A cancer trial’s unexpected result: Remission in every patient
nytimes.com
nytimes.com
my uninformed impression is that there's a lot of new cancer treatments happening now that can turn the tide for a lot of types of cancer.
https://www.lls.org/treatment/types-treatment/immunotherapy/...
Also 2nd gen BTK inhibitors:
I’d highly recommend the book The Philadelphia Chromosome if you’re interested in learning more.
[1] https://www.google.co.nz/search?q=%22metastatic+solid-state+...
Metastatic Melanoma, had spread to his stomach. Got on the trial for Ipilimumab and is still here a decade and change later.
just 12
"All 12 patients (100%; 95% confidence interval, 74 to 100) had a clinical complete response, with no evidence of tumor on magnetic resonance imaging, 18F-fluorodeoxyglucose–positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. "
_____________
The plan is to enroll six patients with MSI, regardless of their primary cancer diagnosis. This cohort will serve to generate hypothesis and initial data to plan a larger study. All analyses from this cohort will be exploratory
> As with most experiments
This isn't true. It's absolutely standard in earlier trials of investigational agents to not have any sort of control arm.
> there's a control group (6 patients).
This isn't true. Within the study you posted, there are two different cohorts, with different patient types included.
> The control cohort may not have had cancer at all
This isn't true. The group you're calling a control cohort (cohort 2) must all absolutely have cancer, and are all actively treated with the study drug (TSR-042).
If comment OP was trying to misinform on purpose, it’s a different story as there’s no opportunity for improvement there.
>> As with most experiments
>This isn't true. It's absolutely standard in earlier trials of investigational agents to not have any sort of control arm.
Can we agree that Clinical trials are a small subset of all experiments? And that Phase 1 isn't as large?
For your second two points you're correct and I agree with you.
https://www.healio.com/news/hematology-oncology/20220605/dos...
> At the time of presentation, 18 patients were enrolled on trial.
> Results among the 14 patients with at least 6 months follow-up showed a complete response among all patients (95% CI, 74-100), with no evidence of tumor on biopsy, digital rectal exam, endoscopic visualization, fluorodeoxyglucose-PET or MRI. The other four patients are responding to treatment.
Is it a small, underpowered study that needs to be replicated? Absolutely.
Could it warrant banning in the future? Sure.
Should it be covered by insurance? Complicated.
We need to unbundle these things.
Here are some interesting case studies of drugs graduating from Phase 2 trials only to fail Phase 3 trials on efficacy and safety grounds: https://www.fda.gov/media/102332/download
[1] https://www.parexel.com/application/files_previous/5014/7274...
That being said I disagree with prescription pads. I should buy antibiotics for my kid without waiting four, five hours to be seen and processed
Disagree. Antibiotics should not be taken lightly, especially by kids. Doctors have been far too liberal in prescribing them even when unnecessary and this has caused people to think antibiotics are to be taken like vitamins.
This antibiotic abuse causes issues that are out of scope to discuss here.
But when a girl with a history of UTI is screaming in pain they come back with "Id rather wait for the cultures to come back"
No. Bugger off and give me the meds. I know my kid. I know what she has. And the culture confirms it three days layer every time.
And yet the Dr gives them out in exactly the same circumstances as I would if I could. Perhaps more liberally, since Im far more concerned about the consequences to my kids of destroying their gut flora.
Making all antibiotics available over the counter would not improve the situation.
Yes, in your case the culture came back positive. But, you're not psychic, you didn't really know that, and you're biased by the fact it's your own child.
Ive had some Drs push antibiotics after they literally just said a persistent cough is probably viral.
Ive had my daughter with blood curdling screams told her urine came out negative and her urine would have to be cultured. They can culture it all they want but I didn't leave without the antibiotic. Guess how the cultures come out? Plural because it happened more than once and the quick test at the Dr. has a high false + rate. Btw, untreated UTIs cause scarring.
Btw, Dr. dont pearl clutch when it comes to their loved one. My colleague, who's married to a physician, got started on antibiotics for Lyme disease before the cultures came back positive. Just in case.
