Some context. One of the drugs in the combination Ipillimumab has been used for a while now, and seems to produce long term survival in about 10% of patients with incurable melanoma. Some of these patients seem effectively cured, having survived 7 years or more without any other treatment. It seems likely that combination therapy will produce a better rate of effective cure. This is a pretty big deal, because advanced melanoma is otherwise a disastrous cancer to have.
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.
>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...
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"?
Could you give a brief explanation (in layman's terms) of why they are so difficult/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?
The images are full of fluff. The bottles are only one step in the process described in the section after that, which includes a dozen or so complex steps, each of which must be executed perfectly. Doesn't look simple.
Actual c cost to produce is probably in the 50k range (still a huge markup). Its a biologic - There is lots of batch to batch variation and some batches have to be chucked if they don't meet QC.
Yes it is, and insulin is hard, but antibodies are even harder, mostly to do with the manufacturing platform "CHO". Also insulin is still more expensive than it should be due to patent ever greening.
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.
Aren't the prices for these drugs so high because they basically have to be made by hand? Since these small drug companies don't have any real manufacturing capabilities.
Let's not forget some people look at curing people suffering form disease as just an Investment?
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.)
> But this is modern medical science how it should be. These are incredible, life changing drugs.
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.
"Cancer" is a word that describes any disease that is the result of uncontrolled growth of your own cells. However, there are so many types of cancer cells and the treatment for each so different that saying we've "cured cancer" is a prime reason why the public doesn't understand or trust these miracle breakthroughs.
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.
> "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 phrase "cure for cancer" does a disservice in general, and even more clearly so on a site like HN where people generally speak precisely. (This is not intended for the person who posted the article - I know that HN guidelines recommend keeping the original title.) Inevitably side-discussions come up about whether something is truly a cure and then we get into discussions of the wording (I am currently guilty of this).
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 who lost a friend last year to skin cancer and has a work colleague with end-stage breast cancer that has spread to her bones - bring it on.
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.
My hunch is, the more greedy the patent holders are, the more likely, and the faster replacement cures will come to market.
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.
I agree, but with one caveat. It's only about greed if the patent / stake-holders make it about greed.
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.
so billions for FB/Instagram/CocaCola/Tesla - all justified.
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.
For someone to see a human being tortured by cancer, and for that person to turn around and say "one day I'm gonna make billions by inventing and patenting a cure" is evil to his core.
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.
I'm not anti free-market capitalism by any stretch. But I would argue that when it comes to life-saving medicine there's no real "market".
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.
I would argue that the reason antibiotics is inexpensive is not because of supply and demand. It's because of competition in the market. If a single entity owned the intellectual property for all antibiotics, my hunch is they would be quite a bit more expensive.
> is not because of supply and demand. It's because of competition in the market
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.
I found this excerpt that might be helpful to our discussion:
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.
you're completely clueless about what it takes to bring modern medicine to market. you argue from a moral high horse that has no bearing in reality.
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?
I'm not saying it's free to manufacture and distribute a product. So of course money has to be charged for a product on some level. I'm not saying "go bankrupt in order to manufacture and distribute the cure for cancer to the world".
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.
As far as I'm concerned, this whole back and forth is not about actual events happening in the world. This is a moral / ethical argument.
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.
In principle I agree with you, however I doubt it was a scrappy startup team of 3-10 scientists who will be reaping the billions, and I bet it will be incumbent pharmaceutical gargantuans who will earn the bulk of profits.
"scrappy" biotechs are the backbone of pharma innovation. genentech as the best known grandpa in that league.
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. :)
>after it's gone, after it's cured once and for all, this bane of human existence, this No. 2 Cause of Death, we will have extended human life a grand total of (drum roll, please) 3.3 years
I get your point, and it's a very dramatic and low statistic. But still, just taking the US, if all 320 Million people live for an extra 3.3 years, that's 1 billion total years of life given to people. A lot of books could be written, science done, or life shared with loved ones in that time. Not to mention all the misery and pain removed.
tldr: They studied two drugs in people with advanced melanoma, and the combination works better than you would expect: median survival for people taking both drugs was almost a year, compared with ~3 months for one of the drugs and ~7 months for the other. It confirms that the newer immunotherapy drugs are great, and save a lot of lives. It's not a new scientific breakthrough, as you might think from reading just the headline.
