diagnosis and after you're cured is, at best, the same.
      - DennisP 2y ago
        Yes of course, even if all her cancer cells have been destroyed, she could still get an entirely new cancer, just like anyone else. She hasn't attained some kind of immunity.
- apwell23 2y ago
  you really have no way to know if cancer has been "gotten rid of". Presumably thing that went wrong in your body and gave you cancer is still wrong. remission = we can't see anything in this scan. you cannot assume scan can 'see' all cancer, there is no such scan. Its no different than taking a pill for high cholesterol you are not cured of the disease .
lancercane 2y ago
I’ve been exposing myself to similar, vaccine induced T cell production to fight cancer, research recently due to a family member recently going through it with pancreatic cancer. https://www.mskcc.org/news/can-mrna-vaccines-fight-pancreatic-cancer-msk-clinical-researchers-are-trying-find-out https://www.mskcc.org/news/can-mrna-vaccines-fight-pancreati... My family member was ineligible for the trial due to requiring chemo before surgery due to ca19-9 markers being above the limit for surgery eligibility. Here are some of my observations as someone forced to the outside: I read the 2017 and phase i papers. They are both very mathy and talk more about the life spans of their induced T cells than their patients. Looks like phase i was 19 patients (16 given the vaccine), 2 recurred, one died, they seem to want to blame the patients’ immune system. The study is: surgery, vaccine, then 12 cycles of chemo regiment, then vaccine booster. I was frustrated to see a lack of any search results for “diet”, “nutrition”, “sugar”, “glutamine”, in either paper. I think the mathy science is cool, and a necessary component, but focusing on pharmaceutical solutions and calculating their efficacy based on if their intended biological reaction occurred, seemingly oblivious of, or defiantly ignoring, lifestyle change appears misguided. Diet and exercise is insufficient on its own, but due to the vast differences in individual diets, studies like these should include lifestyle requirements as a control. Especially if they are going to point at a patients immune system. Diet effects on both immune system function and specifically targeting cancers is uncontroversial and scientifically supported. Why are these two research efforts so siloed from each other?!
- goda90 2y ago
  I think some people try to distance themselves from the diet and exercise parts because of how easy it is to sell quackery in that area. "Take this supplement to cure cancer", "Read my book about the exact diet to cure your cancer!", etc. We'll probably start seeing more and more mixing of traditional or cutting edge treatments like chemo, radiation, and immunotherapy with having the right lifestyle choices to have a stronger immune system. There is research being done, even if limited. Another interesting thing I'd like to see more research done on is metabolic therapy. Not just having a diet to boost the immune system, but targeting the metabolism of cancer cells. The Warburg effect[0] means a lot of cancer depends on glucose and glutamine for energy. Some researchers have tried using a ketogenic diet to reduce glucose, since normal cells can survive without it, plus using drugs to temporarily drop glutamine levels with the hope that the cancer cells starve first. [0]https://en.wikipedia.org/wiki/Warburg_effect_(oncology) https://en.wikipedia.org/wiki/Warburg_effect_(oncology)
m3kw9 2y ago
Must be way way more complicated than just find the cancer protein, make a special cell and inject
- chromatin 2y ago
  "Cancer protein"s are rarely restricted to the neoplastic clone
bufferoverflow 2y ago
People go into cancer remission without any treatment. Single point isn't data, not proof of anything.
- melling 2y ago
  What percentage of people go into remission without treatment?
  - bluGill 2y ago
    Something > 0, which is all we need to know about single point data sources.
- rozap 2y ago
  Yes, clean food diets and meditation are famously very effective against cancer. I've heard eliminating seed oils is a magic bullet.
vonneumannstan 2y ago
Bro didn't you know you can inject Ivermectin directly into your balls and it cures your cancer? Duh.
wonderwonder 2y ago
I have zero medical experience so take this question as it is in good faith. Assuming the process to do this was known, how difficult would it be for a reasonably intelligent person to implement this procedure on their own
- throwaway_acgt 2y ago
  Basically impossible. There's too much specialized knowledge and equipment that go into it.
cbracketdash 2y ago
> "All five were disease-free at their last follow-up, between 10 and 15 years after the CAR T-cell therapy, although the team note they may already have been cured when the therapy was administered." > "The other two surviving patients had cancer that was actively growing or spreading when they received CAR T-cell therapy, but subsequently went into complete remission. One of these patients stopped participating in follow-up sessions eight years after treatment, but the other continued and has remained cancer-free more than 18 years." Based on these statements, the evidence for this treatment is anecdotal at best. Only 2/27 patients lived longer than 7 years. (There are probably more advancements in the last 10-15 years that have increased efficacy)
- mlyle 2y ago
  Getting this many survivors by chance of either group would be unlikely. Patients who have exhausted brain tumor treatments and have continuing growth have expected lifespans of months.