"But, you're not psychic, you didn't really know that,"
No, Im not. I just happen to have a neural network on the top of my head with hundred of millions (billions?) of years of evolution to spot trends.
We literally give industrial quantities of antibiotics to animals. So antibiotic preservation is not an honest reason to lock them up
Tylenol and Advil can very quickly mess up your kid's liver and kidneys if you misdose. Yet, they're over the counter. So safety does not appear to be an honest reason either.
Ironically, statistically considering the forum, most ppl who are against me on this thread believe in drug liberalization including opiates; the one class for drugs I would keep behind the pharmacist's counter.
Btw, antibiotics are available over the counter in Europe. The ones Id use and feel comfortable using
We desperately need to stop doing that too, but at least it optimizes for bacteria that infects animals rather than humans.
I don't think you (and most other people) are anywhere near scared enough of returning to a world without antibiotics.
But then there is horizontal gene transfer.
The world has a lot to be scared of. Ive had an easy life, save for one or two experiences that have dwindled what truly frightens me a lot:
- Dying after my kids (unless my kids have a tremendous disability. Then my fear is reversed)
- Facing God, if He exists. If He doesn't, the nothingness of space.
Pain was on the list, but a bone marrow biopsy knocked it off. A world without modern antibiotics doesn't scare me. Much anyway.
What are you talking about?
> Over-the-counter (OTC) sales of antibiotics is forbidden by law in all countries, but it is allowed for some specific formulations (creams in Norway and Denmark or eye drops in the UK)
https://www.escmid.org/escmid_publications/escmid_elibrary/m...
https://www.cancer.gov/about-cancer/treatment/drugs/access-e...
The decision should be just because a patient and a doctor, because the consequences of such decisions are more far reaching than just those two. We have a well established framework for what a drug needs to prove before they can reasonable be allowed to be given to any human being, no matter their situation, and that barrier of entry is there for a multitude of good reasons. Discarding it just because a specific patient is at risk of dying or because you can get consent is not helping patients.
Allowing dying patients to make those sorts of deals with pharmaceuticals is just as horrible in the grander scale of things, they just stand to save a lot more costs and gain a lot more profits than Netflix would in a “Running Man” scenario.
You are very optimistic. Medics will sell expensive snake oil treatment to desperate families. For example, from the bottom of https://en.wikipedia.org/wiki/Breast_cancer#History
> In the 1980s and 1990s, thousands of women who had successfully completed standard treatment then demanded and received high-dose bone marrow transplants, thinking this would lead to better long-term survival. However, it proved completely ineffective, and 15–20% of women died because of the brutal treatment.
I think you misunderstood. My point was that it would benefit the families because a company would gladly pay a million bucks to give a dying cancer patient the first human dose of 40 drugs they haven’t yet done any testing on, just to get quick human feedback.
The “patient” in that scenario won’t likely get any benefit from the money, but the family they leave behind would.
Obviously this is not something we want to actually see happening, but the cynic in me know that if a company can save billions by skipping all trials and going straight to “dying human” they will, and they’d be happy to pay the expendable subject a million or even more, they still come out net positive.
and who decides that?
Can a drug company give "gifts" to doctor who then recommend the patient use that company's drugs when he/she is dying?
In a sane and humane system, sick people would then be allowed to try it.
Is that really the outcome you want?
You seem to care more about marketing than people's lives. We all have different priorities.
But at the same time, I do get why extensive approval is needed - deaths can and often do occur from allergic reactions and/or side effects to medicines, and the idea is to hopefully lower the ratio of that happening. At some point more people "will" die from allergic reactions/side effects than the time it takes to get approval.
https://marginalrevolution.com/marginalrevolution/2021/01/th...
This is about probabilities, and when lives are at stake, you should take some chances.
This would eliminate the profit motive that other commentators have noted would be a huge issue.
How does a molecule do that!? Enters the blood stream, is absorbed by the cancer cell, and then…? Blocks some enzyme?
