As a dad who lost a son at 12 (2013) to bone cancer and as a brother who lost a sister at 15 (1996) to brain cancer I pray we will finally start funding pediatric cancer above the 4% rate of Federal Cancer Research and the 1% that American Cancer Society give to pediatric cancer research.
There has been 4 whole new chemo treatments in the past 25 years for pediatric cancer patients compared to the frequency adult community. The issue is that every cell in children is growing. So in an older adult you can more easily focus growing cells. What works for children will work better for adults with the probability of less side effects.
I work as part of a group looking for agents that target childhood cancers funded by the National Cancer Institute. We look for compounds that selectively target certain childhood cancer cell types while not affecting other childhood cancer cell lines. We have found some promising leads so far with great selectivity. I don't know what this comment is about, but just wanted you to know that people are working hard on it.
I appreciate and love all the researchers, doctors, nurses who are working on beating cancer and giving children their lives back.
I am angry at the LACK of FUNDS and thus the lack of new approved treatments for children over the last 25 years. There shouldn't be a need for St. Baldrick's and other organizations to fill the hole that left by the government, and non-profit cancer societies. They have left the children out of the cancer research and instead other's must step in.
I'm sorry to hear that. Cancer is horrible at any age, and I've never lost a family member as young as that to cancer, but I can only imagine that it must be even more horrible when its somebody you love that still would have had a whole life to live. We can only hope that child cancer research improves.
As a brother who lost a sister to juvenile brain cancer as well, I have been searching for methods of helping the folks working on the problem. Outside of brain tumor non-profit foundations, have you found other channels to help? I am even thinking leaving ad-tech to work in bio-tech.
St. Bladrick's is my favorite organization for funding for research and they actually helped fund a project that actually turned out to be a great new treatment for children with neroblastoma (Which has killed several of our friends' children).
Why is the funding so low relative to oncology research in general? Does the FDA not allow pediatric cancer therapies to be developed as orphaned drugs or is the growing nature of a child really make it that difficult to target pediatric cancers? Is it because cancer is far more common in the elderly who have much more political leverage?
I imagine there are multiple reasons why developing therapies for children is more difficult, but what would be the adequate level of funding? Less than 0.25% of cancer deaths correspond to patients younger than 20 when diagnosed (and I guess the low incidence is one of the reasons why developing new treatments is difficult).
It is 100% about the numbers. 43 children in America are diagnosed with cancer everyday. 5 children die everyday and it is the number one cause of death for children. 40,000 children every year are being treated. BUT that pales to just lung cancer with 610 diagnosis per day and 427 deaths per day.
I still say that is these are not a good reasons to keep the funding so low.
1) Treatments for Children are immediately beneficial to adults BUT treatments for adults would take at least 7 years but the cast majority they would be unlikely to be of any benefit to children.
2) Treatments for Children will also have less side effects and fewer long term side effects.
3) Children are at the age of around 6 years old when diagnosed and have 60 years+ of a positive life. 2% of lung cancer patients are under 45 years old and average age is 70 on the day of diagnosis.
4) Ethical: If you had a choice for your life to be saved or a child's life but only one of you can have could live what would you chose? If you saw a child about to get hit by a car but it was unclear if you intervene if you would make it would you just stand to the side? I think most of us would hope we would choose the kids. Why are we not doing this when we can actually sit down and think about it?
If it is all about the numbers, can anyone tell me the what is the threshold that a government is willing to spend to save a human life? What is the base threshold and multipliers for e.g. a US embassy-employee in Libya or a kid in Wyoming? I am sure insurance companies have some figures.
Every once in a while we get to read similar news, that this 'selective' cancer killer is just arriving. Can someone more knowledgeable in this field comment whether this is just another clickbait article or not?
I'm not that knowledgeable, but I've been following it.
My impression is that it's quite boring. Most treatments fail at later stages, and nobody talks about them anymore, some treatments are successful and get to market, what means that chemo for a kind of cancer now has less collateral effects, and a higher surviving rate. Nothing has a huge, world changing impact the press makes claims it would have.
Keep repeating that, and you get the nice increasing survival rates for cancer you see on the statistics... What is a huge world changing impact, but only in aggregate.
I am not a doctor, but from reading, there are many different cells and cancers (ways for these cells to misbehave but still not being killed by the body).
As such, there is no singular 'cancer' and no singular 'cancer cure'.
I may stand corrected by somebody more knowledgeable though.
Also not a doctor, but my dad has lung cancer (never smoked, just a "surprise, stage 4 lung cancer").
Specifically, he has the ALK mutation. This occurs in 3-5% of non small cell lung cancers.
