My understanding is that of all cancer drugs approved by the FDA between 2000-2016 (around 90 drugs), the median life extension was just over 2 months...
That 2 months average is often driven by more people alive at the end of a 2 year trial.
Also, 16 years of 2 month extensions ends up being quite meaningful.
See https://www.nature.com/articles/d41586-019-00857-9 for more
Two months was from clinical trials where there's no doubt that the "thumb is on the scale" in a host of ways, creating an exaggerated estimate of efficacy that would be realised in the real world.
The reality is closer to no life extension, with the remaining lifespan is spent sicker than you'd have been without the drugs.
If you created a drug that shifted the ratio to 60/40, and measured right at the 5 year mark. In a population of 100 untreated people, you'd get like 4080 total months lived (80x36 + 20x60). In a population of 100 treated people, you'd get like 4560 months lived (60x36+40x60).
That's only generating an extra 4.8 months of life per person treated. However, you've doubled the number of people alive at the end of trial.
Now obviously this is a toy example that's probably a bit exaggerated, but this type of behavior is exactly why median/average life extension is an inadequate measure alone.
I dont think that is true at all. The data is pretty clear that lifespan is significantly increasing.
>Over time, the mean overall survival has improved from two months in 1973 to five months in 2015. Regarding long-term survival, a clear rise in 2yS is noted, increasing from 2.6% in 1973 to 12.9% in 2013 (latest year of which 2yS data can be calculated; Figure 1 and Tables 1 and 2), occurring mostly after the mid-1990s. A more modest increase is seen in the 5yS, from 0.7% in 1973 to 3.2% in 2010.
>https://www.researchgate.net/publication/348455938_Long-Term...
In general though, I tend to agree that in the US we spend far too much on what essentially boils down to performative end of Life Care. If you ask someone if they would rather spend $200k for 2 months or leave it to their family, I think most people would pick the second option. When someone else is paying, they choose the first option.
You're right, there are a small handful of unusual cancers that we have cures for, and that's great. And some small progress has been made overall. But a lot of money has been spent, and it has been half a century or more, and we don't have much to show for our efforts.
This is mind-bogglingly wrong for most cancers. Several death sentences have been turned into treatable diseases.
Yes, it would be better if we had more complete treatments but it’s far from nothing. I have a friend who was given 6 months to live a couple decades ago, right before a treatment for his not especially rare cancer was approved. He didn’t expect to see his daughter leave elementary school but is still around for her post college career – and as a scientist himself is keenly aware of how much hard work made that possible. We can simultaneously acknowledge that progress has been made but cancer is one of the hardest problems humanity has tackled.
You are right that progress is slow and expensive in a lot of areas.
It seems you are frustrated or angry about it. What do you want people to do? Are we not spending enough on research? Are we spending too much?
I think the skewed distribution is less relevant than the sample group. There are limits to what we can expect from medicine. We don't have improved survival after decapitation, but that doesn't mean surgery has been at a standstill.
It would be interesting to look up survival rates for earlier stages. I expect the difference would be more substantial.
It seems relevant, as a patient to ask, on average, how much longer will I live if I take this drug?
If you run a year long trial where you flip a coin and immediately kill or save people based on the results, your average survival will be 6 months
The may work better, but the drugs only run the studies to that threshold.
My mom died of lung cancer like 10 years ago and the immunotherapy drugs like keytuda all has those disclaimers.
Her pd1 wasn't a good fit, but some like Jimmy Carter responded really well
An exciting, underrated possibility: therapies in conjunction with each other, even if the therapies are initially studied in isolation. Single-agent chemo doesn't work for many cancer types, but multi-agent chemo often does. The same may be true of the small molecules, antibody drug conjugates (ADCs), and monoclonal or bispecific antibodies being tested now. I have squamous cell carcinoma initially of the tongue, and now of the head, neck, and lungs (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and I'm on a clinical trial monotherapy at UCSD called MCLA-158 / petosemtamab. But, if I live long enough, which isn't super likely but isn't impossible, there's a decent shot that the FDA will finally approve Moderna's mRNA-4157 personalized vaccine for melanoma—hopefully in 2025. If I can get mRNA-4157 off label and combine it with pembrolizumab (Keytruda) and petosemtamab (assuming the latter is approved, too), that combo may be much more potent than any of the three in isolation, and I've already failed pembro as a monotherapy and pembro + carboplatin + paclitaxel.
And if that combo doesn't work, or has some unexpected negative effect (including death), well, I'm going to die anyway, and the risk seems worthwhile.
As another commenter observed, the median can be skewed by the number of people who don't respond; among those who respond to a given drug, some don't respond, but some live surprisingly long.