Sometimes we understand the biology after we discover a treatment.
Essential, cancer cells convince the immune system not to attack them, so these inhibitors target the mechanisms by which they do so to get the immune system to take note of these cells. Hope someone more knowledgeable will correct me if I'm wrong.
We can't target the cancer cells, so we tweak the lymphocytes to block PD-1 receptors, thus ignoring ALL cells that express a lot of PD-L! protein.
This unfortunately includes healthy cells.
[0] https://en.wikipedia.org/wiki/Drug_nomenclature#List_of_stem...
[1] https://en.wikipedia.org/wiki/Monoclonal_antibody
[2] https://en.wikipedia.org/wiki/Monoclonal_antibody_therapy
Some varieties of cancer cells release a PD-1 ligand that turns off T cells when they get close to the cancer. So the cancer can "hide" from the immune system.
This monoclonal antibody blocks PD-1 on T cells, turning them into unstoppable murderers. The hope is that they preferentially murder the cancer cells. Wikipedia says that ~5% of patients get dangerous side effects from blocking T cell PD-1, probably because the unstoppable T cells attack healthy kidney or liver tissue. But for people with specific types of cancer, the hope is that turning the T cells loose will kill the cancer first.
Cancer cells (and our own cells) express PDL1. Our immune cells touch PDL1 with their PD1 and if this connection works then the immune cell does not kill.
If the connection does not work (PDL1 or PD1 absent) the immune cell will kill the target cell.
These antibodies either block PDL1 or PD1.
I'm worried that it will take many years until that happens.
Oncology is slow. It really is up to the patients to push the oncologist teams.
For good reason. If we detect cancers early, surgery and radiation are often very good nowadays--often allowing you to skip chemotherapy. And these are far less likely to kill the patient than a checkpoint inhibitor (which can overload your kidneys if it works or give you autoimmune diseases even if it doesn't).
The problem is that there are a lot of cancers we don't detect early-lobular breast cancer, pancreatic cancer, etc. And for things like intestinal cancers radiation is particularly bad.
These kinds of immune treatments are likely to get promoted first line treatments quickly if they really are this good--especially since they are likely to work on stage 4 metastatic cancers for which we don't have anything decent.
She's right now on an experimental checkpoint inhibitor (stage 4 metastatic since a year ago), and it probably gives her another few months, but every time I see her I think that she only has a year left in her life and get sometimes frustrated that the experiments are not optimized to get the more effective treatments in earlier stage.
But, recent work with immune treatments for cancer give me hope. I have not seen so many doctors and scientists say things like "the tumor just melted away" before.
Wonder if docs will start off-label treating earlier with immunotherapy. There's tons of immune checkpoint inhibitors meant for different types of cancers and mutations.
This effect is shared across many tumors with this feature not only rectal and the FDA approved a drug with the same exact mechanism in 2017 (https://www.fda.gov/drugs/resources-information-approved-dru...)
If I had to guess this is a huge marketing plot to bring yet another extremely expensive drug to the market. What is happening is that different drugs (ie different companies) take the space of a specific tumor (Keytruda for lung, Opdivo for melanoma, Tecentriq for liveer cancer) and Dostarlimab is going to claim the rectal cancer space.
That’s an $88,000 treatment for the medication alone. Given the apparent success of the drug, is it expected for the price to drop as the volume of patients spike?
If you're lucky - they have long term care insurance, and that covers most of the expenses for approx 2 to 10 years (depending on how old the insurance is - it's getting harder to find long plans, and they're all getting significantly more expensive as it turns out more folks needed them).
Otherwise... you spend everything, and then your kids pay.
We split my grandmothers down the middle - my mom's had insurance, we covered my dad's.
Vs. a miserable decay for everyone involved at huge expense. It's not worth it. Forget the money. The emotional toll is large and for whose benefit?
In theory you could presumably have some kind of system where a person of sound mind could that said, in effect, "if my condition declines beyond _____ then I want to end it," but doing so would be an incredibly touchy subject even if euthanasia was legalized. Unfortunately there is a very real potential for such a directive to by abused by people motivated by greed (gimmie that inheritance) or who simply don't want to deal with an aging relative who needs more help but hasn't reached the point where their euthanasia directive should be triggered.
