My dad died in July 1996 from a nasty mole on his back. He would ask me to scratch his back and I remember being 8 or 9 years old and having to scratch around it as it was near the seam of his tank top (which likely aggravated it daily). And would make comments about it being "gross". We just didn't know what we know today.
He was drying off after showering one morning and got blood all over the towel from the mole. He went to the dermatologist and was told he had malignant melanoma. This was in September 1995 and he was in the ground before the middle of July 1996. Nine months to get his affairs in order. I remember driving around and seeing his old college pals (one of which I still see once a year or so for lunch to this day). I remember him buying a bag phone, a "car phone" so we could keep in touch as he drove from Eastern KY to Duke University for experimental treatments (I believe it was the one that led to the immunotherapy treatments used today). He told my mom even if it didn't help him he hoped it would help someone.
I avoid the sun with the exception of the back of my neck and the top of my hands. He has no clue (nor do the dermatologists) what caused it but, like other posts mention, likely sunburns in childhood.
I am so hopeful for this treatment and thankful for the progress made on the immunotherapy fronts.
Melanoma in adults is typically tied back to acute blistering sunburn events that happened before the age of 18 (as you seem to be aware). The most common sites of melanoma are chest and back in men and legs in women, areas that are more often than not covered by clothing and not in need of sunscreen.
Cumulative sun exposure on the other hand causes the other types of skin cancer - not melanoma, which this vaccine is targeting.
The most common chemical sunscreen ingredients cause cancer themselves and are wildly overdue for FDA review and removal (that has been held up for political reasons). For those who wish to wear sunscreen I recommend non-nano zinc mineral sunscreen such as Thinksport. Look for "non-nano" and zinc oxide (not titanium oxide, which is often nano in part and also a carcinogen) on the label.
> The most common sites of melanoma are chest and back in men and legs in women
> The most common chemical sunscreen ingredients cause cancer themselves
Both of these statements are out-of-date.
Recent studies show two different histological subtypes of melanoma for young adults vs older adults, each following a different common mode of presentation [1]. Melanoma in younger adults tends to present on the long limbs and is thought to have different contributing factors.
Also "common chemical sunscreen ingredients cause cancer" is a common FUD trope. Sunscreen reduces cancer mortality, full stop. Each person's circumstances vary based on their daily habits, geography, and personal/familial history.
Re: 'Also "common chemical sunscreen ingredients cause cancer" is a common FUD trope. Sunscreen reduces cancer mortality, full stop. Each person's circumstances vary based on their daily habits, geography, and personal/familial history.'
You didn't actually prove anything with your counter point here, as confident as you are - which is as confident to whom you're responding to.
At this level of ideological-indoctrination, it seems each person would have to actually participate [run and observe them] in the trials to see if certain ingredients cause an increase in rates of cancer.
How else do people indoctrinated into a belief, believing they simply know better - and must be right, than have people repeat clinical trials on animal models [or better]? Genuine question.
> Melanoma in adults is typically tied back to acute blistering sunburn events that happened before the age of 18 (as you seem to be aware)
I'm curious how this was studied. I feel like that's when everyone gets really bad sunburns because this has to be extremely hard to actually confirm. Doesn't everyone get sunburns when they were in this age category? It's when we are young and irresponsible, putting on sunscreen requires persistence on something that doesn't seem important in the short term (and arguably is a newer trend).
I totally believe that sun damage on your skin causes skin cancer but studying your choices in your younger years to later years seems quite difficult to confirm through research. Wouldn't they need to confirm adults that were diligent about putting on sunscreen their entire life, including when they were kids?
Re: "Melanoma in adults is typically tied back to acute blistering sunburn events that happened before the age of 18 ..."
With the practical advice to counter this being gradual increase of sun exposure to allow your body to build a deep layer of protection (tan) - of which sun screen will prevent, and then if you miss any spots and get full blast of sun for hours all of a sudden then those will be points of vulnerability.
Pharmaceutical industrial complex: create-advertise the problem, sell the solution(s) = profit!!
Note that your quote from GP only relates to melanoma. They also said "Cumulative sun exposure on the other hand causes the other types of skin cancer."
Its there evidence that the incremental tanning you describe actually protects you from skin cancer and will not cause other cancers? If not, this seems like a very reckless comment.
Melanoma is far more deadly than the other types of cancers. If building a base tan can protect you from the acute blistering burns that are known to cause melanoma, it may be worth it
At the same time make sure you are getting enough sun exposure to avoid bottoming out your Vitamin D levels. Low Vitamin D is linked to a number of bone and muscle issues.