192 points by ranit 2y ago

Recruiting immune cells for cancer intervention is the future, but it will still take a while to get there. >> Over seven years that followed the therapy, 12 patients died due to relapsed neuroblastoma. Among the seven that survived beyond this point, five were cancer-free when given the CAR T-cell therapy but had previously been treated for neuroblastoma using other approaches and were at high risk of relapse. All five were disease-free at their last follow-up, between 10 and 15 years after the CAR T-cell therapy, although the team note they may already have been cured when the therapy was administered.

jandrese 2y ago
The problem is that cancer is your own cells, so immunotherapy solutions are always going to be balanced on a knife point. If you make the tiniest mistake it is Lupus.
- lr4444lr 2y ago
  Wouldn't that likely have a better prognosis than most cancers?
  - meowfly 2y ago
    A family member of mine is going through keynote 522, which is a clinical trial that combines 3 chemos and an immunotherapy prior to surgery. The five year survival rate for stage 3 triple negative breast cancer is normally about ~60% but the clinical trials show with immunotherapy it exceeds 80%. So the survival rates you see online aren't capturing the progress we are making with these drugs. Hashimotos seems worth the risk. An interesting aside is that the patients in the clinical trials who had adverse reactions to immunotherapy and came off the medication had higher survival rates than patients who stayed on it. The hypothesis is that stimulating an immune system overreaction also means it was also highly effective against the cancer.
    - adamredwoods 2y ago
      Interesting theory, but not in my experience. My wife died of MBC and she had lots of reactions. Anecdotally, the pembro + chemo may have given her an extra year, she did well on it.
  - jandrese 2y ago
    Lupus is not generally associated with "good prognosis".
- mbil 2y ago
  I wonder if they could do two phases. Like first engineer T cells that mark the target cell but don’t kill it. And then, if the marked cells are sufficiently scoped to cancer cells, use the same targeting mechanism for cancer-destroying T cells.
  - adamredwoods 2y ago
    Marking them is the challenge. Cells have expressions that we can engineer chemicals to bind with, but sometimes the cancer cells have no expression (Triple negative breast cancer for one). It just mutates and divides faster. This is why chemo works well, it is uptaken by cells that divide faster, like cancer, and hair, mouth cells, etc. But chemo is general, it doesn't specialize. So thus, the new chemo called ADCs (anti-body drug conjugates), are really nice. They target AREAS and release generally.

melling 2y ago

A doctor in Australia has been cancer free for almost 2 years after treating his brain cancer with Car-T therapy https://www.bbc.com/news/world-australia-69006713 https://www.bbc.com/news/world-australia-69006713

apwell23 2y ago
Every therapy works for someone spectacularly. This has been the case forever. It doesn't really prove anything/ main challenge is figuring out why it worked for this particular person when it fails for most. Cancer treatment has always been primitive throw shit at the wall and see what sticks. Still the case today.
- dennis_jeeves2 2y ago
  You are partially correct. But here a broader picture - you may have to get in touch with the person(s) who is claiming the cure to draw a conclusion. Sometimes they may have done multiple trials within their own circle, or if it's a physician on his patients. They generally will have documented their patients. They generally will not have the means to do large scale trials. (I heard that it cost about 10 million, and about 10 years to get an FDA approval). When a unknown/non credentialed practitioners or a physician claim something it is generally ignored - as far as I'm concerned the cancer treatment cartel industry is real (As with almost every other industry), if by the rare chance it does get some publicity (as it happened with the Linus Pauling, Nicholas Gonzales), the cartel indulges in accusations of quackery and character assassination. Now I'm not saying that the small time practitioners are always correct, in fact they are mostly wrong. But they deserve some investigation.
- cjbgkagh 2y ago
  If the therapy had not worked would that be evidence that the therapy is not effective? If so the fact that it did work must be at least some evidence that the therapy is effective. Simple Bayes factor, you can't have one without the other. Additionally, if there is enough similar cancers we can know the rate of spontaneous remission within a particular band of time. This would be much lower than spontaneous remission at any time so that a spontaneous remission at the specific time of treatment could be a rather unlikely event and start to look like decent evidence. Not disagreeing that cancer treatment isn't a shit show but I would suggest that such evidence cannot be easily dismissed due to the lack of the gold standard large scale double blind study.

