Just another overpriced less than impressive drug. Just another study bought and paid for by the company who produces the drug. I would recommend to anyone with cancer and would like to live without being chemo'd to death, radiated or drugged to extinction - look at the Trophoblastic theory of Cancer. Look at how "immuno therapy" can be done very easily from home with the right foods and lifestyle changes. Its so sad that cancer is just another way for the rich to make their money. Rockefellers snuffed Amygdalin treatment in the crib in the 70's when their own dr. Kematsu Suguira at the Sloan Kettering Institute proved there were naturally occuring substance that could not be sold as a drug that kills cancer cells.
1
I am a nurse working in hospice. There are people I know who by the paradigms of even five years ago would have probably been in hospice care by now. But they are getting a new lease on life through immunotherapy. I thank Dr. Gandhi and her colleagues.
15
I wonder. Is any research going into small cell lung cancer? It appears not, although states won multi-billion dollar settlements to care for those with small cell lung cancer. Appears that no one is ever held accountable for anything anymore, but the states and the FDA and CDC should be ashamed of themselves.
5
There is, but SCLC is not as responsive to Immunotherapy as Non-small cell. Still, some patient that get Opdivo+Yervoy or keytruda can do very well
1
i am 69 and have lung cancer, i had surgery where they found 2 small spots and i had the lower right lobe removed. After weighing in on chemo from the oncologists that after 4 months of chemo it would only increase my chances of recurrence by 5% the decision was not to do chemo. It is very hard to have a constant niggling in your head that old mr. cancer would be rearing it's ugly head somewhere in my body within the next 5 years. i wonder if these types of treatments would help me in anyway with better odds or do i have to wait until it comes back? thanks xx
4
I would encourage you to ask your oncologist that question, and let him/her know you are worried about a recurrence. Maybe (s)he could reassure you. I hope it won't recur.
Be aware that even if you were to undergo chemo and/or take one of the newer anti-cancer drugs, your cancer could recur. Facing our mortality is uncomfortable, but in my experience, it gets easier with time to cope with medical uncertainty.
I hope you have family, friends, and/or a counselor to lean on. Social support is so important.
6
Where is lung cancer not related to smoking coming from? For this disease, the treatment is iffy and expensive. Good to hear of progress but prevention will involve decreasing pollution levels and will be resisted by Congress since it could affect profits gleaned by major campaign contributors. I could mention some names.
1
Totally agree with your point, but I want to add that the #2 cause of Lung Cancer is Radon (a point that is probably brought up many times in other replies..). That 1 day test in the basement (when you buy/sell a house is directional at best). For best results, use one of the (cheap, inert) 90 day tests, that you can stash in your basement, then mail in for results...costs about $20 total.
4
On the same day that Denise Grady reported the good news that immune therapy is helping some lung cancer patients live longer, Fortune Magazine reported a 10 per cent hike in Merck’s stock, its investment in Keytruda “paying off in spades.” With a cost of $100,000 per year, one wonders how the bills will be covered equitably for those on employer-based insurance, Affordable Care, Medicare Part D and on Medicaid, especially at a time when states are putting the lid on drug expenses for residents it funds under the federal plans.
Will there be a fair system for getting the drugs, heavily advertised so Merck can get back its initial outlay and more, to the 154,000 patients who contract lung cancer per year? One way to establish an equal playing field is through a SINGLE PAYER option which would oversee the costs and benefits so that everyone has the same chance at getting the latest medications. Such a plan is the New York Health Act (A4738 S4840), fully vetted by financial experts and under consideration this year in the New York legislature. All state residents will be covered for all medically necessary services: primary, preventive, specialists, hospital, mental health, reproductive health, dental, vision, hearing, and PRESCRIPTION DRUGS.
See https://www.nyhcampaign.org/.
13
I was in an intern in 1980. An 80 year old man was admitted to the hospital. We all visited because we had not seen many 80 year olds. The CCU was full of 50- 60 year old patients dying of heart attacks every night on ventilators. I took a friend to the ER recently having chest pain by ambulance. He had a stent placed and his heart attack stopped 14 minutes after arriving in his street clothes. In 1980 it was morphine and hope for the best. In my time there has been a 40% reduction in mortality in death from CV disease. It would be better if everyone was not supersized now
2
What accounts for the reason also NYTimes ovelook Oncological Terrain-Dependent Inherited Real Risk, bedside diagnosed from birth and removed by inexpensive Reconstructing Mitochondrial Quantum Therapy? As a matter of facts, of the two sides of the diagnostic/therapeutic coin, the physicians and media around the world know only that of diagnosis/therapy of the overt disease, that often cannot be healed. I emphasize the other side, i.e., that of the diagnosis/therapy of the potential disease. Such apreventive therapy the best in absolute. Why the general silence?
