(not a doctor, not medical advice, just connecting dots, please take citations to a highly competent practitioner in this specific medicine domain such as the oncologist care provider/team of the patient you are advocating for, this is simply due diligence to prevent potential blindspots, we are all just human)
I’m an amateur but have read a bunch about the new targeted therapies, like immunotherapy. Immunotherapy seems to only work in a small percentage of tumors with a lot of mutations. It’s easier to get your immune system to attack those.
There are other targeted therapies depending on the genetic makeup of the tumor.
BRAF, RAS, KRAS, NRAS, HER2, BRCA, …
Maybe start here. There’s an incredible amount to learn.
I actually wrote my thesis on this. Ovarian is very commonly studied for immunotherapy, but there isn't anything out there outside of the clinical research realms. The data is pointing more and more to solid cancers being much less responsive to immunotherapy than blood cancers. Unfortunately, I don't have good news for you here. We are probably 30 years away from having an IT medicine that doctors prescribe regularly. And even then, it will be insanely expensive
The article has a couple paragraphs about the complexity involved in fabrication and how labor intensive it is:
“Maus walked me through some of the steps needed to create CAR-T cells for the trial. We started with the room where the DNA instructions that are added to the T cell’s genome are written. […] We went on to the lentiviral-production room, where technicians create viral vectors carrying this DNA. From there, we moved to the tissue-culture room, where the vector is mixed with normal T cells to create the CAR-T. Finally, we visited the immune-monitoring part of the lab, where lab techs assay blood draws and other samples from patients, looking for proof that the CAR-T cells have made it to their targets.”
“Jennifer Wargo, a professor of genomic medicine at MD Anderson, referred to the cost of immunotherapy treatments as ‘financial toxicity.’ The patent for June’s CAR-T therapy for leukemia is owned by Novartis, and the median cost for the treatment is $620,000. Even if drug companies don’t try to profit from these therapies, the process is inherently labor-intensive: T cells have to be removed from the patient’s own blood, genetically altered, then reinfused. It’s difficult to determine where economies of scale might kick in.”
Half of that second paragraph seems to not belong there. Why rebrand "expensive" as "financial toxicity"? Why is profit bad when companies' losses are fine? It seems very strange.
Yeah, but that opens many more questions than it answers: this $620 000 figure cannot come out of labor intensity alone, as it represents the cost of thousands of work hours (literally a dozen of doctor full time for a month, or at least 50 well paid specialized technicians working for an entire month on each patient treatment) yet the process described in the text doesn't seem to match this level of labor.
This seems like a space ripe for intelligent robotics automation. Detailed, precise and laborious requiring years of not decades of technical expertise.
Biochemical engineering exists as a discipline and focused on “scale up” of production problems like these. Robots are involved, but most of the time the process is modified to a more stable one.
They are many different kind of immunotherapies, not all of them have to be patient specific. For cell or vaccine therapies a lot work is currently done to create "off the shelf" treatment which may ease the issue with car-t treatments.
My condolences... You should consult with their oncologist, but you could ask for Keytruda treatment. You should be aware that the immune response to a late stage cancer that results could also be dangerous, including high fever and delirium... Best wishes to you and your family...
I heard if you go to the edge of our flat earth, take a massive dose of ivermectin, inect yourself with bleach and dose yourself with light 1 billion times stronger than the sun you will be cured of everything.
Though that cure might be death as you fall off the edge and evaporate due to the strength of the light, but, hey your cured right.
This is an off usage of the items described above.
We did! When my oncologist team at UCSC declared my liver mets inoperable, we researched our way to a different group (at Sloan-Kettering) that had success with 75% liver resections and then the two groups worked together. So there is some do your own research that could be valuable - but it’s more along the lines of a second opinion, and there is no magic.
Ivermectin is an anti-parasitic that primarily targets worms and other invertebrates. It blocks an invertebrate-specific receptor, and is not known to have any other significant targets. It's great for that, and worthy of a Nobel prize. But it's not miraculous Jesus nectar.
What the hell kind of response is this? All they did was point out the typical use case and you presume they want people to die? Either you need a serious break from the internet or you're a troll.
You can't point to a single clinical trial that shows the drug has any effect.
If it did, it would literally be a multi-billion dollar windfall for Merck, a major pharma company.
Why would they have not done a trial? Why would Merck hold back?
Off label is absolutely a thing, but not a long-term thing. Ozempic was off label in use for weight loss, but you can be damn sure the second Novo Nordisk discovered the weight loss opportunity, they sunk a ton of money on studies to make it available with a prescription.
I'm pretty sure there's no real study that says any such thing, although I would not be surprised if you could find some garbage pseudoscience saying otherwise.
If there was, your family member's oncologist would have informed your family member of it.
Also, keep in mind that this article, like so many such articles, was probably a paid industry advertisement. I'm assuming by this time, everyone is aware of graham's submarine article.
Maybe it will change cancer treatment forever, but as far as I know, cancer patients still go through some form of surgery, radiation, chemotherapy, etc.
> If there was, your family member's oncologist would have informed your family member of it.
I have no insight into the OP’s case in particular, but this is objectively untrue in a large majority of cases. The percentage of oncologists who stay on top of and recommend clinical trials to their patients is in the single digits. One thing I’ve learned from following Jake Seliger’s excellent blog [0] is that cancer patients are often on their own when it comes to researching and applying to clinical trials.
> One thing I’ve learned from following Jake Seliger’s excellent blog [0] is that cancer patients are often on their own when it comes to researching and applying to clinical trials.
And, IMO, this mostly makes sense. There's very limited spots and eligibility criteria; we can't throw everyone in a trial. Filtering based on who is most motivated to go through the process makes sense.
The opposite, where oncologists enthusiastically convey the news of trials that probably won't work and offer false hope, isn't great.
The whole point of the trial is to get to the point where we know we can recommend this for more people.
1) To your oncologist, this is Tuesday. For you, this is the most important thing in your life.
You can spend WAY more time running things down than any doctor.
2) Medical trials are notoriously bad about being findable.
We have had several articles on HN about this. There are actually businesses that take money to chop through some of the red tape for you.
3) The average reader of HN has a much different skill set than the average doctor.
Certainly, the doctor doesn't have the same ability to crunch through data like programmers do. Nor are they likely as focused.
4) Doctors have a spectrum from excellent to sub par just like all humans.
The treatments are damn near miracles--when they apply. The other problem is that cancer, just like any life form, will mutate over time and generally becomes resistant to the treatment.
Nearing the end of life for a family member