He's on an inhibitor drug (a successor to Crizotinib) for this specific mutation. These drugs turned a ~6 month prognosis into a 5 year prognosis. But this set of drugs only works on this specific mutation. The cancer eventually mutates around the drug.
State of the art cancer drugs are really amazing, but they're still so far away from a cure.
Perhaps this is how we'll eventually manage cancer. By frequent testing and moving from drug to drug as cancer sheds one mutation and adapts other one, turning cancer into manageable state.
Fundamentally, viewing cancer as whole bunch of different adaptive adversaries as opposed to a single disease is probably correct. Under that view, consider 'cancer' as the mathematical outcome of the genes in the cells in your body attempting to revert to their fundamentally selfish nature and greedily replicate as much as possible. Every gene in your genome got there because its ancestor genes managed to replicate (though perhaps with a mutation or 2 along the way).
So perhaps it's helpful to think of the organism as a giant prison of small bits of self replicating code (genes). Several checks are in place to ensure that no bit of code replicates beyond sane bounds. However every once in a while a guard get's knocked out or cellblock door switch is left unattended, or a prisoner disguises itself, or groups up with another to overpower or sidestep an existing control mechanism. And then it's off to the races. Higher levels of control can attempt to rectify the situation, but they can fail as well. Given that your body has 100 trillion cells, and about 20 thousand genes. You are talking about a 2 quintillion protein synthesizing programs executing, all of them are there for one reason, they had ancestors that were able to reproduce themselves. They don't have any notion of a greater good, or a serving their purpose or any of that. They can't be reasoned with, they are an adaptive chemical reaction, that either doesn't replicate, or does (and perhaps so much so that it takes down the whole system).
So a lot of cancer treatment are going to revolve around, at our level of technology:
- the ability to target specific classes of cells with certain noisy markers, which may or may not be reachable and with a lot of collateral damage and which contain the errant genes and killing them. (e.g. clusters of cells showing up as a visible tumor in an x-ray, cells having certain chemical signatures)
- the ability to deprive (all or better yet classes of) cells of what they need to replicate to slow them down and potentially eventually have them die off taking the cancerous genes with them.
- the ability to shore-up or reactivate compromised internal defenses.
As well as prevention methods such as:
- avoiding weakening systems that protect against replication (e.g. )
- avoiding encouraging massive amounts of mutation (e.g. repetitive inflammation or free radicals or radiation exposure like UV rays or cesium-137 )
...etc
Are any one of these things going to cure cancer? No, they aren't anymore than telling C programmer to use strncpy instead of strcpy is going to stop all buffer overflow attacks, which in turn prevents remote code execution, which in turn prevents botnets. Or marking all attachments to emails as un-executable is going to stop all computer viruses.
But every bit helps, and saves countless lives, gradually this wack-a-mole approach has shown results.
In the future, perhaps it'll be possible to solve cancer by scanning every cell in the body and selectively eliminating cells that fail some basic sanity checks. We aren't at that point yet, but if we were we would have a pretty effective cancer treatment. It would be adding another (very effective) layer on top of all the other systems walking the day to day beat and slowing stuff down. I'd hesitate to call it a cure though, because if it was halted it would just be a matter of time until one of the selfish genes blindly do their replication thing a little to well for everyone's good.
I'm probably not more knowledgeable, but from my understanding, most (all?) cancers are related in that they start as a single mutated cell which replicates in an aggressive way which leads to problems / death.
Since it's a mutated cell, I can imagine extracting DNA from the cancerous area, and doing a diff against your "normal" DNA from elsewhere in your body. This would enable you to identify the difference / unique signature of the cancerous cells, kind of how a software antivirus looks for binary patterns in things that it scans. A mechanism like CRISPR could then be used to effectively target all instances of the mutated DNA / cells in your body, effectively wiping it out.
I suspect this is ridiculously hand-wavy and oversimplified, but something like this might just be viable in our lifetimes.
I think a very interesting research area is to find the core (original, required) mutations involved in a cancer (the current understanding is that normally multiple mutations are required, occurring in a particular progression).
> If a cell makes a mistake in copying its DNA during the process of division, p53 stops it in its tracks, summoning a repair team before allowing the cell to carry on dividing. If the mistake is irreparable and the rogue cell threatens to grow out of control, p53 commands the cell to commit suicide. Cancer cannot develop unless p53 itself is damaged or prevented from functioning normally.
The current hypothesis is that it is similar to bacterial antibiotic escape. Effectively the cells are growing rapidly and acquire mutations. This is why you want to treat with combination chemotherapy. However, there are some big issues. First, we only test drugs in isolation and then sometimes they will try two together after a long long time. This is how leukemia achieved high remission rates back back in the wild wild west days. Today there is a focus on targeted chemotherapies and then of course the holy grail of immunotherapy. I hope we figure out how to program the immune system to great effect. That and viral targeting therapies that use crisper. But these are early days and progress cannot come fast enough.