There are scores of peer-reviewed studies showing cannabis inhibits or reverses cancer but no ongoing studies in patients because of the government’s prohibition on carrying out cannabis research in the U.S. This is shameful and medieval. https://www.nationalgeographic.com/magazine/2015/06/marijuana-science-dr...
5
There's also a strong link between long-term marijuana use and schizophrenia. Mary jane isn't as benign as some would like to believe.
4
"Adding immunotherapy to standard chemo treatments can halve the risk of death..." This summary statement which introduces the article fails to state - for how long the risk of death is reduced, and fails to provide information about the quality of life.
Pleased to see the comments which caution about the first breakthrough report funded by the pharmaceutical industry.
4
How many people have the HUGE cost of these treatments? Most have large deductions with their insurance which can bankrupt them, make them sell their home etc and all for a few more months of life. Is this what we have come to in the treatment of cancer?
7
Not to throw cold water on this huge, breakthrough discovery, but isn't the real question this: why isn't our own immune system already taking out early cancers? ANS: because our stressful lifestyle is overproducing the immune suppressing hormone cortisol. Now, that's the right question.
4
Immune system sometimes cannot recognize malignant cell types because those cells can 'mask' the proteins that the immune system would other recognize.
3
The company that makes the very expensive “miracle” drug paid for the study?
No conflict of interest there, right?
3
The immune-activating drug was a checkpoint inhibitor called pembrolizumab, or Keytruda, made by Merck, which paid for the study.
When I read that sentence, my enthusiasm plummeted. Industry funded research has a nasty tendency to arrive at a conclusion favorable to the industry. Tobacco, sugar, opiates, climate change and on and on. Industry research is not generally concerned with elucidation as much as it is with profits, IMHO. Which really sucks as I am stuck with lung cancer.
8
Low dose naltrexone works similarly for several types of cancer, but has no side effects and is cheap. But I guess there's no hype when there's no profit.
2
A longer life doesn't always correlate with a better life. The urge to stay on the planet is a strong one, but books like "Better" encourage us to think about the ramifications of the treatment decisions we make.
To all of you who have cancer who are posting here: I wish the treatment options you have at present were better, and that trying to decide how to address your illnesses were an easier process to navigate. Best wishes to you and your families.
5
I am immensely grateful for those researchers and scientists who – day in and day out – spend their time developing treatments and cures for myriad conditions. Though I am concerned that the cost of some of these new treatments will be prohibitively expensive for most people, I am hopeful that – as a society – we will find a way to make them available to everyone.
6
There is no downside here. Every case, no matter the expense is the ultimate experiment. Things will be learned not just from the cases in which Immunotherapy works, but also in the cases where it doesn't work. It looks for sure that using the bodies own defenses to fight cancer is the right path.
As late as the 1940s/1950s there was nothing medical science could do for Heart disease, many of the most famous people of the time died of sudden heart attacks, Clark Gable, Tyrone Power, etc , even the most famous American of the time, President Franklin Roosevelt died of a stroke, due to high blood pressure that his doctors had no answers for. Today we can treat high blood pressure in many ways-we have seen a radical change in this branch of medicine but it didn't come cheaply, and one breakthrough came from another, and the ideas like Stents were derided as unsafe in their beginning stages, but new technology and new ideas led to situations where it is the norm, for a person who is having a heart attack to enter the Hospital, get a stent and within a few days going home perfectly fine, the same person who would have surely died 50 years ago. The first step in any progress is the first step in the right direction, from that point-every next step brings you closer and closer to the cure but the key-is to keep walking.
5
Immunotherapy is helping many of us with melanoma as well. I think the treatments will improve and save many lives. Thank you researchers!
6
Humanity will definitely find a cure for every cancer some time in the near future including the ones caused by Tobacco such as NSCLC. But it is our responsibility not to start that first cigarette, and tell our posterity not to start that first cigarette. Granted Tobacco is one of America's first agricultural exports and helped place it in pre-eminent nations of export. But the time has come to globally bury that crop just as we permanently buried the last vial of Small-pox virus in a secure freezer.
6
There is a lot of lung cancer that has nothing to do with tobacco.
5
True, and we should remember that. Many other diseases treated with drugs now could be prevented by lifestyle changes.