ackbar03 2y ago

Problem with CAR-T is still too expensive to use... people should be investing a lot more in early stage drug discovery biotechs! A lot more!!! (I'm doing an early stage drug discovery biotech)

Teever 2y ago
Why is that a better course of action than investing resources in making the existing and effective treatment more affordable? From what I've heard the bottleneck for CAR-T is the lack of technicians who can do the work and automation it make more effective use of the technicians and their time. It seems like there is a clear path to decreasing the cost of this.
- DennisP 2y ago
  Why not both? It's not like those are the only two things in the world. Maybe they're both way more useful than a thousand other ways we spend our money.
fredophile 2y ago
There are companies pursuing CAR-T for veterinary treatments that are driving the costs down. One example I'm aware of is LEAH Labs (https://leahlabs.com https://leahlabs.com) that is working on using CAR-T to make affordable cancer treatments in dogs. Full Disclosure: I am an investor in LEAH Labs.
iancmceachern 2y ago
The problem is Erooms law. Yes we need to invest more, but we also need to figure out why we're getting worse at doing it year over year. My hypothesis, many others, is that the models are flawed. We need better, more fluid models.

mattkrause 2y ago

If you like stuff like this (i.e., beating cancer), badger your reps to get the NIH back up and running! This particular work came out of at least 3 NIH grants and indirectly relies on a whole lot more.

n4r9 2y ago
Could be problematic; cancer research relies on a diverse sample set.
- mattkrause 2y ago
  Ha! I'm afraid to admit how much thought I've put into avoiding words that overlap with the "naughty list", like (statistical) bias and (electrical) polarization. A dead comment says this is all a myth but from somebody in the trenches...it's not. No access to the Federal Register means no meetings to evaluate grants, which means no more grants going out at all.
  - caycep 2y ago
    future of oncological meds might come from PRC institutions, maybe EU; US pipeline will likely dry up
    - firecall 2y ago
      Australian research has also made some excellent contributions!
monero-xmr 2y ago
[flagged]
vkou 2y ago
My reps can't do anything and the ones that can will laugh at anyone who calls them with such a request.
- 2y ago

Workaccount2 2y ago

Can someone explain "remission" to me? Perhaps I am missing something because to me, going 18 years without cancer after having cancer and going through treatment is...expected? Does canceer treatment not actually get rid of the cancer or something like that?

teddyh 2y ago
Relevant xkcd: <https://xkcd.com/931/ https://xkcd.com/931/>
- DennisP 2y ago
  I know that's generally true, but apparently sometimes the odds of recurrence are so low they stop worrying about it. I have a relative who was diagnosed with stage 4 melanoma a decade ago. She got three doses of immunotherapy and her tumors immediately shrank by 2/3, and eventually disappeared entirely. For a while they kept scanning her twice a year, but several years ago they told her it was gone and stopped the scans.
  - Out_of_Characte 2y ago
    That's great to hear but, your risk of cancer before diagnosis and after you're cured is, at best, the same.
    - DennisP 2y ago
      Yes of course, even if all her cancer cells have been destroyed, she could still get an entirely new cancer, just like anyone else. She hasn't attained some kind of immunity.
apwell23 2y ago
you really have no way to know if cancer has been "gotten rid of". Presumably thing that went wrong in your body and gave you cancer is still wrong. remission = we can't see anything in this scan. you cannot assume scan can 'see' all cancer, there is no such scan. Its no different than taking a pill for high cholesterol you are not cured of the disease .

