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Comment by denimnerd42 | Hacker News Reader

Some cancer treatments have advanced a lot. Some are still using the same old drugs. Mother with StageIIIc ovarian in 2019 resection, HIPEC, then chemo. Recurrence in 2020 and every 6-9mo after that with some areas appearing, others shrinking. Platinum resistant in 2022 (many many many different times combined with taxol, doxil, etc). Taxol alone not working now as she had a spread event. Doxil + Avastin is now being tried (again but without platinum). Probably out of options sooner or later even though she can physically handle more chemo. Avastin is pretty much the only advance for this cancer and it's not very good. She's been on it on and off several times with the other chemo drugs. Of course all this depends on the mutations and such. Hers aren't ones anything new if it exists works for. This is a major research hospital with distinguished specialists.

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Yeah "cancer" is a variety of diseases and treatments for some of those diseases have advanced very far and others haven't changed much.

Is it a variety of diseases, or do the different colonies of organ-specific cells just behave differently once they are unleashed?

Different diseases. Not every colon cancer, for example, behaves the same. And if colon cancer spreads to the lungs, it's still colon cancer, not lung cancer.

There are different cell types in the colon, and I would expect a colony of each cell type to behave differently.

Cancer is like a bacterial infection, but with cells from the host. Of course if your lung has an infection of colon cells those don’t suddenly become lung cells.

I don’t see how that makes it different diseases. It is only treated that way because we aren’t attacking the root cause (i.e. the actual broken replication inhibitor in whatever line of cells).

By my honestly shallow understanding of cancer it's not that simple.

For the cancer to not get killed immediately several things have to get broken, not just the replication inhibitor. Once they get to that state is not far fetched to think that they can have or get in the future different mutations, not specifically required to get cancer in the first place.

The comments below us talk about the folate receptor mutation that not all cancers have.

Sure but aren’t the other mutations incidental, in the sense that if we repaired the replication inhibitor the cancer would be cured in all cases? Perhaps there are even different types of replication inhibitors in different cell types, which would add complexity, but fundamentally it’s all still the same class of problem.

The root cause can be different per type of cancer, see for example the landmark TCGA/PCAWG paper:

https://www.nature.com/articles/s41586-020-1969-6

Figure 2 shows the different mutations present in cells in a variety of cancers carry. These genes have a variety of functions. The DNA of cancer cells from different tumor types is different, and TP53, the gene featured in OP, is never mutated in some cancer types. In the end the discussion is a little semantic (what defines a different disease), but if the prognosis, treatment, and molecular mechanisms behind different types of cancers are different, I would consider it fair to consider them different diseases.

Do you know if she has been treated with the new antibody drug conjugate (ADC) technology? Here is an example: https://www.elahere.com/ I am not a physician but I work in the space.

Doesn't have that folate receptor mutation on her cancer. That's what I was mentioning in the last part as I had read about that drug last year.

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