However, let's remember 2 points:
1) Not everyone who has lung cancer got it from smoking; some get cancer as a result of exposure to environmental toxins that they may have encountered unknowingly or had to choose between giving up a job or home or taking the risk;
2) Once someone has lung cancer, heart disease, or whatever,they should be treated the same as anyone else. People should not be punished for poor choices. None of us makes good decisions throughout our lives; we've all done stupid, self-destructive things. Please let's not blame the victims. We have a moral imperative as human beings to alleviate suffering whenever we can. And many of these people have children or others who love them and depend on them, in spite of their foolish habits.
8
Reading the NEJM article, I get that the the 20 month survival in the treated patients was estimated to be ~10% vs. 0 for placebo patients, in this group of highly-selected patients with metastatic lung cancer. There may be reason to hope that immunotherapy may be helpful for some cancer patients, but seems premature to trumpet "longer life!" with this incredibly expensive therapy, particularly based on a small study that has very short endpoints and was funded by the pharmaceutical company. Appropriate for the NEJM, maybe not so much for the NYT.
8
The other business/treatment model is not immunotherapy drugs but personalized/ targeted immunotherapy such as removing some immune cells from a patient then targeting them to that patient's particular cancer cells, growing them to sufficient numbers, then infusing them back into that patient. See CAR T cell immunotherapy.
6
Indeed, this is an amazing procedure. Likewise, the use of a patient’s own stem cells has shown to be effective in the treatment of a variety of conditions. For example, stem cells that have been “coaxed” into healthy heart muscle can be injected into a patient who recently suffered a heart attack, essentially repairing the damaged areas.
3
Note that the drugs discussed in this article are still in clinical trial. They may not live up to the promise in phase III trials. Their future use may be restricted.
Developing new drugs is expensive. Companies like Merck spent billions of their own dollars on promising candidates taking great risk. I just found this post:
"Doubling down on the Keytruda franchise, Merck pays $300M and promises $5B-plus to partner with Eisai on its budding cancer star"
source: https://endpts.com/doubling-down-on-the-keytruda-franchise-merck-pays-30...
That is not profit. It is money bet on a horse that may or may not win.
It does not seem NIH is contributing much to Merck's investment. The agency pumps billions into having the genomes of a million Americans sequenced. I doubt that this will be of much help in understanding why for some patients a multitude of diverse side effects outweigh benefit. Moreover, 'Repeal and Replace' is not going to pay for any of this.
Instead of blaming greedy drug companies for the cost of health care, we should closely examine how the federal government spends taxpayer's billions.
8
Agree!!
While I see the value in not blaming drug companies for being "greedy," its worth noting that virtually every major drug development stands on the shoulders of enormous public investment in research done at universities across the country to which private companies have access. Applying the isolated risk-taker model to drug companies that we continue to perpetuate with dubious "self-made man" mythologies isn't particularly helpful either. I get your point, but your narrative ignores a large swath of the story that continues to spread the cost of risk across the public while enabling massive private profits.
4
Big Pharma is investing so much in research to protract for a few months the lives of cancer patients.
So many new drugs are lately coming on the market and are being widely publicized on television promising miracles .
I am for serious research aiming at cure and real prolonged survival of patients.
When research only objective is pecuniary, I am skeptical, also because very few patients will be able to afford the new therapies and health insurers will try to deny payments for theses new drugs .
More emphasis , more regulations and more investment should be put in prevention and on making therapies already available more affordable.
Let’s not forget the recent scandals of so many “ old drugs “ whose price has been astronomically increased by unscrupulous predatory practices of Big Pharma . Remember epinephrine pen for example ......
4
This study shows an improvement of FOUR MONTHS.
Strike one.
Quality of life during those 4 months was not measured.
Strike two.
The study was paid for by the manufacturer.
Strike three.
Immune therapy is for sure the future in oncology and many other fields but this is not it. Quoting doctors for anecdotal results is a poor service to the community and is anathema to science.
15
Studies into cancer survival must start somewhere and four months is statistically significant. Ball one.
That will be a baseline for future comparative studies as other therapeutic agents are added, or subtracted. Data wins. Ball two.
The government would not fund this research and so the company has little alternative. A review of the NEJM article looks as though academic integrity has been preserved. Implying author bias is a serious allegation of academic fraud. Ball three.
Anecdotal results and opinions by recognized experts are not published as peer reviewed articles in scientific journals. The NYT is proper in quoting the opinions of those who are learned and familiar with the issues. Ball four.
7
A truly breakthrough treatment would be one where the statement "CURE for the majority of cases and a CONTROLLABLE condition for many of the rest" is made. Anything less is simply false hope and propaganda to make money.
