9 ms·
New treatment eliminates bladder cancer in 82% of patients
- newfocogi 1y agoMy (non-AI) Summary: - "TAR-200 is a miniature, pretzel-shaped drug-device duo containing a chemotherapy drug, gemcitabine, which is inserted into the bladder through a catheter. Once inside the bladder, the TAR-200 slowly and consistently releases the gemcitabine into the organ for three weeks per treatment cycle." - Phase 2 Clinical Trial - 85 patients with high-risk non-muscle-invasive bladder cancer - "treated patients with TAR-200 every three weeks for six months, and then four times a year for the next two years" - 70/85 patients—the cancer disappeared and still gone 1yr later in almost 50% patients - FDA granted TAR-200 a New Drug Application Priority Review - Johnson & Johnson manufactures TAR-200
- woeirua 1y agoUnfortunately the recurrence rate after 1 year here is still quite high. Good progress, but not a cure yet.
- tptacek 1y agoOnly a small percentage had a recurrence that progressed to later-stage muscle-invasive illness, though.
- lordofgibbons 1y agoDo cancers have a tendency to come back with better drug resistance if it's not fully eliminated? at least a resistance to the drug that got rid of it the previous time?
- tomsto 1y agoEmphatically so, yes
- codr7 1y agoReturn customers generate more profit.
- AnimalMuppet 1y agoNot if the same thing can't be used to treat them again.
- GoatInGrey 1y agoCynical take, but not wrong. Though this reads as though the implied message is preaching the suppressed cure conspiracy theory so I'll respond to that interpretation. What you're missing the competitive factor of this. If your drug strings your patients along while your competitor releases an effective cure, guess who's getting all the business? Look to Sovaldi and Keytruda for recent examples.
- tptacek 1y agoThe competitor with the effective cancer cure will take all the business.
- const_cast 1y agoPeople say this because it sounds right and dramatic, but if they knew and understood what cancer is, they'd understand why treating it is so hard. For those unconvinced, cancer is your own bodies cells gone rogue and trying to kill you. Now, this happens all the time. Luckily, our immune system is awesome and catches it. Cancer is when your immune system does not catch it. it's invisible, indistinguishable from your skin cells or your lung cells. Its not like the flu or pneumonia - there is no foreign body, there is no attacker. Its you. So then treatment means we need to kill living, actively reproducing cells in the human body. Well, a fire can do that. The trick is, how do you kill the cancer cells, which your own immune system cannot even distinguish as cancer cells, but not harm your normal cells? Turns out that's very hard and very grueling. Chemo is very effective, but you still lose your hair and damage just about all your organs in the process. And, for the record, we do have "one off" cures for cancer - surgery. Just cut it out. The trouble is cells are microscopic and there's billions of them. Rarely will they be so perfectly contained you can get them all in one go. No, you miss some, and they sit there, growing, until the cancer is detectable again. And they move, they use your own blood and lymphatic system as a highway.
- octaane 1y agoFor some cancers yes, for other cancers, no. Sometimes resistance to therapy is a matter of time, not prior lines of therapy.
- ac2u 1y agoI wish I could find the article, but there is a clinic somewhere that ran trials where they deliberately wouldn’t treat the cancer too aggressively. Instead they experimented with treatment frequency but with control being the aim instead of elimination. The theory being that they could keep it at bay indefinitely and lower the chance of selection pressure kicking in. The thought behind their approach is that they wanted their patients to die of something different than their cancer.
- apwell23 1y agoyes they are resistant to that line of therapy once it stops working. Sometimes that resistance carries over to other lines too. For example, Enzalutamide doesn't work for prostate cancer if you were already treated by abiraterone.
- laughing_man 1y agoThe same logic applies to cancer cells that you seen in antibiotic resistance. The treatment kills the cancer cells on which it's most effective, leaving the most resistant. When it comes back, they're all going to be resistant.