It would, but the alternative is to make people live though this mental decline as we currently do. IMO it would be well worth the risks to be able to ameliorate the end of peoples lives.
My plan is to end my life well before I hit severe mental decline (not “if it gets worse”, with all the ambiguities that entails). If that cuts a few years off then a be it!
Walk out to a storm or blizzard not equipped for it. Go fight a bear or lion or crocodile. Go for a swim that you can't come back from. Do some high risk type of adventure that in high age is not even discussed. If you make it, great experience, move to next one.
The list is literally endless and can be done in some form even by quadriplegics. It allows you to plan goodbye and closures, wills etc. The fear and pain and suffering is concentrated into such a tiny sliver of time compared to dying discussed its uncomparable.
It just takes balls to accept that this is it, what mattered for you in life is over, and now its time to think about your closest ones and not yourself. Like a breakup, many will continue living in bad relationship since its a small amount of pain and evil every hour, every day. Instead of standing up and walking off to uncertainty and freedom.
You say that now.
I am close to someone looking at this now after holding that exact view for a lifetime, what I see them actually doing is delaying and delaying and confronting that, even on their darker days when they are thinking hard about doing it, the logistics of zero-risk-of-survival suicide are pretty terrible.
It's sobering to watch because I, too, hold the view you lay out above, and now watching this, I think I'd better work out my logistics while I'm relatively young and healthy.
What I've heard about long term care insurance is you can't really buy a plan with useful coverage anymore. The old plans were good as long as the insurer remained solvent, but many didn't.
I did some math on the premiums he'd paid for the insurance, and the payout. It was a break even.
In other words, putting the premiums into an HSA would have financially worked out a lot better.
That's incorrect. With Medicaid, the recipient is require to spend down their assets to a small amount, then Medicaid will pick up the remainder. The recipient's children aren't on the hook for anything. Of course, they won't receive any inheritance since the estate of the recipient has been drained prior to Medicaid.
IMD over 65 is only offered in some states, and have strict requirements for facilities that accept medicaid (not all that many do near us).
In our case, the waiting time was about 3 years for a room in the facility closest to us. Alternatively, there was an option about 4 hours away.
Worse, both medicaid facilities we looked at were... bad. Frequent complaints about abuse, very high rates of staff turnover, very little stimulation for residents (one was basically a single old tv on the wall in a cinderblock room - it looked basically like prison).
So yes - Medicaid will cover some costs in some cases, but really - the kids end up paying.
One of those cases where US individualism and utter lack of social thinking (completely unrelated to socialism/communism but many simpler folks fail to distinguish that) screws up needful parts of society
American healthcare system is absurdly inefficient.
This has nothing to do with research and cost of development anymore (if it even ever did).
What should it cost instead?
> Dude was living off of government research grants.
Let's imagine his work comes to fruition. The drug is expensive but efficacious - is this not a good thing? Should the government have not helped fund this drug because now it's expensive?
The alternative is a world without that drug and without as much incentive to produce the drug. I'm not sure that's a good trade.
Which segues nicely to this pairing of public funding and private enterprise. No, if the drug wouldn't be sold for a profit then the incentive to make it wouldn't exist and the funds would not be applied for and the ironic pairing - if it is ironic, which I don't think it is - wouldn't exist either.
Unless we're going to believe that researchers go through the mill of applying for funding and doing research simply to get the funding and stay in badly paid employment?
Can’t displace Chomsky as a famous linguist if he writes a letter to everyone’s dissertation committee if they criticize him.
> When he was asked what the device would cost, he cheerily replied "whatever the market will bear."
I also do not need to assume that companies undertaking research are doing it for profit as that is their reason for being companies, and even in the case of research being not directly undertaken for profit, that research - if useful - will go into drugs that are then sold with the intention of making a profit. Not solely, whether cynically or altruistically, the hope will be that the drug is effective.