3
Yes, if we can’t have everything we want, right now, there’s no point in trying to combat this terrible disease.
6
These comments are littered with so much cynicism. The discovery of checkpoint inhibitors has been a truly great leap forward in the history of oncology. Are these pioneering drugs perfect? Nope. Nobody is claiming they are. Do they have horrible side-effects in some patients? Yes, nobody is claiming they don't. But surely anyone with even the most basic understanding of what they CAN do is able to see that this is a staggeringly impressive progress in our understanding of cancer biology? I think that the discovery of checkpoint inhibitors will go down in history as one of the seminal moments in medical science. Manipulating our immune systems to fight cancer? It's genius. In fifty years the scientists who invented these molecules, and the patients who enlisted in their clinical trials, will be revered as heroes.
25
All the above may be true but a 4 month improvement in survival will not allow these patients to see the real future of immune modulation.
1
I was tempted to respond to the cynics and critics but choose not to wallow in negativity. My wife is a beneficiary of immuno-therapy. Renal cell, stage 4, metastasized to lungs and brain= no cure. Her original urologist gave her a 5-10% chance of long-term survival. I remember bicycling with her early on and wondering if the day would come where I would give everything to ride with her one more time. It is a roller coaster, but immuno medications, abetted by a kidney removal, brain surgery, stereo-tactic radiation and here we are 5 years later, happy, a long future before us and planning to ride our bikes this afternoon. Don't tell me it wasn't effective or worth it! The difference? My wife's sunny attitude and realistic attitude. "Cures" are a process and winding path. PS I just volunteered for a clinical trial for an Alzheimers drug, preventative, to give back to the others who came before us in the development of ground breaking medications.
18
As someone sitting at the presentation of these results at the AACR Congress, I agree. Those mentioning an average (actually median) benefit of 4 months are underinformed. The challenge is that some patients do extremely well, and some patients do not benefit at all. When you combine results like that, the overall effect can seem modest. Another big theme of this Congress, not mentioned in the article, is trying to understand the differences between responders and non-responders to immunotherapy, so that in the future, only patients who are likely to benefit will get the drug.
8
For 60- 70% of the people being encouraged to undertake this therapy, the results are to make the remainder of their already brief days a mess of suffering and failure. Huge expense when millions of people go without basic health care. No thanks.
7
Universal Medicare. Guess you missed the recent discussion about whether curing diseases was even a tenable business strategy that should be pursued. Great idea if we quickly puts the brakes on the Republican Party's destruction of all safeguards against environmental toxins. But we will pay dearly for the corrupt Scott Pruitt, not just his insanely paranoid and lavish spending. Addiction treatment services that include alcohol and tobacco and vaping devices and smoked hemp products would save millions and lives and money indeed. I'm weary of cutting patient's tongues and lips and lungs and jaws out from the use of these products. Oh, and breasts.
2
The business pages are hyping the clinical trial success of Merck's pembrolizumab product for lung cancer. Add it to chemo and you get almost 70% one year survival rates. Well, that's something.
But: a year and a half after treatment, the cancer returns in 75% of patients. And almost 100% of patients get side effects: nausea, anemia fatigue. And a course of treatment costs $150,000.
Now: we have a vaccine for lung cancer. It's called tobacco prevention. It costs way less than that. It has no bad side effects. It also prevents heart disease and non-cancer lung disease. And it delivers way better than a few months of low-quality life. It delivers 10 to 15 years more life, and higher quality of life for your entire life.
I'm happy that patients got some help with Merck's new product. But late-stage intervention like this is the most expensive, least effective thing you can do. Tobacco prevention, and specifically policy change, is the most effective, least expensive thing you can do.
11
The problem with your statement is that people that have never smoked or used tobacco develop lung cancer. Some, actually, from alcohol consumption. It's well documented. I would wholly support any efforts to incarcerate or otherwise punish those that smoke in parks or public areas, in any building or area where animals or humans live, however. Second hand smoke is also a factor in some lung cancers.
7
True, but don't forget my mom's mom Pearl and dad's dad Jack, who both died of lung cancer, and never picked up a cigarette in their lives.
2
Those evil drug companies---spending billions to develop life-saving treatments---and then having the gall to charge money to recoup their investment and fund the next generation of therapies.
The government should confiscate their ill-gotten gains !
10
and it only costs a jillion dollars a month.
live long and prosper
2
Please Please watch this amazing documentary- HEAL
The cure is not by poisoning the body with chemo treatments and radiation !
