I've heard that the improvements in cancer survival are mostly a statistical trick centered around earlier detection.

That people aren't actually living longer with cancer, they're living longer while we know they have cancer.

Is there any truth to that?

You seem to be knowledgeable on this topic.

What’s your prediction for the next five years?

mRNA cancer vaccines are the most exciting new treatment about to hit the clinic. Moderna's Phase 2b intismeran autogene randomized trial found a 49% (!!!) reduction in the risk recurrence or death for patients with high risk melanoma already on standard treatment. Several Phase 3 trials are underway. mRNA vaccines have the potential to work for a wide variety of tumors.

(95% confidence interval is 0.294-0.887, wide but not too wide, n=157, to be expected for phase 2).

How they work is also completely fucking insane. Intismeran autogene is personalized for every patient via sequencing their tumor DNA. That's sci-fi shit. If you're not impressed by that, you should be. Fast and scalable DNA sequencing, neoantigen identification, RNA synthesis, none of this is easy and all of it relies on recent innovations across multiple fields.

The first proofs of concept for personalized vaccines like this date back to 2017[1] or 2015[2]. The process for designing the vaccines requires a machine learning algorithm first published in 2020[3]. Details of the algorithm aren't available, but it validated against data published in 2019[4], and there have been many recent advancements in algorithms and datasets for biotech ML that it likely relied on. As you might already know, mRNA vaccines were first tested in humans around the 2010s[5].

[1] https://www.nature.com/articles/nature22991 [2] https://pubmed.ncbi.nlm.nih.gov/25837513/ [3] https://aacrjournals.org/cancerres/article/80/16_Supplement/... [4] https://pmc.ncbi.nlm.nih.gov/articles/PMC7138461/ [5] https://pubmed.ncbi.nlm.nih.gov/26082837/

https://en.wikipedia.org/wiki/Timeline_of_cancer_treatment_d... I won't debate what merits a major breakthrough. I will say, that while there hasn't been any major developments in the past five years, I can't draw any conclusions from that tidbit of information.

Both patient participation in clinical trials and compassionate use of experimental treatments are fairly common for cancer patients, with various accessibility barriers. (One issue with the latter, for example, is that the incentives aren't lined up for companies to provide unapproved drugs to dying patients, you're way more likely to get a horrible complication that leads to bad press than a miraculous recovery).

Here's an insightful blog series about Jake Seliger's experience participating in clinical trials. He was a regular HackerNews user who passed away in 2024: https://bessstillman.substack.com/p/please-be-dying-but-not-...

In the US, the FDA has a Compassionate Use exemption to clinical trials for exactly this circumstance!

There must be informed consent, no reasonable alternatives (which, in cases we deem terminal, is often the case), and some evidence pointing to the treatment possibly being helpful. It's an excellent ethical program that gives patients a choice and advances science.

Both of my parents have benefited from access to early medical trials. One is currently very late stage IV cancer. Access to trials is usually proxied through respected doctors/oncologists affiliated with major hospitals rather than offered broadly. I assume for reasons of experimental protocol and integrity the overseeing doctors are typically not the same as the conceiving research team.

Xenografted human tumors in mice != human cancer. The support structure of the tumor (tumor microenvironment) differs between model mice and humans, cells derived from human cancer that can be cultivated in a lab and xenografted differ from typical human cancer cells, and xenografting requires immunodeficient mice, just to name a few factors that affect treatment response.

Mice models of cancer are useful, but you should never be too surprised when something that works in mice doesn't work in the clinic, xenografting or no. Cancer is complicated.

Doesn't harm the mouse. But would it harm the normal human cells?

The cost absolutely matters. If something costs tens of thousands of € per month for a long time then it will either not be approved or will be used very rarely. The cost is not irrelevant because the insurance does not have infinite money. They need to decide which cures, medicines, operations they fund. They can spend 1000€ to cure 100 people of something or to spend 100k to maybe cure someone with an experimental treatment.

This is one of the issues with the modern cancer cures, thst they are very specific to the cancer, the patient, need one off lab work for each patient and this makes them very expensive and not affordable to many. Despite having public healthcare the managers of it still need to decide what to spend their limited funds on.

Yes? Countries that subsidize healthcare don't calculate infinite value per person.

> Other countries use insurance, so once again the end cost is essentially irrelevant.

I think it matters because oftentimes insurance companies won't cover treatments if a cheaper form of treatment exists. It doesn't matter if the old treatment is less effective or a much worse outcome for a patient. This is especially true for "new" treatments.

Of course it does. Countries have budgets. Expensive drugs aren't doled out like candy; they require screening, waits, connections, and even bribes.