lancercane 2y ago

I’ve been exposing myself to similar, vaccine induced T cell production to fight cancer, research recently due to a family member recently going through it with pancreatic cancer. https://www.mskcc.org/news/can-mrna-vaccines-fight-pancreatic-cancer-msk-clinical-researchers-are-trying-find-out https://www.mskcc.org/news/can-mrna-vaccines-fight-pancreati... My family member was ineligible for the trial due to requiring chemo before surgery due to ca19-9 markers being above the limit for surgery eligibility. Here are some of my observations as someone forced to the outside: I read the 2017 and phase i papers. They are both very mathy and talk more about the life spans of their induced T cells than their patients. Looks like phase i was 19 patients (16 given the vaccine), 2 recurred, one died, they seem to want to blame the patients’ immune system. The study is: surgery, vaccine, then 12 cycles of chemo regiment, then vaccine booster. I was frustrated to see a lack of any search results for “diet”, “nutrition”, “sugar”, “glutamine”, in either paper. I think the mathy science is cool, and a necessary component, but focusing on pharmaceutical solutions and calculating their efficacy based on if their intended biological reaction occurred, seemingly oblivious of, or defiantly ignoring, lifestyle change appears misguided. Diet and exercise is insufficient on its own, but due to the vast differences in individual diets, studies like these should include lifestyle requirements as a control. Especially if they are going to point at a patients immune system. Diet effects on both immune system function and specifically targeting cancers is uncontroversial and scientifically supported. Why are these two research efforts so siloed from each other?!

goda90 2y ago
I think some people try to distance themselves from the diet and exercise parts because of how easy it is to sell quackery in that area. "Take this supplement to cure cancer", "Read my book about the exact diet to cure your cancer!", etc. We'll probably start seeing more and more mixing of traditional or cutting edge treatments like chemo, radiation, and immunotherapy with having the right lifestyle choices to have a stronger immune system. There is research being done, even if limited. Another interesting thing I'd like to see more research done on is metabolic therapy. Not just having a diet to boost the immune system, but targeting the metabolism of cancer cells. The Warburg effect[0] means a lot of cancer depends on glucose and glutamine for energy. Some researchers have tried using a ketogenic diet to reduce glucose, since normal cells can survive without it, plus using drugs to temporarily drop glutamine levels with the hope that the cancer cells starve first. [0]https://en.wikipedia.org/wiki/Warburg_effect_(oncology) https://en.wikipedia.org/wiki/Warburg_effect_(oncology)

m3kw9 2y ago

Must be way way more complicated than just find the cancer protein, make a special cell and inject

chromatin 2y ago
"Cancer protein"s are rarely restricted to the neoplastic clone

bufferoverflow 2y ago

People go into cancer remission without any treatment. Single point isn't data, not proof of anything.

melling 2y ago
What percentage of people go into remission without treatment?
- bluGill 2y ago
  Something > 0, which is all we need to know about single point data sources.
rozap 2y ago
Yes, clean food diets and meditation are famously very effective against cancer. I've heard eliminating seed oils is a magic bullet.

vonneumannstan 2y ago

Bro didn't you know you can inject Ivermectin directly into your balls and it cures your cancer? Duh.

wonderwonder 2y ago

I have zero medical experience so take this question as it is in good faith. Assuming the process to do this was known, how difficult would it be for a reasonably intelligent person to implement this procedure on their own

throwaway_acgt 2y ago
Basically impossible. There's too much specialized knowledge and equipment that go into it.

cbracketdash 2y ago

> "All five were disease-free at their last follow-up, between 10 and 15 years after the CAR T-cell therapy, although the team note they may already have been cured when the therapy was administered." > "The other two surviving patients had cancer that was actively growing or spreading when they received CAR T-cell therapy, but subsequently went into complete remission. One of these patients stopped participating in follow-up sessions eight years after treatment, but the other continued and has remained cancer-free more than 18 years." Based on these statements, the evidence for this treatment is anecdotal at best. Only 2/27 patients lived longer than 7 years. (There are probably more advancements in the last 10-15 years that have increased efficacy)

mlyle 2y ago
Getting this many survivors by chance of either group would be unlikely. Patients who have exhausted brain tumor treatments and have continuing growth have expected lifespans of months.