Basically this. Even though there isn't one particular cure all solution, there are many more treatments available which are more effective than in the past.
CAR-T therapy works in certain leukemias(blood related, hematological cancers). Yes, it works, but side effects can kill the patients due to cytokine storms. Recently, Juno therapeutics stopped one of the trials.
We don't have a general 'cure' for all kinds of cancers.
This type of therapy (engineered cells) has been discussed for a long time but has yet to hit the mainstream. This trial is the first hit at that kind of mainstream success.
The problems with this type of approach are 1. Safety 2. Cost and 3. Target.
Gene therapy (and engineered cells) has a long history of deadly accidents. Before we start injecting people with engineered cells we need to be absolutely sure that those cells aren't going to turn into cancer themselves (or who knows what else). Results so far have been promising.
This is niche personalized medicine, as a result it is extremely expensive. These cells need to be customized for each patient. However, considering what's at stake, it may be worth the it.
As the article states, the target is a problem. Leukemia and Lymphoma are easy targets compared to more truculent solid tumors. For this to cause a revolution in cancer research it needs to be able to address a wider swath of cancers (not just blood cancers).
Tl;DR : This is an incremental step along a new path. Another promising tool in growing toolbox.
There are several companies that are doing some interesting work in this are. Check out www.cuebiopharma.com. They essentially take a sample of the cancer, then generate antibodies from the patient to attach it. It is a simple injection, no chemo, no surgery. They have been showing very impressive results with this treatment. It will not work on all cancers though, I believe liver.
CAR-T-cell therapy is very promising but the salient quote here is this:
"You need a good target, and that's probably the biggest obstacle to this kind of therapy," Cohen said. "We found a good target in leukemias and lymphomas. In solid tumors, it's been a bit more evasive."
The target protein has to be exclusively associated with the type of cancer cell that the treatment is designed to kill. If it occurs in other types of cells, the results could be disastrous. Even successful immunotherapy treatments can destroy healthy cells, and researchers concede that achieving pinpoint accuracy remains a major challenge. Unfortunately, there have already been cases in which CAR-T patients have died.
This is always the problem. It's always hard to have pinpoint accuracy in biology, and hopefully we'll get better at it but it's a hard slog.
Also remember that while this is promising, remember that this approach is only going to work with surface-available targets. They won't work looking at cell-internal targets, which is obviously where a lot of cancer has gone wrong.
That seems to be the basic problem when dealing with cancer. As it is a core behavior of our body run amok, it is damn hard to stop it without also killing the patient in the process.
"Researchers have seen promising results so far, but there have also been tragic outcomes, with five patients dying while undergoing treatment during clinical trials this past year."
It would be good if they could explain if that was caused by this new treatment or if the cancer was just too far advanced when treated.
In general, I suspect they know. If the death was caused by the drug the patient should show signs of abnormal immune response, like those of a cytokine storm: https://en.wikipedia.org/wiki/Cytokine_storm
Also if the trial is allowed to continue, the study's monitors have decided that the study protocol wasn't violated, thus the drug wasn't 'misbehaving' to an unacceptable degree. Of course in late stage cancers with few/no further approved treatments, the decision of go vs no go on any course of action is often left to the patient and family, so 'unacceptable' can become a matter of will.
From all I've read, administration of immunotherapies of all kinds is tricky and often leads to treatment complications often due to improper administation of the drug or inadequacies in monitoring the patients' response, since most doctors (like oncologists) are inexperienced in recognizing early signs of abnormal immune response.
One research avenue would be using dialysis to remove cytokines. Ordinary dialysis does not remove much, but apparently there are some new filters that might work:
One hint inside was the strong side effects caused by the sudden cytokin toxin release due to the immune system metabolizing sometimes literally kilograms of cancer bacteria in a very short time.
I've kinda developed a thing against headlines that seem to announce something great and wonderful, but in fact are purely speculative. One way to lure in readers.
Maybe this problem is too hard for humans to solve. We've spent a long time trying to crack this nut. I am more bullish on Machine learning solving this problem quickly in the next 5 years.
Plant based diet has been proven to slow and even reverse cancer, but there's no money in it. It will take time but slowly doctors are beginning to acknowledge that our biggest killers are the result of what you put in your body.
There has been 4 whole new chemo treatments in the past 25 years for pediatric cancer patients compared to the frequency adult community. The issue is that every cell in children is growing. So in an older adult you can more easily focus growing cells. What works for children will work better for adults with the probability of less side effects.
Those interested int he history of childhood cancer here is a good short history and why we are so helpful for immutheraphy. https://www.stbaldricks.org/blog/post/the-history-of-childho...