New cancer drug kinder than chemotherapy

I am sorry to hear about your dog. Pets can be an integral part of one's family, which often (sadly) goes unacknowledged. My first dog died of hemangiosarcoma. There were no treatments besides chemotherapy at the time. From a cursory search, your dog's treatment appears somewhat reasonably priced. Scientific progress is amazing. I hope the treatments go well.

I actually worked with MGH on their first proton treatment software for non cyberknife proton treatment. Later scaled it into AWS so their dosimetrists could iterate on treatment plans much faster. The initial treatments were incredibly successful and much easier on the patient, but theres no miracle either.

Patients still suffer adverse reactions, and you will have margins of error, not to mention you do not have unlimited time to develop a treatment plan that is perfect. It's a time/efficacy trade off and the goal is to hit as much of the cancer as possible, while maintaining a SAFE dose of radiation, not a zero dose. What is a safe dose? Well, the more aggressive your cancer the higher that number gets too.

Some patients still receive high dose radiation while on proton treatment simply because their cancer is that aggressive, typically suffering the same grade 1-2 diarrhea and vomiting as any other form of radiation.

Proton treatment is far superior for most cancers, especially deeper cancers like colon and prostate.

It's a living example of how tragic a new treatment option is, unfortunately proton centers are expensive to build and take years. So many people are still passing away from treatable disease and having to endure high dose chemotherapy in other cases.

Worth noting here is that "proton flash therapy" is a new therapy, but "proton therapy" is not. Proton therapy is a lot more recent than x-ray therapy, but still a conventional therapy.

Flash therapy is the part is which just now entering clinical trials, where you treat the patient with ultra-high dose rates (so you deliver the same dose of radiation, but in maybe 90 ms instead of 90 seconds). There are indications that healthy cells are better at recovering from the ulra-high dose rate than tumor cells are, which means it would have a protective effect on healthy tissue, but the mechanism behind it is not known. The type of radiation is not specified, it can be protons, electrons, x-rays, etc.

So "proton flash therapy" is a Flash therapy that uses protons. Other clinical trials are using electrons instead, i.e. "electron flash therapy".

On the topic of interesting Physics contributing to new cancer therapies, there is also Boron Neutron Capture Therapy (https://www.neutrontherapeutics.com/about-bnct/). I gather the gist of it is that it builds up boron isotopes around a tumour, then bombards it with neutrons that mostly pass through the body but interact far more with the boron isotopes. Energetic particles are emitted, have a low range, and hopefully kill just the cancer cells. Apparently all in less sessions than with X-ray or proton therapy.

Disclaimer: I am not a doctor or medical physicist, I’m just fortunate enough to briefly use a machine intended for this purpose in separate nuclear physics studies. I believe BNCT has been done before with reactor sources of neutrons, but for some reason not as a standard treatment and there’s only one left in Taiwan for this purpose. The new development, afaik, is the ability to use accelerator neutron sources for this. Would love it if anybody knows more!

Is there a way to like emit energy in a narrow beam from a bunch of different angles around a central target such that they only overlap in the center/target and the frequencies resonate in that location in such a way to reach a higher frequency past which there is a destructive effect but below which is safe and non-destructive?

/knows nothing about physics

An inventor named Royal Rife experimented with destroying tumors by finding the resonant frequencies of the cancer cells.

I downvoted you mainly because Sabine is a font of misinformation in areas outside her direct expertise.

Particle beams for cancer therapy aren't new; shortly after the invention of the cyclotrone, EO Lawrence did this with neutrons in the late 1940s and proton beams were being used successfully in the 50's. She leaves out these details and only mentions trials from the 1990s.

Let me guess without looking at the video. Is it about the Bragg curve?

As someone in the industry you're 100% wrong.

These aren't "tiny wins". These are massive advancements in cancer treatment. And they're happening every decade or so, and added together is drastically changing outcomes.

This is one study.

"Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population."

https://jamanetwork.com/journals/jama/fullarticle/2598772

While I agree there wasn't much progress for years - actually now is quite an exciting time in cancer - new effective treatments are coming on stream all the time, with many more in the works - not to mention much better diagnostic tools.

There are a ton of challenges to better oncology treatments. First, as many have noted, cancer is a constellation of diseases. Often a single tumor will contain multiple different, but related groups of cells. So most treatments will only work for a subset of cancers, and then only until the cancer evolves to be resistant. So any advance, will be necessarily “modest”, the reality of the situation is that there will never be a silver bullet. The closest we’ve come is immunotherapies, the class of treatment described in the article. These are a legitimately incredible advance, completely curing many people without the side effects of chemo. That said, theyre limited because cancer can evolve to defeat the immune response, and occasionally the immune system either under or over-reacts.

Also if you think there’s no sense of urgency, you haven’t talked to anyone actually in the field. Do you really think oncologists (pediatric oncologists!) aren't eager to cure their patients?

My pet idea is that rather than targetting cancer, we should be trying to find and correct DNA-errors before they become cancerous. Otherwise we are just playing whack-a-mole with a slowly degenerating cell population.

>We’re eeking out tiny wins over decades,

I glean from many non-main stream sources (who are generally labeled quacks or naysayers, I have lost track of sources) :

- There have been almost no improvements in cancer treatments especially chemotherapy for _several_decades. Some sleight of hand involving some statistics and the fact that cancer can now be diagnosed in an at an earlier stage, means that the survival rate that is calculated by the survival of people Beyond 5 years of the first diagnosis, is higher.