- jijijijij 1y agoI think a cancer’s treatment resistance means losing differentiating marks and becoming more and more like a stem cell. With these evolutionary processes it’s a given, the surviving mutation was already present at the time of treatment. The higher the genetic diversity the higher the chance of said mutations. A cancer’s genome is often highly unstable, since apoptosis is disabled, so diversity tends to be high. Metastases usually imply a good chunk of "god mode" features gained already, for solid tissue cancers (soft tissue cancers are a bit different), so it’s a bad starting point. Imaging cannot detect any tumor below say 2mm, so ultimately you never know the true stage or treatment success. So a cancer doesn’t "return", it grows above the clinical threshold again. Treatment is kinda a genetic tautology: If it works you didn’t had a treatment resistant cancer, if not you did. Or: If you lose, you never had a chance.
- amacbride 1y agoBladder cancer has a notoriously high recurrence rate, unfortunately. (I worked for years in NMIBC molecular diagnostics.)
- tptacek 1y agoSay more? You've got some domain expertise on this story and I assume an interesting story to tell!
- chrisgd 1y agoMy dad had his bladder removed. Cancer came back 18 months later and he was gone 4 months after that. It sucks. Plus, I regret that he had to live with a colostomy bag for that time. His quality of life probably higher if they do the other option (name escapes me).
- 0xWTF 1y agoFFS, I'm a physician and I had to look up that the acronym. Have mercy on people: NMIBC = non-muscle invasive bladder cancer.
- tptacek 1y agoRight but the first time in a message board thread you have to type "non-muscle invasive" you learn the acronym real quick. :)
- bsder 1y agoThis was for a high risk cancer that was already treatment resistant. This is an unusually effective treatment with remarkably smaller side effects. If it is this good, it will probably start getting used more broadly.
- Teever 1y ago> The standard treatment for this type of bladder cancer is an immunotherapy drug, Bacillus Calmette-Guérin, Can anyone explain why the vaccine for TB works to treat bladder cancer?
- QuercusMax 1y agoThis "drug" is a weakened form of the bacterium, which apparently stimulates immune response. So I guess it works for both TB and bladder cancer just by getting your immune system to notice something is amiss?
- imranq 1y agoTurning it off and then on again works in a lot of surprising places
- octaane 1y agoI can explain. BCG infects the actual epithelial cancer cells inside the bladder, triggering Th-1 response (production and release of cytokines by activated CD4 T cells). The cytokines induce an inflammatory response, which I turn activates other immune system cells such as CD4 and CD8, NK cells and macrophages. The immune cells then attack the bladder cancer cells, hopefully destroying them, thus "fighting cancer". Source: Li J et al, NPJ Vaccines. 2021;6:14.
- tiahura 1y ago“almost half the patients were cancer-free a year later.”
- onlyrealcuzzo 1y agoThat's one way of looking at the glass half empty. If half of people get rid of cancer for 1 year that is still outstanding - ESPECIALLY if the majority of those remain cancer free for quite some time after.
- apwell23 1y ago> remain cancer free for quite some time after. OS is more relevant than PFS
- codr7 1y agoIf we wanted patients to survive long term, then maybe we could try a treatment that doesn't destroy their immune system in the process.
- tptacek 1y agoInvent it and your grandchildren will retire rich.
- burnt-resistor 1y ago
- cowmix 1y ago[flagged]
- anonymars 1y agoUltimately that's one reason why the US got the atomic bomb and not the Nazis. Ironic.
- cityofdelusion 1y agoRealistically speaking, Germany was never on track to produce atomic weapons before their war economy was obliterated by the allies. The program was not taken seriously or had proper investment. The war machine was already severely starved of resources prior to their even more significant land losses in 1944. I honestly can’t even think of an alternate (realistic) timeline where they achieve a delivery system for atomic weaponry.
- southernplaces7 1y agoThe delivery system would have been mostly irrelevant if they'd gotten the bomb on time. Having even one functional nuke at any time at all before or just shortly after June 6th 1944 and dropping it on London or even around the Normandy beachhead (well within German reach even in 1944) would have pretty much killed the D-Day landings stone dead immediately, and that was something they certainly plausibly could have done if it had been taken seriously by the leadership early enough. The V-Weapons program alone cost MUCH more than the Manhattan Project, for example, and it was (despite being technically incredible for its time) a total waste of resources under the circumstances. The Germans also spent so much money on so many absurd things that had they simply directed it more precisely to the bomb at an earlier time, cost at least wouldn't have been a limitation. Even as things stand historically, they created a number of completely cutting-edge weapons despite all the catastrophic problems you describe, so much so that the US, USSR and UK all spent years after the war, largely cribbing off what the Nazis' R&D had already developed to some extent.