To patients? It should be free.
To society? The initial research cost plus the bare manufacturing cost.
Someone has to pay. Who pays?
> To society? The initial research cost plus the bare manufacturing cost.
And we're back to a society which is poorer in terms of both health and wealth.
If you remove the profit motive then investment falls, new medicines become less likely and lesser in number, and medicines remain higher in cost due to lack of pressure (competition from new drugs, competition from new entrants, new techniques etc).
Altruism, necessary as it is, does not fill that void alone, and it certainly won't be filled by hoping government makes everything "free".
The last 200 years proven otherwise. All basic research around airplanes, semiconductors, satellites, GPS, GSM, fiber optics, CD/DVD and much much more was almost entirely tax funded.
No, the government should set a reasonable price for the product they funded. A high enough price to fund manufacturing, a low enough price to ensure that people who need the treatment have ready access to it. If the upper bound on price is too low for universal access, that's what subsidies are for.
Instead, we have free money to bootstrap extractive capitalists, at cost and detriment to people who need care.
Do the investors at the company you work at set the prices for the products you produce? That would be strange.
> Instead, we have free money to bootstrap extractive capitalists, at cost and detriment to people who need care.
It's "free" money because the capital costs are high and it's risky. I don't think it's the only or the best way but it is a valid way, but it doesn't remove the right to make a profit.
As to it being "detriment[al]" to the people who need care, they're getting a drug that didn't exist before, right? And this also should (generally) make existing drugs cheaper, right?
If he wants to charge "what the market will bear," then he should fund the research through the market.
If he wants government handouts to do the research then the public deserves to get the benefit that it's paying for - we're not funding it to make some guy rich.
I'm not saying it should be free, but he's already opted out of the market, so he loses out on market pricing. Manufacturing cost plus some reasonable percentage for the creator.
The government (which is really a government of and for the people, right?;) gets what it wants - a new drug - and jobs are created, trade happens, taxes are levied, health improves leading to (theoretical) money saved, more hours worked, more taxes… There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
So? Nobody has a right to free money. If investors don't want to fund the research, and the researcher doesn't want to share the results with the public, then no money for them. They can go off and work on something else.
> There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
You're putting words in my mouth. I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.
Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing. If the inventor doesn't like it, then they shouldn't take funding from the government.
Funny to see a pro-corporate welfare argument on HN.
It's not so that's your mistake.
> > I'm all for cutting subsidies,
You see, I wrote that. However, as we can see when I continue I am able to see the benefits to a system I don't agree with. It's called being reasonable and not strawmanning your opponent.
> > but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear.
> So?
So… I gave that argument right there. "the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear." If your response to this is "So?" then you've just said "So?" to "the drugs never appear". Strangely unappealing.
> Nobody has a right to free money.
Aside from having not made that argument and it not being relevant, you're arguing that people should get free drugs. Nobody has a right to free drugs. Now you're arguing against yourself.
> > There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
> You're putting words in my mouth.
Which words? Punishment? Ah, the percentage.
> I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.
How magnanimous of you. What would you set the percentage at? How would you get companies to manufacture things at cost for you? That's just not how a business survives, and the only people I've ever heard make this kind of argument are people who've never run a business and never will.
> Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing.
No, that's not how government funding works, that's how you appear to think it should work in this fantasy you've constructed. Governments often provide funding to private companies that do not create some magical legal right to that company's products.
> If the inventor doesn't like it, then they shouldn't take funding from the government.
I'll repeat, that's not how government funding works. I'm against subsidies in general and in this case but I'd take this dysfunctional way over yours.
Rich people from all around the world travel to American hospitals if they have serious health problems, not to public hospitals even in rich countries like Norway. Public healthcare works (poorly) as a way to distribute existing treatment, but is worthless at incentivizing development. Really, the entire world is unfairly parasitizing on Americans to fund medical research.
One example of cancer outcomes on a per country basis: https://worldpopulationreview.com/country-rankings/cancer-su...