10 minutes direct sunshine per day is said to be enough to generate a full compliment of vitamin D, and typically will not result in tanning. However, reduced exposure can be easily offset through diet or vitamin supplement.
> He told my mom even if it didn't help him he hoped it would help someone.
He did help. Absolutely. A friend was diagnosed with stage 4 melanoma 5 years ago, and she's in full remission today with an optimistic prognosis. Her life is possible because of researchers and people like your dad.
Tell that to my GP. Both my parents had melanoma, and they each had one additional type of skin cancer each. Their dermatologist is insistent that I get checked, but my GP doesn't think it's necessary, so my HMO won't pay for it.
My HMO pays almost 100% of in-network care with a referral (there is a nominal per-visit co-pay), so that at least wouldn't be an issue there, as long as I don't run into silly things like "The facility you visited was in-network, but Person X who did some of your care was an out-of-network contractor" which has bit me for emergency care before.
I'll try, but my 3 previous GPs, who were all better than my current one, are no longer in-network. Presumably the insurance doesn't pay well enough to keep the better doctors. It's a substantial amount of paperwork (both with the insurance and the new GP) with no guarantee things will be better.
For many people it is. They cannot see another doctor if they want to continue doing things like eating food. If they're lucky enough to be insured at all.
~20 years ago a young father on my block had a mole on his neck that ended up being a fatal melanoma. He otherwise looked so healthy.
He said it might have been from sunburns when he was in the Boy Scouts.
I will never forget the look on his face when I spoke with him, a look of bewilderment wrestling with anger.
His wife teetered with grief and confusion, trying her best to be strong while trying to bear the sickening reality that nobody could have prepared their family for.
I always get an annual dermatology checkup now because of him.
Please explain to someone that has never seen a melanoma - this person had a single 'mole-like' mark on his neck (presumably small?), and that alone killed him? or was it 'mole-like' and eventually got so big that it killed him?
Having a hard time understanding how something so small, and so easily removed can kill someone.
I have so many 'moles' on me, I wouldn't even know what to look for.
The concept you want to understand is metastasis. When a cancer metastasizes, it sends out cells that become cancers elsewhere in your body. One day just just have a little melanoma, the next day it sounds out cells that become cancers in other organs: your lungs, your liver, etc.
Some skin cancers, like basal cell carcinoma, never metastasize. Melanoma is one that will.
Think of metastasis as, that particular cancer evolving to a level where it can successfully break through the "impedance mismatch" of colonizing other tissue.
At that point it's more like multiple cancers at the same time, with the very cruel consequences of exactly how drastic that sounds :/
my late dentist went skiing, got a nasty cough, died 2 weeks later, lung cancer. no symptoms before. just a seemingly fit and healthy normal weight 30-something guy with a wife and kids. (maybe he inhaled too much enamel dust or who knows, the point is that humans are very bad at noticing these things on themselves/others.)
There are plenty of sources online to tell you what to look for, but my dermatologist sticks with "pink and brown makes you frown". Irregularly shaped with strange combination of pink and brown is a flag to watch out for.
I've had a couple basal cells (the way less scary one) and the easiest way to identify those is just look for a pearly pimple that won't go away.
The combination treatment has won U.S. breakthrough therapy and European Medicines Agency PRIME scheme designations, regulatory programs that aim to speed development of innovative treatments. Still, Hoge said that even with the new data it would be some time before the companies can file for approval of the treatment.
But also remember the other invisible graveyard - the people who aren't dead because they received ineffective treatments.
I do agree that drug approval processes need to consider the negative cost of delay, but in this specific case, from further in the article we see:
> Moderna is currently building a dedicated facility in Massachusetts to produce the vaccine at commercial scale, which it hopes to finish sometime next year.
> "We need to make sure that we have that near completion before we could even contemplate asking for approval," Hoge said.
And the reason for this is that you typically need to submit detailed manufacturing information as part of your new drug approval process. This allows the FDA assess how likely the drug you actually sell will provide the same benefits as those in the trial, as well as make sure you don't like... dunno forget to serialize stuff and ship out contaminated product.
to be fair, mostly because biology/pharmacology/medicine is vexingly treacherous.
but! generics can get easy approval, they need to show that their active ingredient is the same molecule and it has a very similar biological uptake profile, and that's it (at least in Europe, but as far as I know it's very much copied from the US process)
so that's not that high bar. and of course "big pharma" knows damn well how to change just some little thing to have a different-but-same molecule but with a few more years of patent protection.
