Fun fact: you can identify these drugs as Monoclonal AntiBodies due to the suffix -mab.
This category has been incredibly successful against a wide variety of debilitating illnesses like autoimmune, cancer etc. My doctor told me that surgery for arthritis is a dying specialisation in medicine, because the new drugs like infliximab are so effective.
The discovery of how to produce them got the Nobel Prize in Medicine in 1984, and the more recent discovery of how to tailor them via directed evolution got the Nobel Prize in Chemistry in 2018.
There is no cure for osteoarthritis because it is purely mechanical degradation of joints with aging. You get a lot of pain as your joints disappear. Most of the treatments are symptomatic (strong painkillers) or surgery (replacing joints with prosthetic ones). Very different from RA as a condition.
There is a solution for osteoarthritis, joint degeneration - it's by injecting your bone marrow, stem cells into the joint. A company in the US, Regenexx, has been doing research on stem cell treatments for 18 years now. Other places in the world have been doing stem cell research for 30+ years, it just hasn't become mainstream or widespread yet - so the knowledge isn't distributed well yet.
The evidence isn't strong for it either. The randomised controlled trials have very small n-numbers, are unblinded, have subjective primary outcomes. Needs a big trial to convince people it works.
You can see before and after MRI imaging of areas with injury and then healed. Obviously we have to define the process of what is being talked about when saying "stem cell treatment" and determining degeneration level of tissues, along with health of the individual - and therefore the health and potency of their own stem cells, are other factors to consider.
I'd say the bigger issue is filtering out the bad-greedy actors who jump into this space, who are piggybacking on the excitement generated from of word of mouth from patients who have benefit greatly - from clinics who have protocols they follow for what they know works and what won't work.
I have been getting stem cell treatments from a clinic in the US for a few years now to treat many different areas of injury (limited number of areas they can treat due to limited amount of fluid they have to use after aspiration and post-processing) and from my own experience, and that of speaking with other patients in waiting rooms (and even hotel lobby) who have returned for additional treatments - it certainly works, heals, regenerates tissues with the right protocol and condition. The most painful injection spot I had was a ruptured, torn disk, in my low back - I am doing that area again on the 16th of this month, as part of a number of areas, because it helped permanently reduce radiating pain from that area greatly; I plan to do an MRI of area a few months after this next treatment to have post imaging.
PD-(L)1 inhibitors are a special class though and help the immune system in becoming sensitive to tumor cells and start killing them around the body. Other MAbs like Bevacizumab (an angiogenesis inhibitor, prevents formation of new blood vessels) or Herceptin (Trastuzumab, targets the HER2 membrane protein often over-expressed in certain types of breast cancer) have been on the market for much longer and fall under so called "targeted treatments". The targeted drugs hardly ever lead to a cure, whereas the new immune drugs may even cure people from metastasized cancer (in 30 to 60% of cases in some tumor types). Be aware that the side effects of the new immune drugs may also be severe and mimic auto-immune disease-like symptoms, essentially you are forcing your immune system into higher gear (higher sensitivity, less specificity).
More importantly, the specific and incredibly successful class of immune checkpoint inhibitors(PD-1 inhibition is one example) got the Nobel Prize in medicine 2018, awarded to Tasuko Honjo and James Allison. See https://www.nobelprize.org/uploads/2018/10/advanced-medicine...
Summary: The death rate from cancer has dropping slowly but surely each year (at about %1.5-%16 rate). This last reported year was largest single percentage drop in that process - 2%. That could also be phrased as 98% of the deaths happened the previous year (2016) also happening that year (2017). Half-full, half-empty, etc.
So it's a blip but an encouraging blip. At the same time, the headline makes this sound much more extreme and excite.
Half-full - If the 2% rate is retained in 35 years the number of cancer deaths will be halved. Considering that 87%[1] of cancer-related deaths happens after 50 it is a very hopeful outlook for young people
Could it be that people are dying from opioid ODs, suicide, and other means that tragically cut lives short? Cancer risk seems to be a function of time and entropy. The longer someone lives, the more likely I suspect they'll succumb to cancer eventually.
That was my first thought, but the article specifically addresses that. It's due to improved treatments for lung cancer. Take lung cancer out of the data and the death rate improved by 1.4% last year, which is basically the same as the baseline 1.5%/year rate that cancer deaths have been dropping since 1991. If it were due to the opioid epidemic, you also wouldn't see that sustained drop over 3 decades - life expectancy in the U.S. has only been falling for 3 years.
I wonder if this drop can be attributed to the approval of pembroluzimab? Our oncologists speak highly of it and it got to market around the mentioned time period
Absolutely. They mention immunotherapy in the article, and pembro (aka Keytruda) is the best-selling drug in that class. Another big one that was introduced around the same time is nivolumab (aka Opdivo). Immunotherapy has really transformed certain parts of oncology (including melanoma, which they mention in the article as well), which is why some of the foundational researchers won the Nobel last year.