I'm guessing this just controls the tumors and prolongs their life? That is great but most people have serious side effects or the cancer becomes immune to these drugs. But we are headed in the right direction. My father passed away from melanoma a year ago. Since I have a high chance of getting this later in life, I'm happy that we are advancing this quickly.
I haven't read the paper, but according to the article, "The treatment, known as immunotherapy, uses the body's immune system to attack cancerous cells." Rather than trying to kill the cancerous cells, the drugs allow your body to attack the tumors.
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.
Based on the linked article from The New England Journal of Medicine would one be able to tell if this is a cure that will be patented by Evil Corp? Or are these researchers publishing these findings as "open source"?
I'm presuming the 2 drugs themselves are patented? Otherwise I have a hard time believing 4 doses would cost 100k?
"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."
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.
As a lay person, its hard not to see the word "breakthrough" as essentially meaningless as its so overused. Insulin, and the polio vaccine I can see in that category... But there have been so many drugs like Avastin (which sadly I had personal experience with through my wife's cancer, which were supposed to be breakthroughs.. miracles etc... Yet, when the dust settled and more data beyond the initial company reported data came to light, it extended life expectancy by very little time.... Our oncologist was pretty good about holding expectations in check. But if we went by the company's claims, we would have been sadly disappointed through false hope, as well as the VAST majority of people who took Avastin. Or Erbitux was another. It was offered to my wife as an option... The pharma gloss used all sorts of superlatives, yet for her cancer, it would have given her an extra few weeks based on some of the studies we were able to dig up. For the kind of money spent for (in some cases) really shitty quality of life, $100k might be better spent on improved hospice care and pain control for the person.
I agree with you that the word is overused. Avastin is most certainly not a breakthrough, I don't know any oncologist that considers it as such.
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.
If you google "Avastin breakthrough" (remember, we lay people have far more time with Dr. google), its still touted as this miracle drug, and is even being pushed as a treatment for non colon cancers of which there is little evidence it does anything... And remember, there are oncologists / doctors who lend their name to the company PRs... Its so sad to think someone would spend $20k on a useless drug, when $20k towards supportive treatments would go such a long, long way for quality of life :(
I know there are genuine big steps forward. The cancer that killed Terry Fox for example is so treatable now. And there are good and effective drugs out there, and some that are bullshit. But from the perspective out here, its difficult, sometimes very difficult to tell the real breakthroughs from marketing hype.
You're presumably referring to the 1000 mountains PhD comic (was XKCD). The difference with the immune drugs is that the immune system can recognize ~500 of the 1000 mountains (the most mutated cancers). So by getting around the immune-evasion system, the immune system can clean up most highly-mutated cancers.
FTA: The findings, revealed at the at the American Society of Clinical Oncology, and published in the New England Journal of Medicine, could save tens of thousands of lives in the UK alone within a decade, doctors say. Patients who could expect to live for just a matter of months under existing treatments, could see their tumours completely destroyed and go on to enjoy a normal lifespan under the new treatment.
If you're talking about average effects, sure, it might be just a few months longer.
Pretty sure that I speak for most humans when I say that a $100k medical treatment might as well be a $100m treatment.
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.
My traditional chemo was $20,000 for each treatment, twice per month. Much more expensive than $100k per year. I'm lucky to have insurance, so I didn't bear the cost. The insurance company paid a substantially lower amount for the treatment.
So it does seem expensive but from my experience it's cheaper than what we have now.
I am no expert, but I am guessing like with most things the newest medical technology starts of at it's most expensive point, then decreases over time (as economy of scale or improvements in production efficiency kicks in). So if this treatment is 100k now, but 10k in 5 years and 1k in 10 years (just postulating) it makes it very affordable for people 10 years down the track. Once governments add the treatment to their pharmaceutical benefits programs the cost at that time could be close to zero for a lot more people.
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.
Just caught part of the 2013 documentary, "Fire in the Blood", wherein pharma actively worked to keep affordable generics out of government programs in poor nations. Millions suffered and died nedlessly as a result.
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.
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.