Moderna Melanoma Vaccine Cuts Death Rate in Half
reuters.com
reuters.com
Get your moles checked.
My dad died in July 1996 from a nasty mole on his back. He would ask me to scratch his back and I remember being 8 or 9 years old and having to scratch around it as it was near the seam of his tank top (which likely aggravated it daily). And would make comments about it being "gross". We just didn't know what we know today.
He was drying off after showering one morning and got blood all over the towel from the mole. He went to the dermatologist and was told he had malignant melanoma. This was in September 1995 and he was in the ground before the middle of July 1996. Nine months to get his affairs in order. I remember driving around and seeing his old college pals (one of which I still see once a year or so for lunch to this day). I remember him buying a bag phone, a "car phone" so we could keep in touch as he drove from Eastern KY to Duke University for experimental treatments (I believe it was the one that led to the immunotherapy treatments used today). He told my mom even if it didn't help him he hoped it would help someone.
I avoid the sun with the exception of the back of my neck and the top of my hands. He has no clue (nor do the dermatologists) what caused it but, like other posts mention, likely sunburns in childhood.
I am so hopeful for this treatment and thankful for the progress made on the immunotherapy fronts.
Melanoma in adults is typically tied back to acute blistering sunburn events that happened before the age of 18 (as you seem to be aware). The most common sites of melanoma are chest and back in men and legs in women, areas that are more often than not covered by clothing and not in need of sunscreen.
Cumulative sun exposure on the other hand causes the other types of skin cancer - not melanoma, which this vaccine is targeting.
The most common chemical sunscreen ingredients cause cancer themselves and are wildly overdue for FDA review and removal (that has been held up for political reasons). For those who wish to wear sunscreen I recommend non-nano zinc mineral sunscreen such as Thinksport. Look for "non-nano" and zinc oxide (not titanium oxide, which is often nano in part and also a carcinogen) on the label.
> The most common chemical sunscreen ingredients cause cancer themselves
Both of these statements are out-of-date.
Recent studies show two different histological subtypes of melanoma for young adults vs older adults, each following a different common mode of presentation [1]. Melanoma in younger adults tends to present on the long limbs and is thought to have different contributing factors.
Also "common chemical sunscreen ingredients cause cancer" is a common FUD trope. Sunscreen reduces cancer mortality, full stop. Each person's circumstances vary based on their daily habits, geography, and personal/familial history.
You didn't actually prove anything with your counter point here, as confident as you are - which is as confident to whom you're responding to.
At this level of ideological-indoctrination, it seems each person would have to actually participate [run and observe them] in the trials to see if certain ingredients cause an increase in rates of cancer.
How else do people indoctrinated into a belief, believing they simply know better - and must be right, than have people repeat clinical trials on animal models [or better]? Genuine question.
With the practical advice to counter this being gradual increase of sun exposure to allow your body to build a deep layer of protection (tan) - of which sun screen will prevent, and then if you miss any spots and get full blast of sun for hours all of a sudden then those will be points of vulnerability.
Pharmaceutical industrial complex: create-advertise the problem, sell the solution(s) = profit!!
Its there evidence that the incremental tanning you describe actually protects you from skin cancer and will not cause other cancers? If not, this seems like a very reckless comment.
I'm curious how this was studied. I feel like that's when everyone gets really bad sunburns because this has to be extremely hard to actually confirm. Doesn't everyone get sunburns when they were in this age category? It's when we are young and irresponsible, putting on sunscreen requires persistence on something that doesn't seem important in the short term (and arguably is a newer trend).
I totally believe that sun damage on your skin causes skin cancer but studying your choices in your younger years to later years seems quite difficult to confirm through research. Wouldn't they need to confirm adults that were diligent about putting on sunscreen their entire life, including when they were kids?
Tell that to my GP. Both my parents had melanoma, and they each had one additional type of skin cancer each. Their dermatologist is insistent that I get checked, but my GP doesn't think it's necessary, so my HMO won't pay for it.
Many GPs aren't taking new patients (or at least from whatever insurance you have) or the initial new patient visit may take 4+ months to schedule.
GP is not a particularly popular choice for doctors as it pays significant less than any specialty does.
He did help. Absolutely. A friend was diagnosed with stage 4 melanoma 5 years ago, and she's in full remission today with an optimistic prognosis. Her life is possible because of researchers and people like your dad.
I'm sorry for your loss.
He said it might have been from sunburns when he was in the Boy Scouts.
I will never forget the look on his face when I spoke with him, a look of bewilderment wrestling with anger.