- The primary approach to treating cancer (especially with chemotherapy and radiation) appears flawed. Cancer is a systemic disease so even if you destroy the tumor, you will have more of those propping up, because the body is already predisposed to creating them.

- It's a money making scam ( just like any other industry) that thrives in keeping a patient as sick as possible for as long as possible

-A lot of naive, but well intention people fall for the above three points mentioned.

Of course any attempt to even mention that people could be wrong would be retaliated with: you don't-care-for-people-dying response. Heroics generally trumps common sense

Molecular solutions are punch card science.

I really want to do whole-body clonal work. Our bodies and genes are machines, yet we still haven't put them to work. We're plastering over the breaks with crude tools that feel like modern day bloodletting. The blast radius in the transduction pathways is huge and imprecise.

I've written extensively about this topic on HN. Give me a minute and I'll dig up some references.

Edit:

https://news.ycombinator.com/item?id=35321368

https://news.ycombinator.com/item?id=32379247

https://news.ycombinator.com/item?id=30407908

I took blinatumomab in 2015 (in my late 20s). It literally saved my life. However, the risks of blinatumomab were seen as much riskier than chemotherapy. Most notably, blinatumomab has a significant risk of triggering a cytokine storm[0], a frequently-fatal immune reaction cascade. When starting a cycle of blinatumomab, the hospital required that I be inpatient for 7 days and they checked my vitals at least once every two hours. (This was _miserable_ for my sleep schedule, which is already a mess when in the hospital.) My regimen was 7 days in the hospital, then 21 days at home constantly connected to the pump, then 7 days of recovery time before starting another cycle.

At the time I took blinatumomab, I had already had unsuccessful treatments with two different chemo regimens. At the hospital system I was at, at least one failed chemo regimen was a pre-requisite for blinatumomab, as it was only indicated for "refractory" or "recurrent" cancers. I assume this is more related to the chance of acute death and (at the time) relative newness of blinatumomab compared to established chemotherapy regimens. (B-cell ALL is sadly very common in children, but this fortunately means that there is a LOT of funding research into the disease.)

After going through 3 one-month cycles of blinatumomab, it was becoming less effective, but I was able to line up a allogenic stem cell transplant which has (knock on a thousand woods) kept me clean for the 8 years since.

[0] https://en.wikipedia.org/wiki/Cytokine_storm

Literally, yes. On the NHS, they will exhaust cheaper solutions that have a fair probability of working before trying more expensive ones. Age, long term prognosis, whether they have dependents, and some other factors are also considered.

It'll be substantially cheaper in the UK.

That poison chemo was and is a vast improvement on puberty-killing radiation, for instance. It’s a spectrum

dumb question... is it purely the demand that makes it this expensive? The "you need this or you die" aspect? Or is the cost of research and manufacturing for this stuff so astronomical that it warrants such a high price?

I almost don't want to even know... if I find out it costs only ~$5 to develop a dose, and they're charging $200k to dying people... ugh

I’m new to this idea and NOT educated in biology let alone oncology, but here’s a meta study that suggests early exposure to famine is associated with increased cancer risks, if tenuously: https://www.sciencedirect.com/science/article/pii/S127977072...).

Of course looking at the effect of famine on an adult populations would do more to investigate your hypothesis than the effect on developing children.

But famine seems a bit extreme, no? Aren’t there also regional studies that show regional dietary/nutritional factors that correlate with lower cancer rates?

Life was not good for people who ate traditional diets. https://jacobin.com/2015/05/slow-food-artisanal-natural-pres...

Chemo has tons of well-known long term negative effects. The idea with replacing Chemo with Blina is that it has a measurable similar short term effect (get rid of the bad cells) with less (so far) long term effects.

Usually the cancer cells are throughout the body, even if the tumors themselves have not spread. This is why you might cut out a solid tumor, and then give chemo

Antibody drug conjugates are one attempt at doing this. Basically attach chemotherapy drugs to molecules (antibodies) that bind only to proteins on cancer cells

In particular, this is a treatment for leukemia; a blood cancer.

When my dog had a subcutaneous form of cancer, one treatment discussed was local injection of a chemotherapy agent in the tumor area along with electrochemotherapy to help make the tumor more susceptible to the chemo treatment.

We opted for surgical removal instead.

https://en.wikipedia.org/wiki/Electrochemotherapy

Things like that are done where we can figure out how to get the drugs there. Not an easy problem though.

There's "topical" chemo for some stuff, but it's uncommon. Most chemo is either in pill form, or (as was for me) delivered intravenously. So it goes through the whole body.

Radiation therapy can target specific areas. It's still used instead of chemo in some cases.

As I sit here getting chemo for B-Cell ALL, most of us don’t have any other option, it’s chemo or death.

My own immune system is attacking my joints. Without treatment I'll be disabled within 10 years. What's your advice doc?

It can be preferable to having your body slowly town apart by its own immune system.

Theres a field of auto-immune disorders, where patients suffer from their own immune system. I believe they would disagree with you.

Yeah okay. I could have chosen to die instead. Think that would have been better?

Can you speak from personal experience? Not meant to be a rhetorical question, just wanted to give you a chance to elaborate.