- 1y ago
- blackhaz 1y agoMy father currently suffers from bladder cancer, he's currently in palliative care, he's in Ukraine. If there are any medical professionals here, could someone provide an advice - is there any chance to get him access to TAR-200?
- gautamcgoel 1y agoSo sorry to hear this, I wish him the best.
- apwell23 1y ago1.look for clinicaltrial on https://clinicaltrials.gov/ https://clinicaltrials.gov/ . 2.See if your father qualifies for any 3. Enroll 4. Get B2 visa. All medical treatment is usually covered once you are accepted into the program. good luck!
- moi2388 1y agoThere are EU trials as well. Perhaps contact your physician, insurance or Johnson & Johnson directly. https://euclinicaltrials.eu/ctis-public/view/2023-507685-10-00 https://euclinicaltrials.eu/ctis-public/view/2023-507685-10-... To be honest, chances are slim to none. But worth a try.
- pkaye 1y ago
- TheAmazingRace 1y agoI really wish this was available earlier, because I just lost a family member to bladder cancer yesterday morning. :(
- ecoffey 1y agoThat is tough, I’m sorry for your loss.
- TheAmazingRace 1y agoThank you for the condolences.
- javiramos 1y agoSorry for your loss.
- xxr 1y agoVery sorry for your loss. An uncle had bladder cancer about 15 years ago, and while he survived, it began a very steep decline that led to his passing in 2022.
- bdcravens 1y agoSo sorry to hear. My father passed from bladder cancer that metastasized 20 years ago.
- selectodude 1y agoAlways kind of bittersweet to read these breakthroughs in cancer treatment.
- deleted 1y ago[deleted]
- A_D_E_P_T 1y agoThere's an open access paper on the development of the drug here: > https://www.sciencedirect.com/science/article/pii/S1078143924010445 https://www.sciencedirect.com/science/article/pii/S107814392...
- pugworthy 1y agoTo be clear, here is the rest of what the article title should be... > ...for individuals with high-risk non-muscle-invasive bladder cancer whose cancer had previously resisted treatment
- tptacek 1y agoOnly those patients were admitted to the trial, so the effectiveness of the treatment on later-stage muscle-invasive disease is unknown. That it's scoped to patients who are BCG-unresponsive ("previously resisted treatment") makes the breakthrough more significant, not less.
- GoatInGrey 1y agoThis is relatively common with experimental therapies in trials, and thus shouldn't be interpreted as the final say on its usage. Part of the reason why is that it's difficult to convince patients or providers to reach for the experimental treatment in trial before the current standard of care. Many first-line treatments began as second/third-line or salvage treatments before experiencing line promotion or (if surgery is involved) neoadjuvant promotion. Keytruda is a good example of this progression in action.
- ltbarcly3 1y ago"New treatment eliminates bladder cancer in 82% of patients" - current HN title (matches article) I don't like headlines like this because they lack any necessary context. Knowing that a treatment eliminates cancer in 82% of patients isn't data unless we know more or already experts in this field. For all I know the previous treatment was 99% effective but just cost more or something. PR-style headlines very often use misleading statistics to get attention, so this wouldn't even be surprising. - What was the previous treatment's success rate? Was it 22% or 81%? - What are the other tradeoffs? If the previous treatment was also 82% maybe this one doesn't cause incontinence, or maybe it's non-invasive? How you should make a title: "New treatment eliminates cancer in 82% of patients, a major improvement" "New treatment is first non-invasive way to eliminates cancer in 82% of patients" "New treatment way to eliminates cancer in 82% of patients - without causing incontinence" "New treatment eliminates cancer in 82% of patients without radiation"
- tptacek 1y agoThis is 81% CR in patients who had already had recurrence and progression after front-line treatment, so neither of your concerns about the headline are relevant to the actual story.
- ltbarcly3 1y agoI don't think you understand my point, i don't have two specific concerns lol.
- tptacek 1y agoThe former point you made simply isn't addressed by the study, and the latter point effectively increases the percentage of patients that can be put in full remission; you're right, it's not 82% of all NMIBC cases, it's a superset of that number.