Just google medical outcomes for any disease on a per country basis.
Do you really think the best hospitals in France or somehow worse than the best hospitals in the USA? Especially when the best hospitals in the USA still have the same fundamental problems as the rest of the American system?
I am aware that most of the cutting edge clinical trials in my field occur in the US. I have also seen people travel to the US for treatment of rare diseases. And I know that this isn't a surprising thing for the US in general, just look at our universities.
It's actually pretty funny that the only other response I got was someone saying that this is super obvious/true across fields in the US and thus not an interesting statement.
I don't know if it is a weird American bias or what. I'd take a look at the bias there and this belief in American exceptionalism as it doesn't pan out in the data.
Cutting edge clinical trials and those companies are global in nature. I mean just look at the Moderna team and where they conducted those.
That's basically the case for everything in America, so I'm not sure that it says anything remarkable about the American healthcare system.
Like can you think of anything else in America that you couldn't apply that statement to?
Capitalism works only with competition. But competition is against capital owners short-term extractionism (or rather against ceos who feels need to justify their pay). IMO solution is to let workers vote on CEO pay changes and punish white collar crime better and many problems of capitalism might get solved.
EDIT: IMO it won’t work as long as globalization can be exploited to suppress working class and avoid regulation
Do the drug companies in Europe do any different though?
- that sounds a lot like ransom?
- I think if they adopt a policy of price-discrimination to the point of literally taking you for all (or most) of what you're worth (or projected to be worth), we should turn around and apply the same reasoning to corporate tax rates.
It is a bit like car insurance here, which keeps rising because insurance companies keep edging the cost of a claim upwards (courtesy cars at extortionate rates, repair, ...) because there's no insentive to keep costs down or not profiteer.
With the NHS's buying power for drugs, they can get a little bit nearer a sensible margin from the supplier rather than the insane US costs underwritten by inflationary insurance.
In the current model, pharma only stays in business by recouping all of the during the patent protected period of any drug that makes it to market.
You will not see a price reduction, if it doesn't require chemotherapy or significantly reduces the number of rounds of chemotherapy, this drug will cost $150k+ for full treatment.
All of this assumes side effects are better than chemotherapy. Given chemotherapy care plans are some of the most arduous, it will be hard to be worse than chemo.
Is that the american price or the "other developed countries" price?
Market dynamics don’t come into play when there’s only one. If competitors appear or after patents expire it may get cheap, but the cost early on will have no relation at all to production costs.
If you want to learn more about pricing in healthcare the "Pricing, Value, and Ethics" lectures for this course is really interesting.
https://openlearninglibrary.mit.edu/courses/course-v1:MITx+1...
https://www.fda.gov/about-fda/center-drug-evaluation-and-res...
Drug patents are good for 20 years from the filing date, so you have about 10 years to recoup all of your costs, recoup the necessary fraction of your amortized R&D expenses on drugs that didn't go anywhere, and hopefully turn some profit, before your patent expires and generic manufacturers undercut you.
The result is that cutting edge drugs are extremely expensive for the decade or so after they first become available while the patent holder uses their patent-provided monopoly to set prices at the maximum that insurance companies and government health providers will pay. Your link is discussing the period of time after the patent expires and generic manufacturers get into the game, but the drug being discussed here with its $88,000 treatment cost is still in the patent-protected cost-recouping stage, where it's not subject to normal market principles of supply and demand because the supply side is a temporary monopoly.
A cursory search on clinicaltrials.gov and I can find 7131 cancer studies started in 2021 alone. It's therefore not unreasonable for this one to be just a random fluke.
If that's what they mean the survival rate wouldn't be 67% so this would imply a 1349 in 1350 chance the treatment is better than the average treatment?
People who suffer from rectal cancer usually undergo surgery to remove the primary tumor. But those trial patients weren't operated on, their treatment was non-invasive.
How many rectal cancer sufferers who never undergo a surgery survive? I would bet that it is a lot less than 67 per cent.
This looks much more like tossing a dice 18 times and getting a 6 every single time!
