Cure for cancer one step closer after 'spectacular' breakthrough
europe.newsweek.com
europe.newsweek.com
Cost effectiveness... well ipillimumab costs 100k a year for 4 doses, and nivolumab is probably going to cost another 100k at least on top of that, and is generally continued indefinitely, and the medication to turn off overly vigorous immune responses can also be expensive...
But this is modern medical science how it should be. These are incredible, life changing drugs. The hype is justified. They are already spreading through many different types of cancer: lung, renal cancer, liver cancer, some breast cancer, some colon cancers. Toxicity is an issue, but this is generally temporary, and the quality of life tradeoff is different when there is the possibility of making the next 7 christmases. Furthermore, you have to balance the toxicity with the symptoms from progressive cancer or old style ineffective chemotherapy.
I cannot imagine a chemical process to create those drugs that justifies the prices mentioned.
Is the price at least subsidising the costs of research, or is it an arbitrary price set by the drug company because "it can"?
There are solutions to this, and countries that are not mine will probably avail themselves of them sooner or later.
These aren't cheap to mass produce.
Edit: Not the best source I could find, but this cites costs (not at scale) :
http://www.immunochemistry.com/services/antibody-development
Even still, $25k/pill seems steep. That's roughly 10x the cost of pure plutonium.
:P
These biomedical companies are in business to make shareholders rich--it's just about the money. Maybe medicine has always been just about the money?
The prices most drug comapnies charge for their latest drug seem outrageous? Want a jaw dropper--look into Biomarin drug prices. Read their prospectus--it reads more like a hedge fund, rather than bio company. Oh, and one of their buildings is sitting on the San Andreas Fault. Found that last sentance interesting--I guess lawyers were being proactive?
But then again, I'm for government funded research, I would like to outlaw forprofit Insurance, and I have become a huge skeptic of modern medicine.
(As a side note; If you noticed your generic drug is not dropping in price like it did years past, you are not loosing your mind. Supposedly, large drug companies(companies whose drug patents are expiring, or expired) are buying smaller generic drug companies, and either shutting down the operation, or keeping the generic price, of the newly aqquireed company, artificially priced high. I believe congress, or the FDA is looking into this slick business tactic? It's completely legal now.)
We would see prices of antibodies go down if the manufacturing could be switched to something "not CHO" but the IP landscape is locked up by a company! They will expire in 10 years or so.
[1] http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014...
I would bet if these processes were carried out "transparently" we would find alot of waste and inefficiencies.
I get the feeling things will change once Silicon Valley finally decides to get more invested in the pharmaceutical industry.
It's a Monoclonal antibody, they are currently by far the most expensive drugs ever made.
They are very difficult to make, and almost impossible to make in bulk. It's not a chemical process, it's a biological one.
Unfortunately monoclonal antibodies are also some of the most promising drugs currently available. They can do things no other drug can.
It's really too bad they are so expensive to make.
Wikipedia[1] is full of jargon, but one caption says "Monoclonal antibodies can be grown in unlimited quantities in the bottles shown in this picture". So the process at least looks scalable. What materials/constraints can possibly cost $25k per dose?
[1] http://en.wikipedia.org/wiki/Monoclonal_antibody#Production
My mother, after an involved but seemingly victorious war with breast cancer, was then found to have stage-4 cancer on her spine. But as you said, modern medical science is pretty amazing. What might have been a death sentence 10 years ago is now just a chronic ailment kept in check by an expensive pill and occasional radiation therapy.
Amazing stuff.
That being said, these PD-1 inhibitors are a huge breakthrough for any type of cancer that uses this mechanism to evade the immune system. One of the hallmarks of cancer cell growth is their ability to evade the immune system. PD-1 (programmed cell death 1) is a receptor on immune cells like T cells that tells these immune cells to "stand down"/go inactive. Some types of cancer secrete molecules that activate this receptor, inhibiting the immune cells. Drugs like Nivolumab block these receptors, keeping the immune cells active, allowing them to attack cancer cells when they encounter them.
Metastisis (cancer cells spreading around the body) is what kills cancer patients, and drug strategies that can keep this from happening are key to keeping people alive. (Re-)activating the immune system against the cancer cells is a great strategy that's had some recent breakthroughs. Another recent breakthrough method, called CAR-T cell therapy (chimeric antigen receptor t-cells) also activates the immune system against cancer. In that case, they take immune cells out of the cancer patients body, use gene therapy to inject genetic material needed by the cells to recognize cancer cells, then grow those cell and re-inject them back to the body. This has been wildly successful in certain types of cancer, like certain leukemias and lymphomas, and may be successful for other types. Here is a nice article that covers these general strategies for those interested: http://www.forbes.com/sites/matthewherper/2015/04/20/immune-...