- ltbarcly3 1y agoMy point was that the title didn't contain enough context. The examples of 'improved' titles were purely demonstrative of titles that have some extra context to motivate what is special about this treatment - as in they are just made up to show what a good title would provide to give more context. You are missing the point completely.
- virtualwhys 1y agoMy father had bladder cancer, which was caught relatively early as the cancer had not yet spread beyond the bladder wall. The doctor performed a rather uncomfortable surgery (the pathway for a man is not pleasant) and then injected the TB virus into his bladder, which is apparently an effective treatment for this type of cancer. It's been 20 years now, no recurrence. Think he was treated at Dana Farber in Boston. Having gone through what was likely a life saving treatment he has become, ironically, anti-western medicine -- don't blame him, having a surgical implement shoved up main street doesn't sound like a walk in the park :)
- hereme888 1y agoThat's not 82% of bladder cancers. It's 82% of those whose bladder cancer is fortunately not invading the muscle, and after failing current standard treatments.
- tptacek 1y agoAs I noted elsewhere in the thread: (1) For this trial, patients with MIBC (as opposed to NMIBC) weren't in the cohort, so we don't know what the results will be with MIBC. (2) "After failing current standard treatments" makes the result more impressive, not less.
- tolmasky 1y ago[flagged]
- tomhow 1y agoEschew flamebait. Avoid generic tangents. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- tolmasky 1y agoYeah, I know the rules. But I also know they were written before our current reality. More important rules seem to be being rewritten in front our eyes, so you never know. Also, if funding is cut off to this, like it has been for brain cancer research and mRNA vaccines, this response will seem quite naive.
- tomhow 1y agoThe guidelines evolve over time and have had minor alterations even recently. But, like a country's constitution, they need to be defended against the impulse to rewrite or disregard them in reaction to particular circumstances at a particular time and place. That aside, if anybody could demonstrate how tangential/off-topic comments like this on a forum like HN can materially improve federal/global politics, we'd be pleasantly surprised. Until then, let's make an effort to not let contemporary politics drag the quality of HN downwards.
- tolmasky 1y agoYou listed two violations: "Eschew flamebait. Avoid generic tangents." I can understand the first one, but the second I think is debatable. RFK Jr.'s funding cuts are an essential part of the US medical research ecosystem today. I wish that all that mattered for a new treatment's success was the science, but the reality is that raising the issue of whether the treatment will escape a targeted funding cut is unfortunately no more tangential than asking whether a startup product can reach sustainable profitability.
- gwerbret 1y agoSome important things not mentioned in this press release (not to detract from the idea of new treatment approaches of any sort): - All patients had their tumors surgically removed before they were started on treatment. Thus the trial wasn't testing cure so much as delay of recurrence. - These were very superficial tumors, meaning they were growing on the very surface of the inner bladder, just like skin tags. These aren't the ones that kill people. Patients with superficial bladder cancer who don't respond to BCG can be treated for quite a while just by having the tumors surgically removed whenever they recur (using a minimally-invasive procedure known as a transurethral resection of bladder tumors, TURBT). - Fun with words: the press release called this a clinical trial, but it's not -- it has no controls, no real statistics, no randomization, none of the things that make up the usual standard in medicine. The authors of the paper call it a "study", which is basically a research experiment. They don't use the word "trial" at all in the paper. Having said all that, I still look forward to seeing a proper trial. Edit: wordsmithing.
- rtaylorgarlock 1y agoI'm perturbed by PR-driving rhetoric in the medical world because of what this causes, e.g. another commenter asking about a family member and if this could be helpful. Seeing what isn't directly visible in the PR is important in this case.
- ferfumarma 1y ago> the press release called this a clinical trial, but it's not Yes, it is. Any intervention in humans that is meant to create generalizable information regarding a treatment intervention is a clinical trial. The quality of the information is not as strong as a double-blind, placebo controlled, RCT, but it is still accurate to call it a clinical trial.
- gwerbret 1y agoBy the tenor of your response, I assume you understood what I meant in this very-non-medical of forums, which means you understood why the paper's authors themselves chose not to call their study a trial (even though they registered it as a "clinical trial", as is necessary for any clinical study in humans involving a treatment intervention). Which leaves me wondering about the purpose of your response.