(and again, yes, it's not that the process is super duper trivially applicant friendly, but the costs in the system are not in the filing.
it's mostly because there's no real common infrastructure for the whole end-to-end iterative process. there's a lot of separate cottage industries for each step, all charging a fuckton of money, all providing mediocre services, mindboggingly shitty software for managing trials/data/patients, no incentive to improve, doc/xls based workflows, you can imagine how inefficient and slow - and thus extremely costly - these specialized services can be, etc.)
I understand the temptation to blame the FDA when some exciting, revolutionary therapy seems to be slow getting approval.
In my case, the therapy that finally worked for my cancer was only allowed as third-line after I had gone through two rounds of heavy chemo. Now it's second-line, which means way less toxicity for those after me. In hindsight, I definitely could be angry they didn't at least try it on me before BMT.
But that's the problem, you only know what's safe in hindsight. Two-arm clinical trials are expensive and slow but they are the gold standard that continues to deliver countless life-prolonging therapy.
There is so much money being made in cancer treatment these days which in the US is all coming from private for-profit companies. One unsuccessful (non-toxic) trial I was in saw the company bragging about its progress in its annual report while the trial was still going!
The FDA is the only thing stopping these companies. Every time a standard-of-care treatment is safe and effective you can thank the FDA for doing the unglamorous work of holding these companies accountable.
But that's the problem, you only know what's safe in hindsight
That's part of the point: safetyism is a problem: https://en.wikipedia.org/wiki/Safetyism. If you personally want to wait until more data is in, then wait, but let the rest of take reasonable risks to move things along. I would, and want to, and suspect many others will too.
Every time a standard-of-care treatment is safe and effective you can thank the FDA for doing the unglamorous work of holding these companies accountable
Every time someone dies because the FDA has killed or slowed effective treatments, you can thank them for doing the unglamorous work of holding back progress. The dead aren't posting to Hacker News.
Give me (and others) the freedom to try. I'm a dead man walking anyway, which you don't seem to get, or acknowledge.
This is great news. We can always use better treatments. I had a case of metastatic melanoma (III-A) in my early 20's and the drug of choice at that time was interferon, which was not a particularly pleasant experience. There were experimental vaccines at the time as well, so these new vaccines have been multiple decades in the making.
As some unsolicited practical advice, yes, it's always good to protect one's self from the sun using long sleeves or sunscreen. However, melanoma can and often does occur in areas that does not receive sun exposure. This could be between your toes or inside your butt cheeks. As a result, it's worthwhile to have a dermatologist conduct a skin exam once a year. Normally, this is covered under a specialist visit for insurance and for many insurance plans this is a flat fee.
Outside of a regular exam, any growth that has unusual size, shape, or color should be checked by a dermatologist, especially if it changes. My lesion was raised off the skin and red in color. It also changed and grew over time. If one can not immediately see a dermatologist, lacks insurance, or money for a visit, regular pictures of the skin blemish or growth can help track changes. If it changes, though, it really does require a dermatologist to look at it.
Lastly, dermatologists can and do make mistakes. In my case, my lesion was dismissed as a benign nevus at first visit. When I revisted the physician six months later, it was larger and was finally biopsied to discover it was melanoma. It is possible that the cancer metastasized in the interim period, but we'll never know. That said, if one is concerned about a growth and the physician defers, it is very simple to tell the dermatologist that you'd feel more comfortable if we biopsied the growth just to be sure. You don't have to be mean and I've never been refused. At that point, they take a small sample of the growth and send it to the lab. Then, you know for sure. Normally, the sample is taken by using a razor blade and skimming off some of the surface. It's fast, easy, and while not painless, it is not particularly painful. Generally, this is rolled into my specialist visit fee for insurance, but they may send an additional billing code to insurance.
Finally, dermatolgists can be difficult to schedule with. Honestly, their schedule is often filled with cosmetic procedures like skin peels and botox because it's so profitable. That said, any dermatologist can do a biopsy, so just call around to find one with an opening that takes your particular insurance.
I apologist for the side talk. I often find the whole talk to your doc discussion regarding skin lacks details, so hopefully this helps. Great to hear that the treatments are progressing.
Thanks for the advice. I haven't had any type of skin cancer but will definitely keep this in mind since a lot of family members have had it in the past.
A friend's kid had a specific rare childhood melanoma that, when Googling, showed a 90% mortality rate. Thankfully that number is apparently before recent immunotherapy advancements, but it was pretty terrifying. This article is a happy click for me.
A little bittersweet for me, lost an uncle to this about 10 years ago...but still happy and a little inspired, proud of our species. I really hope ours is the last generation(s) that have to suffer through that awful disease.
I'm guessing that this vaccine is only used post-diagnosis.
