| ▲ | RomanPushkin 4 hours ago |
| Experiencing cancer in my family I can tell for sure all of that buzz is quite exciting, but in the last 5 years there haven't been breakthroughs that would significantly improve outcomes for an average patient. |
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| ▲ | slapshot 4 hours ago | parent | next [-] |
| There have been massive improvements in treatments in the last 5 years. Sure, cancer is far from being "cured" - but survival today is far better than 5 years ago for many forms. Among many others: - CAR T therapy going from lab to oncology suite (first launch 2017, but use rapidly growing) - Approval of Keytruda and similar for many additional forms of cancer (see the 2021-2026 milestones here: https://www.drugs.com/history/keytruda.html ) - Liquid biopsy going from lab to PCP's office - starting with Grail Galleri and moving from there (yes, the NIH results were weak, but the idea of a liquid biopsy at all would be laughed off 10 years ago) - Move of Atezolizumab and Tecentriq from infusion (hour) to injection (minutes) to increase availability - Lower dose CT scanning for lung cancer, including for non-smokers And a long line of immunotherapies that are making the leap from lab to chair right now. The last 5 years have probably been the most exciting in cancer research since the launch of the monoclonal antibodies in the early 2010s. There is still incredibly far to go, but the trend is in the right direction: https://employercoverage.substack.com/p/decline-in-cancer-mo... |
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| ▲ | parineum 3 hours ago | parent | next [-] | | 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? | | |
| ▲ | greygoo222 2 hours ago | parent | next [-] | | Short answer, no. Long answer, it's a variable you need to consider when doing data analysis, and it depends on what exactly you're talking about, but it's absolutely not true for improvements in cancer survival general. One alternative method is to look at per-capita death rates, for example: Reduction in US and UK childhood cancer death since 2000
https://ourworldindata.org/grapher/cancer-death-rates-in-chi... Reduction in several countries' age-standardized breast cancer death since 2000
(Why did it increase in South Africa? I'm not sure, maybe socioeconomic factors)
https://ourworldindata.org/grapher/breast-cancer-death-rate-... Reduction in global age-standardized cancer death rate since 2000
(Scroll down to second graph. Since the population is getting older, age-standardization makes a fairer comparison)
https://ourworldindata.org/grapher/cancer-death-rates 2000 is an arbitrary year I picked for clear visual changes without needing to haggle over statistics. If you want to feel optimistic, switch the childhood cancer death graph to 1960-now. This method has different possible failure points. It could be that less people are getting cancer, or that people who would get cancer are dying of other causes, or reporting of cause of death has changed, though this is very unlikely for some figures, such as leukemia death rates for children in the US. Statistics is hard. Overall though, the evidence is very good that cancer survival has improved a lot due to better treatments since 2000. If you have a more specific claim you're dubious about, I'd be willing to look into it for you. I'm very enthusiastic about this topic. | | |
| ▲ | parineum 2 hours ago | parent [-] | | I'm not exactly dubious about anything really, it was just something plausible I had heard a while ago and, while I don't recall where I heard it, I must have given it some credence for it to stick with me. |
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| ▲ | dsjoerg 2 hours ago | parent | prev | next [-] | | Cool question. What form would an answer take? We need some detection benchmark data thats invariant over the period of interest. I hope the data exists but I would be surprised. Another way to come at it would be mortality data. But that has a bunch of its own problems. Everything is changing at once, it makes this kind of science so hard. | |
| ▲ | inglor_cz an hour ago | parent | prev [-] | | IIRC survival improvement has happened across all staging categories, including the worst one (IV, distant metastases found), so the answer would be "no". A friend of mine, aged 50, has worked in pediatric oncology her entire (nursing) career. The ratio of surviving kids has flipped from 30/70 to 70/30 during her tenure. |
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| ▲ | RomanPushkin an hour ago | parent | prev | next [-] | | > CAR T it was available for [some] UCSF patients more than 5 years ago | | |
| ▲ | elcritch 40 minutes ago | parent [-] | | Now its available to many standard patients and for more types of cancers. Thats huge progress. |
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| ▲ | baxtr 3 hours ago | parent | prev | next [-] | | You seem to be knowledgeable on this topic. What’s your prediction for the next five years? | | | |
| ▲ | greygoo222 2 hours ago | parent | prev [-] | | 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/ |
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| ▲ | ImageXav 3 hours ago | parent | prev | next [-] |
| It may feel that way due to the iterative nature of medical improvements, but over the past few decades there has been a consistent reduction in cancer mortality rates across most types of cancer [0]. Treatments really are getting better and more targeted. Immunotherapy has made huge breakthroughs. Combination treatments allow for significantly improved lifespans and better quality of life during treatments. There are a few cancers that remain hard to treat, but I have a lot of confidence that in the coming decades we will make strides in attacking them. That being said, I'm very sorry to hear about the pain you and your family must be going through. I've had a few close loved ones undergo cancer treatment and it was tough. [0] https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac... |
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| ▲ | greygoo222 2 hours ago | parent | prev | next [-] |
| Examples aside, 5 years isn't long enough for a treatment to move from early mice trials to clinical use. The average time from application to FDA approval is about 10 years. The breakthroughs happening now will benefit average patients later. It's frustrating, but it's not because we've run out of innovations. |
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| ▲ | Retric 4 hours ago | parent | prev [-] |
| Major breakthroughs of the kind you’re talking about are extremely uncommon. Instead it’s lots of little gains that keep adding up because cancer isn’t adapting overall people still get the same mutations they got 10,000 years ago. So average person with cancer does better when any individuals cancer treatment improves and it keeps compounding over time. This doesn’t mean everyone with cancer gets a slight improvement, often it’s specific types or stages that improve without impacting others. Where general progress comes from is it’s not the same improvements year after year. |
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