His wife teetered with grief and confusion, trying her best to be strong while trying to bear the sickening reality that nobody could have prepared their family for.
I always get an annual dermatology checkup now because of him.
Having a hard time understanding how something so small, and so easily removed can kill someone.
I have so many 'moles' on me, I wouldn't even know what to look for.
Yes they can be removed, but if the cancer has already spread then it may be too late.
Just like an iceberg I guess...
Some skin cancers, like basal cell carcinoma, never metastasize. Melanoma is one that will.
At that point it's more like multiple cancers at the same time, with the very cruel consequences of exactly how drastic that sounds :/
I've had a couple basal cells (the way less scary one) and the easiest way to identify those is just look for a pearly pimple that won't go away.
These delays help fill graveyards in the meantime: https://marginalrevolution.com/marginalrevolution/2021/01/th.... The tragedy goes mostly unremarked on, because the dead don't agitate or vote.
I do agree that drug approval processes need to consider the negative cost of delay, but in this specific case, from further in the article we see:
> Moderna is currently building a dedicated facility in Massachusetts to produce the vaccine at commercial scale, which it hopes to finish sometime next year.
> "We need to make sure that we have that near completion before we could even contemplate asking for approval," Hoge said.
And the reason for this is that you typically need to submit detailed manufacturing information as part of your new drug approval process. This allows the FDA assess how likely the drug you actually sell will provide the same benefits as those in the trial, as well as make sure you don't like... dunno forget to serialize stuff and ship out contaminated product.
In so many cases, the changes trigger a review of the whole process - rather than the changes.
but! generics can get easy approval, they need to show that their active ingredient is the same molecule and it has a very similar biological uptake profile, and that's it (at least in Europe, but as far as I know it's very much copied from the US process)
so that's not that high bar. and of course "big pharma" knows damn well how to change just some little thing to have a different-but-same molecule but with a few more years of patent protection.
(and again, yes, it's not that the process is super duper trivially applicant friendly, but the costs in the system are not in the filing.
it's mostly because there's no real common infrastructure for the whole end-to-end iterative process. there's a lot of separate cottage industries for each step, all charging a fuckton of money, all providing mediocre services, mindboggingly shitty software for managing trials/data/patients, no incentive to improve, doc/xls based workflows, you can imagine how inefficient and slow - and thus extremely costly - these specialized services can be, etc.)
In my case, the therapy that finally worked for my cancer was only allowed as third-line after I had gone through two rounds of heavy chemo. Now it's second-line, which means way less toxicity for those after me. In hindsight, I definitely could be angry they didn't at least try it on me before BMT.
But that's the problem, you only know what's safe in hindsight. Two-arm clinical trials are expensive and slow but they are the gold standard that continues to deliver countless life-prolonging therapy.
There is so much money being made in cancer treatment these days which in the US is all coming from private for-profit companies. One unsuccessful (non-toxic) trial I was in saw the company bragging about its progress in its annual report while the trial was still going!
The FDA is the only thing stopping these companies. Every time a standard-of-care treatment is safe and effective you can thank the FDA for doing the unglamorous work of holding these companies accountable.
That's part of the point: safetyism is a problem: https://en.wikipedia.org/wiki/Safetyism. If you personally want to wait until more data is in, then wait, but let the rest of take reasonable risks to move things along. I would, and want to, and suspect many others will too.
Every time a standard-of-care treatment is safe and effective you can thank the FDA for doing the unglamorous work of holding these companies accountable
Every time someone dies because the FDA has killed or slowed effective treatments, you can thank them for doing the unglamorous work of holding back progress. The dead aren't posting to Hacker News.
Give me (and others) the freedom to try. I'm a dead man walking anyway, which you don't seem to get, or acknowledge.
As some unsolicited practical advice, yes, it's always good to protect one's self from the sun using long sleeves or sunscreen. However, melanoma can and often does occur in areas that does not receive sun exposure. This could be between your toes or inside your butt cheeks. As a result, it's worthwhile to have a dermatologist conduct a skin exam once a year. Normally, this is covered under a specialist visit for insurance and for many insurance plans this is a flat fee.
Outside of a regular exam, any growth that has unusual size, shape, or color should be checked by a dermatologist, especially if it changes. My lesion was raised off the skin and red in color. It also changed and grew over time. If one can not immediately see a dermatologist, lacks insurance, or money for a visit, regular pictures of the skin blemish or growth can help track changes. If it changes, though, it really does require a dermatologist to look at it.