Long term, sure. Short term, you'd be looking at the link between air quality levels and chronic diseases like COPD, asthma, and congestive heart failure.
That might show up as an increase in the number of living people with these conditions.
The most significant variable is newer treatments though because the benefit is so huge compared to previous gold standard treatments that this variable cannot be ignored.
This article is short.. I don't understand how e-cigarettes (granted the liquid is not full of shitty chemicals) can not be an improvement. The carcinogenic compounds were said to come from tobacco combustion byproducts. Theoretically in e-cigarettes.. there's no combustion, only vaporization of nicotine and the liquid. So what's the link ?
There's no doubt that e-cigarettes are better than normal cigarettes. There's also no doubt that e-cigarettes are worse than no cigarettes.
However that doesn't answer the question whether they're an improvement. For that you need to look at what people who use e-cigs would do otherwise. And then it gets really complicated, because you really don't know and can only make estimates. That's why this is a question difficult to answer.
One trouble with e-cigs that prevents them from being an unmitigated win is that their aggressive marketing targeted towards children is highly effective at getting new users addicted to nicotine. This is a reversal of the trend of long term gradual decline in the use of tobacco-derived products (in developed economies, anyway).
On the face of it this seems unrelated to lung cancer rates, but there's concern in the public health community that some percentage of these users will graduate to smoking tobacco over time.
I don't think we really know whether those concerns will be borne out, or whether they'll counteract adults switching in time to save themselves.
I have trouble believing that people will actually switch from ecigs to actual cigarettes. Adjustable nicotine flavored steam vs cough-inducing smoke with possibly less nicotine?
I guess a cigarette is smaller and easier to use where there’s no electricity source?
I guess a small percentage might migrate, though, as always happens with anything where you _can_ migrate.
A small percentage would try regular cigarettes in the first place too. It will be interesting to see if small subgroup of bigger, new subgroup is larger than historical subgroup.
I would assume because people who have been smoking for years still have the associated increased risk of lung cancer and it'll take years for the people who are purely vapers to start making a statistical difference
It's hard to take this very seriously when the claim is that it's "only" due to advances in the treatment of lung cancer. Given that lung cancer rates are almost surely driven by smoking rates, and that the rate of adults who smoke regularly has dropped significantly over the last couple decades, how could the fact that there are fewer adult smokers not also be a significant factor in declining lung cancer rates?
To claim this is only driven by treatment innovation and not public policy changes is wildly misleading.
The rate has been declining for years, but this year the decline is larger than expected. They're talking about that increase in the reduction of the rate.
What's your point? The YoY decline in smoking rates since 1970s is not linear.
This stat is effectively meaningless without accounting for the rate of the US pop that develops lung cancer in the first place. If you want to measure treatment effectiveness, then the right measurement is something like '% of US population that develops lung cancer who are effectively treated/cured' and not 'overall cancer death rate'.
The fact this headline is so broad when it's really about lung cancer and not all cancers and doesn't account for any factors outside of 'treatment innovation' leads me to believe this was pushed by some healthcare trade group.
If you're interested in hearing a counter point to these types of medical "press release" articles, I can't recommend enough following Vinay Prasad on Twitter. Here is his thread about this report: https://twitter.com/VPrasadMDMPH/status/1215081457854468096
I personally think that part of the reductions are coming from foreign healthcare screenings (off the books) and/or a combination of early term options).
The cost for treatment [1] may have some considering alternate options for screenings and treatment after seeing someone elses experience/ordeal beforehand or reading about first-hand accounts online.
The reductions are absolutely coming from new treatments in particular immunotherapy.
When I started Med school 19 years ago the average survival of metastatic melanoma was 6 months, it is now closer to 5 years (ie basically remission). Many other cancers (including lung, which this article pinpoints as being the main driver in falls over the last 12 months) are now benefiting from the second and third generation of these drugs
This absolutely should be taken with a grain of salt.
First realize that these statistics are calculated via an entire field, known as “medical statistics” not surprisingly, that has enormous controversies inside of it.
Using a variety of mathematical calculations and formulas, they arrive at something called the “average death rate” that is supposed to massage out the differences between geographic regions and populations to determine the final number.
Devra Davis, Ph.D., M.P.H., wrote about this to tragic degree of detail in her book “The Secret History of the War on Cancer”. For background she was Director of the Center for Oncology at the University of Pittsburgh Cancer Institute and is still also a Professor of Epidemiology there.
The cancer death rate has not budged that much in 40 years. Survivability has extended, absolutely, and that is worth something, but not more than a few years. Compared to AIDS, a disease also without a real cure but that has extended survivability by decades this is unacceptable.
The amount of brilliant researchers driven out of the field, the failure of the Susan G Komen foundation to invest in actual research (this can be seen as more of a problem with the nonprofit industrial complex though and not per se cancer research), the null hypothesis requirement failures at NIH, and just the general climate of unethicalness and neoliberalism that began emerging in the mid 1970’s are all blamed, and there is truth in most of those arguments.