Anyone know if there's talk of using this profilactically, like the HPV vaccine? (I realize that viruses != cancers, but IIUC hpv can sometimes lead to cancer, which is why I thought to ask.)
“The vaccine is custom-built based on an analysis of a patient's tumors after surgical removal. The vaccines are designed to train the immune system to recognize and attack specific mutations in cancer cells.”
Looks like their is a level of personalization going on that requires actual existing cancer.
Well, not really, what (mass) mRNA trials have shown is that they don't deliver long term immunity, and each time you give someone an mRNA booster the immune reaction gets more severe, until the point at which it might give them serious long term side effects or even, in severe cases, kill them. It doesn't actually make sense in most cases to use mRNA over traditional vaccines--but they have been producing fascinating non-prophylactic immunotherapy treatments with mRNA, where triggering a severe, and specific, immune response would lead to positive results (like with specifically targeted cancer treatments).
As someone who just lost the love of my life to complications of metastatic melanoma, I’d encourage you to tune out the naysayers and nonsense around these treatments.
Melanoma in particular heads to the brain often and is difficult to treat. 10-15 years ago, it was a death sentence. Today, 60-70% of qualified patients will survive 5 years or more thanks to immunotherapy. A chunk of the 30-40% are folks who have difficulty tolerating the therapy, have poor response, or other complications. In my wife’s case, complications from brain surgery delayed treatment and the combo of mets and immunotherapy response created a bad situation.
Today, about 50% of melanoma tumors have a BRAF mutation, and a medication that can delay growth and buy patients time to get better in order to get treatment. In my wife’s case, that wasn’t an option.
COVID demonstrated that these vaccines bend the death curve, reduce severity and offer positive immune response. If that were available early this year, the chances are my wife would be alive, finishing her second course of immunotherapy.
Facts speak, brother. People with your point of view are more likely to get a severe infection, more likely to die as a result of a COVID infection. If you want to be a 30 year old with the expected outcome of an 80 year old, you’re free to make that choice. I wish you well.
I prefer to keep stupid reactionary politics out of my medical care. I’d rather have my wife alive and for my son to have a mother. Fortunately, others will have that opportunity.
If you fail to notice that Pfizer burned all good medical practice when rolling out their piece of shit vaccine and constantly lying about its efficacy and lack of side effects there is, I am afraid, nothing I can do for you. Enjoy your mRNA vaccines my friend and hope for the best.
I'm unfamiliar with anything in this line of research -- the Covid mRNA vaccines haven't provided longer-term immunity, but that's not at all due to the mRNA, but due to the nature of coronaviruses, how quickly they mutate and how many different mechanisms they have for cell entry. "Traditional" vaccines were actually performing worse for Covid19.
I'd be curious to read more about long-term immunity issues if you have some links?
It is, in countries that negotiate price. The US is doing the equivalent of walking into a market where everyone else is negotiating, and taking the vendor’s first sky-high offer.
The short answer is, we sequence their genomes, identify mutations that change a protein sequence and are highly expressed, then run those all through suites of algorithms that predict how well they'll be presented to the immune system. (mostly neural networks trained on far-too-sparse experimental data). This prediction is the hard part right now - we still don't understand enough about how the immune system identifies and interacts with these altered peptides to do really accurate predictions of which ones will be most effective. Throw in that these tumors are actively suppressing the immune system in various ways, and it's complicated! There is lots of research going on, though, and lots of promising early results, like this one
How much of the end to end process requires artisanal human touch? In some future day, is there a chance of tailored mRNA is industrialized to the point that we go from biopsy to vaccine as a standard course of care?
Two out of three Australians will be diagnosed with some form of skin cancer at some point their lives [1] due to the higher atmospheric UV. This is going to prevent a lot of unnecessary death. Modern medicine is fantastic.
Weirdly, while this is not the first time i read about this vaccine, this is the first time i read an explanation about how it work.
Seems to be a tad expensive, but also generalizable. Hopefully it can replace hormone therapy for breast cancers, and be extended to all common cancers.
Didn’t see any pricing information? Sadly all incentives are to not make it less expensive and to simply extort the institutions on the payment side and give rebates to everyone who doesn’t have an institution to back them. Much of medicine is intentionally expensive to prop up revenues (and indirectly profits while maintaining a defensible percent of revenues margin).
But maybe not here - Moderna got a lot of experience with mass scale production in the pandemic. If they orient it here we could see biopsy based / pre surgical vaccination of cancer at mass scales which would require scaled out pricing.
Current personalized cancer "vaccines" arent really comparable. They typically cost millions and require the a team of scientists to harvest your cells and create tailored biologics to treat you.