There have been a lot of breakthroughs recently. If we keep pushing like this we'll someday soon be fortunate enough to be legitimately surprised when a friend or family member dies of cancer, and many other diseases.
* It's almost 60% of advanced melanoma patients
* Advanced melanoma is difficult to treat
* Small-seeming improvements in lifespans for late-stage cancer patients can be very significant, given the lethality of late-stage cancer
* One of the two drugs, Nivolumab, also recently demonstrated effectiveness against advanced lung cancer --- another difficult-to-treat cancer
Reddit AskScience is probably a good place to watch for updates on this.
http://www.nhs.uk/news/2015/06June/Pages/Immunotherapy-drug-...
Some useful points:
> "Severe side effects were seen in 55% of those taking the combination, 27% of the ipilimumab group and 16% of the nivolumab group. The most common of these side effects were diarrhoea and bowel inflammation...Side effects of the drugs were also a considerable problem. After one year, only a relatively small proportion of people in all treatment groups were still taking the drugs. In the combination group people had often stopped taking the drugs because of side effects. It will be important to compare people’s quality of life while taking these different drugs and their combination."
...
> "Some of the wide media coverage of this study, arguably moves into the realm of hype. Much of the reporting could give the impression that immunotherapy is a new discovery. In fact it was first used in the late 1980s, and has been used in the treatment of various conditions."
...
> Overall, people taking the combination lived longer without the disease progressing (average 11.5 months) compared with either drug alone (average 6.9 months with nivolumab and 2.9 months with ipilimumab). People whose tumour displayed the protein that nivolumab targets (PD-L1), did just as well with nivolumab alone as the combination. The study is ongoing and it’s not yet known whether people taking the combination treatment live longer overall than those taking the individual drugs.
The novel therapies for melanoma are by no means curative in general, but they add a tremendous amount (relative to the overall life expectancy) and should rightly be heralded (and their cost debated).
as someone working in life sciences - years off, even with FDA fast track. the incentive to reap billions is justified, this is far more important than a fucking social sharing app - it better be more profitable. the best minds should work on a cure for cancer not bullshit timewasters.
biotech is the other big startup area of the modern economy. full of VCs, unicorns and abysmal failures. but, their blockbuster products actually help people. :)
And if that day comes, I certainly hope one of those replacement cures puts the greedy ones out of business.
On a darker note, I think your second comment speaks volumes about the kind of human being you are. I hope one day, years from now, you will take the time to come back to this comment and have the ability to reflect on just how sad your world view was at one point in your life.
On a lighter note, I agree that the best minds in the world should work on solving the hard / important problems of the world. With that said, machine learning / artificial intelligence (what alot of those "timewasters" are probably working on) will be what takes the human race to the next level. If you think "finding the cure for cancer" is next level, I am here to tell you we haven't seen anything yet. Machine learning / artificial intelligence is what's going to take us there.
The parent comment I was replying to seems to imply it would be a good / welcome idea for patent / stake-holders to be greedy and make billions in profits.
same for something that is a product that takes billions to develop and get approved, plus saves actual lives? how DARE I!?
resources in a capitalist society get allocated by rewards on efforts. i want the best resources working this, hence the incentives need to be spectacular. competing against HFT and other hot areas here.
If I am so blessed to be in a position that I have invented a cure for cancer, I am giving it away. At the most I want to break even. If I make a single penny from the invention I'm donating it to charity.
If you're motivated by profit, you should not be in the business of saving lives.
developing a cure for cancer costs real fucking money, gobs and gobs of it. you think clinical trials and FDA approvals come for free? ramping up a supply chain around it?
ever developed any product? ever?
But the place where I draw the line is when mega corp decides to hold the cure for cancer hostage until their profit demands are met.
My point is that: for anyone, either implicitly or explicitly, to say it's ok to look another human being, with terminal cancer, in the eyes and say "I have a cure for you, but you can't have it unless you help me fulfill the wishes of my stockholders (aka profits)" is evil.
How about use the money to invent the next cure?
Once you go that far you realize you can do a lot of good by having a business that helps people. Unlike a charity it's self sustaining.
If I'm diagnosed with a fatal disease, and I'm told someone has the cure, I don't say "hmm, I'd love to buy it, but that sounds too expensive". Instead I say "where do I sign, I don't care how much it costs, take everything".