> [sponanteous remission of cancer] incidence is roughly one in every 60 000–100 000 cancer patients, but the true figure is unknown (2). Spontaneous regression of colon cancer seems to be particularly rare
https://academic.oup.com/jjco/article/45/1/111/888056
So using 0.0016% and 12 patients (which is what the paper the NYT actually links)
For a ~50% chance of seeing one trial with 12 patients have complete remission you'd expect to see ~43k trails.
(1 - 0.000016)^43000 = 0.502577
I wouldn't discount this study based off of those numbers.
(Tangentially I think your stats are a little messed up there - you calculated the expected number of people out of 43000 surviving, not the trials returning a false positive. Assuming 0.0016% that chance is astronomically small, so your argument is stronger.)
Cartoon montage: "By my calculations..." followed by driving a car off a bridge.
Edit: as someone who works in cancer research, I can tell you that your prior for 18/18 locally advanced colorectal cancer patients achieve CRs without surgery should be ~0.
https://www.nejm.org/doi/full/10.1056/NEJMoa2201445
Otherwise redo your napkin math and cursory search to answer, specifically, whether all these cancers disappearing within weeks of dostarlimab treatment could be a fluke. And do not compare this to "rectal cancer's rate of survival", which is irrelevant and a completely different set of (parametrized) statistics, and also do not compare it to the total number of "cancer studies", which was an arbitrary choice and yielded this meaningless conclusion. Even if this kind of analysis was useful, why did you compare against the number of cancer studies, rather than rectal cancer (1910), or dostarlimab (41), or studies with the same staging and genetic pathology? It's meaningless.
I don't believe you're qualified to tell anyone about the significance of this study, and much less dismiss it as a fluke.
Pun intended?
I concede that if a quick remission is extremely rare that does change the outcome, though I don't know how common that it.
Picking 'Total number of "cancer studies"' was not arbitrary. A similar article could have been crated for e.g. "promising drug cures breast cancer" so you need to take all of them into account. Actually probably every study conducted of all high-profile diseases that are likely to wind up on the HN frontpage - in a counterfactual universe we could be discussing a miracle Alzheimer drug or the like.
If you don't even know whether spontaneous remission is rare then you should not be offering an opinion about this. It's not even pertinent because these remissions were clearly not spontaneous, but it should alarm you to have spoken so recklessly about a disease which is essentially fatal. What you're saying amounts to "there's a good chance cancer just goes away on its own". Incidentally, this is also the least amount of math I've ever seen in a napkin math argument.
But in aggregate these sorts of comments are annoying as hell on every medical article posted to HN. Now you have to hope a sufficient mass of well-informed commenters is here to rebut them. In the best-case, these comments are simply misguided, but in the worst case it becomes a watering hole for all the antivaxxers and conspiracy theorists on this site to gather
But that is the human condition, I guess. Scientific progress and learning brings regrets, often very momentous ones in retrospect.
From here on out, it'll be scans every three months or so to make sure it hasn't come back, but her doctor says that if it does come back it'll grow so slowly and weakly that it's just not going to be worth bothering with.
I expect you can imagine the look on Mum's doctor's face when we went in for the most recent scan results - it can't be often an oncologist gets to give someone the best news in the world.
Is there an overview somewhere of new treatments over the years, and their effect? What is the progress we have made?
The idea of trying immunotherapy if chemo fails seems completely backwards.
Cancers will be mostly treatable within our lifetimes though (in many cases already are). All the pieces are there technology wise.
I don't see this getting to market anytime soon.
Also, don't expect this stuff to be available anytime soon. FDA process is pretty slow, and sometimes political. Maybe if it were effective against Sars-Cov-2, FDA would be willing again to rush it though the door. Still can't wrap my head around how stuff like Molnupiravir made the cut. They just don't have any shame.
https://www.fda.gov/patients/learn-about-drug-and-device-app...
But, yeah, the FDA is all over the place.
But aye, they aren't cheap.
I definitely hope that we can come with a cheap method of -mab production. I am almost sure we one day will.