There is an old joke about how many white upper middle class cancer patients does it take to screw in a light bulb? Two, one to do it, and the other to write a book about it.
I go back and forth about whether that joke is inappropriate, and Mark Nepo is one such person who falls into that category but has written moving essays about the experience, but every time I read Barbara Ehrenreich’s “Cancerland” it makes me incredibly bitter. And I say that as a person who really likes Tony Robbins for the most part but who still is disgusted by the whole forced optimism cure through hope that the entire industry has turned into in lieu of actual breakthrough achievements. The fact that the latest and even somewhat exciting area of research in cancer treatment is the investigation on the role and use of viruses, a soviet innovation that has been investigated by the Russians since Stalin was alive even though they were mercilessly mocked for decades for this, is just tragic.
> The cancer death rate has not budged that much in 40 years. Survivability has extended, absolutely, and that is worth something, but not more than a few years. Compared to AIDS, a disease also without a real cure but that has extended survivability by decades this is unacceptable.
Ignoring the fact that cancer is a much harder problem than HIV, extending survivability is how the cancer death rate changes. Everyone who doesn't die by other causes would eventually get cancer because DNA replication can only happen so many times before accumulated replication errors trigger it. In a sense, curing HIV means more people will die of cancer (other things equal).
Also, cancer is not one thing. You have a particular type (like NSCLC), but also your particular genetic mutations may be unique or nearly so, affecting different combinations of oncogenes and tumor suppressors in different ways. This makes it extremely difficult to treat. Even broadly useful approaches like cancer immunology work better for some than others.
> There is an old joke about how many white upper middle class cancer patients does it take to screw in a light bulb? Two, one to do it, and the other to write a book about it. I go back and forth about whether that joke is inappropriate,...
IDK about inappropriate, but maybe find an outlet for your anger other than cancer patients?
There are lies, dammed lies and then there are statistics. The -mab treatments are amazing if they work as they are so targeted the impact/side effect ratio is amazing (getting Dupilumab for dermatitis, it is a miracle drug for me). But everyone hearing the good news about the cancer stats has to ask themselves - the US life expectancy has inched down recently so do these numbers square up with this probably more accurately measured life expectancy number?
Cancer death rates and overall life expectancy are both accurately measured and have been for decades. There's no reason to doubt either number. There's no mystery about the decline in life expectancy: it has been extensively studied and the major factors include increases in suicides, substance abuse, and obesity.
Sounds like one of the 'they're out to get us' conspiracy theories.
But even if I were to indulge in it, you know you can simply pick not to have treatment or pick your type of treatment (up to a certain degree). Nobody is forcing any specific type of treatment.
Sure, but it isn't a useful exercise. Presumably there are limits to the current new treatments, once we figure out what those limits are we will hit a new death rate. I expect to see that before 2050. Then we have to wait for the next new treatment.
It seems unlikely that there are an infinite number of great treatments waiting to be discovered. Most likely we are asymptotically approaching some non-zero minimum death rate. (note that the function is not linear, and we just saw one interesting step)
You think carbs cause cancer? Oh my, the anti-carb brainwashing is more powerful than I thought. If anything I predict there will be a future upsurge in some cancers (colon etc) if people keep avoiding carbs. We need fiber. Fiber comes from foods that contain carbs.
Let me offer an easy explanation: normal rates of annual progress in cancer treatment and prevention were compounded by (quite abnormal) decrease in life expectancy. Which naturally makes cancer, which correlates highly with age, less common. Basically, people are dying of meth or fentanyl before they get a chance to get cancer.
This possible explanation is explicitly addressed and debunked in the article as the reason for cancer deaths declining. As has been mentioned elsewhere in the thread, this is about immunotherapy.
Don't mean to be a killjoy, and perhaps this is stating the obvious for the HN crowd but this doesn't mean the broader rate of cancer is down; but that medical treatment has improved. The latter being more lucrative than prevention (at least for the med community).
I'd also like to mention, that these are deaths limited to cancer. Death is attributed to something else this stat will be affected. This is, in theory, you can "survive" cancer but die from something related to that condition and it won't count as a cancer death.
I'd liken it, somewhat, to war. Yes, less soldies are dying. But survival comes at a cost. No arms. No legs. Mental and emotional wounds. Etc.
I'm not knocking the progress with cancer; only providing some necessary context that's often missing.
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The point is, beating up data is easy. Be mindful of what you might be looking at, especially if the outcomes are good for an industy's well-being.
Here are some of the most widely cited studies of pembro in lung cancer that illustrate its clinical benefit:
Open label pembro vs chemo in first line non small cell lung cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa1606774
Development of PD-L1 biomarkers in 495 patient phase 1 study: https://www.nejm.org/doi/full/10.1056/nejmoa1501824
Pembro + chemo in lung cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa1801005
Pembro + docetaxel for previously treated lung cancer: https://mdanderson.elsevierpure.com/en/publications/pembroli...