Even if you strip out the profit motive, you still have huge amounts of skilled human labor
Yes, but that’s the beauty of industrialization. As scales grow, manual skilled processes become automated. I’m not asserting todays mRNA based on a sequence of a single virus genome is comparable - but that the process of industrializing as a skill is in fact a skill in an enterprise that once perfected can be applied to more complex domains.
The profit motive is reflected more in terms of keeping high revenue producing processes inefficient to justify higher profits with the same margin. Medicine is replete with examples of processes that can be dramatically more efficient and widely available, but are not optimized because it reduces profits by reducing gross revenues. High margins invite scrutiny, high revenues invite investment.
I agree with the march of progress and the hopeful commodification of new technologies. I also agree that there are a number of counterproductive incentives driving up the cost of healthcare. Regulatory capture and lack of payment controls means efficiency is not rewarded.
It is similar to the California energy market, where electric providers are fixed, and rates are set by the sate on a cost plus basis. It should be no surprise that electricity production costs are multiple times higher than other states if manufacturer profit is capped at 8%.
Hopefully, in a few decades: got cancer? Go for a biopsy, wait a week for a personalized vaccine. Even if some cells survive, mutate and start growing again, just repeat the procedure. Cancer becomes a somewhat annoying chronic illness.
Well, let's hope that repeatedly injecting people with mRNA over the course of a lifetime doesn't create other problems--I guess if the alternative is death, then there's nothing else one can do anyway
industrialization usually requires making the same product for everyone. E.g. back in the day everyone had custom fitted shoes, now we choose from pre-made sizes.
Its not entirely clear such tailored processes can be easily automated.
Programmable automation absolutely allows for industrialization of personalized stuff. It depends greatly on can the production of the actual mRNA be programmed flexibly enough to allow the last mile work non tailored but programmable. However the entire pipeline of collection, sequencing, and the planning of the mRNA can absolutely be fully automated. The last stages that may be manual can be industrialized in the sense there’s a repeatable process that can be compartmentalized into functional roles ala assembly lines.
I don’t know it needs to be industrialized to the extent producing ibuprofen is, but I’m not as bearish that individualized medicine can’t be industrialized and done at scale - especially if aspects of the tailoring can be programmable. Even if it’s not now - as scale increases, maybe technology meets that?
By the way you can in fact get tailored clothes produced through automation. Shoes, pants, shirts. There are products that will scan your body shape and an automated process produces a custom fit for you. They’re slightly more expensive, but I think the sales process is cumbersome and they never took off vs big box of throw away ill fitting garbage to cover our body with and throw away. That’s more a sad statement of modern culture than a limitation of our ability to automate and industrialize.
Moderna and its mRNA vaccines is truly magic. Like someone born 500 years ago - if they saw what Moderna was making, they would think this is God like power.
Because it is. DNA/RNA is the language of all life. Moderna is literally working at the language of life layer to produce their vaccines.
Side note: in the article, I find it a bit inappropriate that the first paragraphs only talk about the effects on the stock prices of both involved companies, before going into details of the research and how the vaccine works…
They certainly should, when one actually happens. Luckily most military members are (hopefully) smart enough to tell the difference between a real threat and some fake video popularized by Bret Weinstein or Alex Jones.
This is very neat! The effect has only been observed up to three years out, but this seems like it could become a pretty cost-effective option?
Also, misc side note: I keep reading the words "Madonna" and "Cults" in the title even though they're not there. Was very confused when I first clicked the link.
Get your moles checked.
My dad died in July 1996 from a nasty mole on his back. He would ask me to scratch his back and I remember being 8 or 9 years old and having to scratch around it as it was near the seam of his tank top (which likely aggravated it daily). And would make comments about it being "gross". We just didn't know what we know today.
He was drying off after showering one morning and got blood all over the towel from the mole. He went to the dermatologist and was told he had malignant melanoma. This was in September 1995 and he was in the ground before the middle of July 1996. Nine months to get his affairs in order. I remember driving around and seeing his old college pals (one of which I still see once a year or so for lunch to this day). I remember him buying a bag phone, a "car phone" so we could keep in touch as he drove from Eastern KY to Duke University for experimental treatments (I believe it was the one that led to the immunotherapy treatments used today). He told my mom even if it didn't help him he hoped it would help someone.
I avoid the sun with the exception of the back of my neck and the top of my hands. He has no clue (nor do the dermatologists) what caused it but, like other posts mention, likely sunburns in childhood.
I am so hopeful for this treatment and thankful for the progress made on the immunotherapy fronts.