Lastly, dermatologists can and do make mistakes. In my case, my lesion was dismissed as a benign nevus at first visit. When I revisted the physician six months later, it was larger and was finally biopsied to discover it was melanoma. It is possible that the cancer metastasized in the interim period, but we'll never know. That said, if one is concerned about a growth and the physician defers, it is very simple to tell the dermatologist that you'd feel more comfortable if we biopsied the growth just to be sure. You don't have to be mean and I've never been refused. At that point, they take a small sample of the growth and send it to the lab. Then, you know for sure. Normally, the sample is taken by using a razor blade and skimming off some of the surface. It's fast, easy, and while not painless, it is not particularly painful. Generally, this is rolled into my specialist visit fee for insurance, but they may send an additional billing code to insurance.
Finally, dermatolgists can be difficult to schedule with. Honestly, their schedule is often filled with cosmetic procedures like skin peels and botox because it's so profitable. That said, any dermatologist can do a biopsy, so just call around to find one with an opening that takes your particular insurance.
I apologist for the side talk. I often find the whole talk to your doc discussion regarding skin lacks details, so hopefully this helps. Great to hear that the treatments are progressing.
Anyone know if there's talk of using this profilactically, like the HPV vaccine? (I realize that viruses != cancers, but IIUC hpv can sometimes lead to cancer, which is why I thought to ask.)
Looks like their is a level of personalization going on that requires actual existing cancer.
Melanoma in particular heads to the brain often and is difficult to treat. 10-15 years ago, it was a death sentence. Today, 60-70% of qualified patients will survive 5 years or more thanks to immunotherapy. A chunk of the 30-40% are folks who have difficulty tolerating the therapy, have poor response, or other complications. In my wife’s case, complications from brain surgery delayed treatment and the combo of mets and immunotherapy response created a bad situation.
Today, about 50% of melanoma tumors have a BRAF mutation, and a medication that can delay growth and buy patients time to get better in order to get treatment. In my wife’s case, that wasn’t an option.
COVID demonstrated that these vaccines bend the death curve, reduce severity and offer positive immune response. If that were available early this year, the chances are my wife would be alive, finishing her second course of immunotherapy.
I'd be curious to read more about long-term immunity issues if you have some links?
Moderna's research pipeline has been full of cancer medications, which seem to be very promising.
I wonder how they identify the targets in each genome. Is there an optimizing expert system? Generative AI?
[1] https://www.phrp.com.au/media/media-releases/two-in-three-au...
Seems to be a tad expensive, but also generalizable. Hopefully it can replace hormone therapy for breast cancers, and be extended to all common cancers.
But maybe not here - Moderna got a lot of experience with mass scale production in the pandemic. If they orient it here we could see biopsy based / pre surgical vaccination of cancer at mass scales which would require scaled out pricing.
Even if you strip out the profit motive, you still have huge amounts of skilled human labor
The profit motive is reflected more in terms of keeping high revenue producing processes inefficient to justify higher profits with the same margin. Medicine is replete with examples of processes that can be dramatically more efficient and widely available, but are not optimized because it reduces profits by reducing gross revenues. High margins invite scrutiny, high revenues invite investment.
It is similar to the California energy market, where electric providers are fixed, and rates are set by the sate on a cost plus basis. It should be no surprise that electricity production costs are multiple times higher than other states if manufacturer profit is capped at 8%.
Its not entirely clear such tailored processes can be easily automated.
I don’t know it needs to be industrialized to the extent producing ibuprofen is, but I’m not as bearish that individualized medicine can’t be industrialized and done at scale - especially if aspects of the tailoring can be programmable. Even if it’s not now - as scale increases, maybe technology meets that?
By the way you can in fact get tailored clothes produced through automation. Shoes, pants, shirts. There are products that will scan your body shape and an automated process produces a custom fit for you. They’re slightly more expensive, but I think the sales process is cumbersome and they never took off vs big box of throw away ill fitting garbage to cover our body with and throw away. That’s more a sad statement of modern culture than a limitation of our ability to automate and industrialize.
Because it is. DNA/RNA is the language of all life. Moderna is literally working at the language of life layer to produce their vaccines.
Side note: in the article, I find it a bit inappropriate that the first paragraphs only talk about the effects on the stock prices of both involved companies, before going into details of the research and how the vaccine works…
Science news go in the opposite order.
Also, misc side note: I keep reading the words "Madonna" and "Cults" in the title even though they're not there. Was very confused when I first clicked the link.