Cures to fatal diseases are not products that can be given a real market value based on supply and demand since everyone who is ever told about the product who needs it is willing to give up all of their earthly possessions to obtain it.
From that perspective for someone to say "Hmm, yeah I'd love to give it to you but I'm gonna need more. You see my stockholders aren't gonna be happy if I only take all you own. It's clearly worth more than that." seems a little out of touch. In my mind profit is not the right motivation for developing cures for fatal diseases.
That argument doesn't work. Antibiotics can cure many fatal diseases, yet they don't cost all that much.
The reason is supply and demand, the exact thing you say can't be done.
The supply is that it's easy to make them.
The demand is that people can pick other drugs.
Other things that work into the equation is how much effort it took to invent it, and how many people get sick and need the particular medication.
Or in other words, market economics works just fine even for that type of treatment.
And elderly people refuse treatment all the time in order not to waste resources they want to pass on to their kids.
Competition is a form of supply and demand, so your sentence is contradictory.
It's still wrong, there are lots of patented medications on the market every year, many for treating fatal diseases, and they don't charge outrageous amounts.
I posted this earlier, maybe you didn't see, but this drug is a monoclonal antibody. That is by FAR the most expensive type of drug we have ever invented. That's the reason for the cost, not the patent. It will still be expensive even off patent.
The law of demand states that, if all other factors
remain equal, the higher the price of a good, the less
people will demand that good. In other words, the higher
the price, the lower the quantity demanded.
So let's consider a scenario. The drug is available on the market for $100. Will I buy it? Yes. For $1000? Yes. For $10000? Yes. For $100000? Yes. For $1000000? Yes. etc.. For $10000000000? Yes, but I can't afford it. Notice I never said no. The pharmaceutical company, the hospital, and the insurance company said no. I don't see where the "law of demand" enters into the equation.
I can't see how it is possible to shim "supply and demand" into a market where the only decision you make when purchasing is "If I don't purchase it, I will die".
On the other hand, simply through adding a competitor into the mix suddenly both parties need to figure out how to keep costs low so the consumer will pick them over their competitor. The fact that there's competition in the market place is orthogonal to the "law of demand".
In other words, no matter how many competitors exist in the marketplace there will always be the same number of people saying "yes" to the purchase. Exactly the same number of potential customers no matter how many competitors exist in the market. All of whom will purchase it if they can afford it.
Yes. I don't see how this is 'overpriced' in comparison to tech exits
http://asserttrue.blogspot.com/2013/02/taeubers-paradox-and-...
To give some background, your own body already tries to kill cancerous cells through cytotoxic t cells. The tumors that get serious are the ones that escape the immune system. However, strengthening the immune system has its own problems, since it can attack your own cells (autoimmune diseases), or cause other problems (like Crohn's disease).
So I'd imagine the cancer cells probably won't get immunity to the drugs, but other serious side effects could come from the treatment.
I'm presuming the 2 drugs themselves are patented? Otherwise I have a hard time believing 4 doses would cost 100k?
http://blog.ycombinator.com/new-hacker-news-guideline
"Critical thinking is good; shallow cynicism, on the other hand, adds nothing of value to the community. It is unpleasant to read and detracts from actual work. If you have something important but negative to say, that's fine, but say it in a respectful way."
https://news.ycombinator.com/newsguidelines.html
"Avoid gratuitous negativity." "Resist commenting about being downvoted. It never does any good, and it makes boring reading."
I've always felt that this was wishful thinking on the part of the mods. Discussions about downvotes (or completely legitimate questions as to why something was downvoted) are no more boring than hundreds of other topics discussed here every day.
I think the word is justified in this context however because the rationale behind immunotherapy is very sound, and it seems able to cure a non-negligible proportion of patients with otherwise incurable disease.
For $100,000.00
I guess the upsides are it does appear to be more than a month or two and the side effects are manageable.
There's some quote like "any quantitative value is qualitative at sufficient scale". $10,000 is the most expensive thing I've ever purchased--and I'm still paying it off.
Of course we all want the best treatment Right Now, and sadly some people will die who cannot afford a certain medical procedure or medication, but this still seems like a discovery and advance worth thinking positively about.
And, "true costs", of course, had little to do with it. Our economic priorities are heartbreaking. Little wonder, as our most important economic entities (corporations) are granted personhood, but would essentially be classified as psychopaths if they were actually human.
So it does seem expensive but from my experience it's cheaper than what we have now.
If you're talking about average effects, sure, it might be just a few months longer.