A radiologist applying evolutionary principles to cancer research | Hacker News Reader

A radiologist applying evolutionary principles to cancer research

wired.com

40 pointsjonbaer10 comments

Summary: Cancer cells are competing against each other as much as they are competing against healthy cells. If you use a high treatment dose you select for the drug-resistant cells and long term it can be worse. If you lower the dose of the drug you slow down the rate of evolution of the cancer, even if you don’t kill as many cells. Overall it suggests it may be better to try to “coexist’ with the cancer rather than try to kill every cell.

By the same logic you should not take the entire bottle of antibiotics after an infection, because you're more likely to select for resistant bacteria.

What's interesting is that nearly all current research shows that combinations of drugs is the most effective solution for eliminating cancers. So it would be nearly the opposite effect. If you let it grow slow you're potentially causing organ damage, letting it spread further which makes it harder to kill, and prolonging side effects of chemo which can be super severe for many people.

The article points out that different cancers respond differently. High-mutation cancers are the most likely to be effectively treated with drug combinations or by using dosing cycles to manage the cancer.

There’s usually a metabolic cost to maintaining any kind of drug resistance. When the drug isn’t present that cost confers no benefit.

As always, cancer isn’t one disease and there won’t be any single silver bullet. Just lots of different strategies, eventually selected by sequencing a specific tumor to determine the most effective one.

Yes different cancers respond differently, obviously there isn't a silver bullet, but what's being suggested is dangerous and possibly life threatening and doesn't take into account that a lot of people already limit their chemo because of cost reasons and then die early. There's a whole reason trials exist and that's to determine effective doses and overall survivability. If there was a benefit seen in trials of lower doses they would already use those doses. This is junk science at best that completely ignores a massive body of research that already exists.

"makes it harder to kill" Unfortunately, this is still thinking in terms of the "cure" mindset as opposed to co-existing with cancer. Maybe you just can't kill cancer. Try not to think about "let it grow" vs "managing the growth". If aggressive treatment leads to hardier cells forming, which can then break off and lead to metastasis. There are other chronic conditions which we can live with such as diabetes and HIV that were previously thought of as early death sentences, it is not inconceivable we can get there with cancer.

Cancer gets cured all the time. Note that curative treatments are aimed at reducing the number of cancer cells to zero or near zero eg with surgery or chemotherapy.

These evolutionary strategies are a cute idea that might buy some more time in relatively indolent cancers with therapies that already work well. It’s a niche indication at best.

So we might get there, but realistically the methodology is really flawed. Cancer is, for all cancers, a failure of our own immune system to recognize cells that have gained a genetic defect that doesn't cause proper cell apoptosis. This isn't a foreign invader, this is our own cells with a flaw. While it's cute to think about just living with it, if you're not completely preventing the growth in some cancers you're not really doing much.

We can cure most cancers nowadays through surgery, radiation, and chemo...if we catch them early enough and they don't spread. If you're talking about coexisting with cancer, you're already past the point of worrying about it spreading. It's already metastasized. Coexistence only makes sense if it's something you could live with. If you want to see how well this works out ask Steve Jobs how co-existing with his cancer worked out, because this essentially amounts to letting the cancer spread further and more aggressively which will damage even more organs. The hardier cells will already exist, your body will just have to fight off more cancer cells.

The only, and I mean only, way to live long term with cancer is to allow the immune system to fight off the cancer and keep it at bay by removing the inhibitors that prevent recognition and reaction. I hope the day that cancer becomes chronic is today, but realistically I'm probably not going to live to see the day that it does. This article is just another drop in the bucket of false cures and pseudo-scientific nonsense that exist for cancer that aims to provide hope and to take advantage of already desperate people, who often don't have the financial means to cover the costs of chemo, infusion pumps, CT Scans, PET Scans, ports, rides, medications, etc.

Interestingly, the drug-resistant cancer cells are also less "efficient" than non-drug-resistant cancer cells. This can be exploited by the "drug holiday effect" - give patient drug number 1 - resistant population takes over, change drug - non-resistant population wins again and drug number 1 works again

https://www.nki.nl/topmenu/about-the-nki/news/drug-holiday-e...

link to paper discussing new classification scheme based around evolution of cancers

https://www.nature.com/articles/nrc.2017.69.pdf

we are working in a similar space, the challenges of getting this to something that is beneficial to patients are immense. Getting the science working is one thing, regulation & reimbursement strategies for this are equally as intimidating. Complexity in tackling cancer is not just at a cellular level, it is also at a healthcare system and social level.

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