Many cancer patients has adopted a new approach and full recovered. We need to step out of the box and less funded Drs, pharmaceuticals and big Corporations. Wake up America!!
1
I just read about 80 Amazon reviews on this movie, and sorry but most aren't as persuaded as you are. It also doesn't sound like the film focuses on "cure", so much as "healing", which is a different concept and can be realized in the absence of cure. Also, it is very anecdotal, as even your comment implies ("Many cancer patients"). You could, by the same logic, pick cancer patients who were cured by Western Medicine, however few you may believe them to be, and use that as an argument to say "Wake up non-believers in Western Medicine". The truth lies somewhere in the middle, and I would use meditation and good thoughts as part of my fight against any disease, along with whatever the best docs I can find want to push into me.
7
https://nyti.ms/2b2KRvs
Please maintain some perspective and healthy skepticism before accepting results like this as reproducible and magnificent as the oncologists (who should know better) quoted seem to think this is.
7
Most people who smoke don’t get lung cancer (or any of the other smoking related cancers).
If it was easy to quit then no one would be smoking.
No other cancer diagnosis, when revealed, has the follow up “did you smoke?” rather than “I’m sorry”
Let’s stop looking to blame people for getting lung cancer. Let’s stop having patients w/lung cancer who never smoked feel they have to qualify talking about their diagnosis with an “I never smoked” as if that would eliminate the risk. The stigma, blame and shame get in the way of research funding, support services and emotional support from others that lung cancer patients deserve and need.
45
Thank you for your comment. It's painful enough to deal with illness without the extra burden of blame/guilt.
15
There is no other addiction anymore that is "treated" by will power and guilt. Some people, try though they will, can not quit. I'm not one of them but I love someone who is.
9
The article did not mention the side effects associated with this new treatment, so I am annoyed that my time was wasted.
Stupid to completely leave out the most important information.
7
Pmac: They did briefly mention side effects. Reread the article.
1
I have known several people with immunotherapy for lung cancer and melanoma. The side effects were awful, the quality of life they said was not really worth it...blindness and uncontrollable bowel movements. I don't know what the prevalence of these side effects are but for these people it was bad.
5
Please address whether they were phase II participants or after toxicity tolerances had been subject to greater assessment.
8
These were not phase II participants.
3
Over $100K is too much for a simple amount of drugs. I mean think of the people who dont have that money and they were soon going to die?
These doctors should think about people who dont even have money but still have lung cancer. What on earth are they supposed to do then?
10
Mohammed: What on earth are they supposed to do? The answer: die. Drug companies don't care about people.
Look at how they jacked up the price of Epipens.
1
At this very moment, my beloved wife lies dying next to me. The only noise I can hear, besides her belabored breathing, is the humming of an oxygen concentrator machine. She was diagnosed with NSC long cancer 27 months ago. We tried a combination of chemo, radiation and Opdivo immunotherapy. All seven treatment modalities failed, and at great cost in terms of horrible suffering, not to men money. (She was never a smoker, BTW.) we discontinued all non-palliative treatment last September.
In January, the tumors spread to her eyes, rendering her blind, a particularly cruel symptom for a librarian like my wife. She has been unable to walk or feed herself for the last two months. Her mind is mostly gone and she has trouble remembering my name after 16 years of marriage.
So, please be more careful about raising hopes regarding immunotherapy at least in it's current form. We are now praying for death as a deliverance. Nine of us will "survive" in the long run, and quantity is most certainly NOT always better than quality of life. Take heed, dear readers...
63
I'm so sorry.
22
Prayers for her that she has an easy passing.
6
I am so sorry your wife has suffered so. How fortunate she was to marry such a wonderful partner. I wish peace and rest for your wife and for you.
14
My oncologist said the prices charged by many providers are a fraud and the only insurance entity(company), who stand up to them is Medicare.
12
Let me start by saying: I hope everyone gets the treatment and cures they need, whatever the cost.
But when I read:
"The findings should change medical practice immediately, cancer experts say: Patients with this type of lung cancer should receive the new type of treatment, immunotherapy, as early as possible after the diagnosis is made."
..alarm bells go off.
And then when I read that the study was funded by the drug maker itself, the pieces all come together.
I'm sure there is good science here too and people will be helped, but let's remember that the nonpatients most excited about this are the same people who are selling it.
Drug makers were behind the push to prescribe opiates too (https://www.jsonline.com/story/news/investigations/2018/01/28/past-inves... among many articles and sources) and look how that turned out. I'm not saying this is the same, I'm just saying, let's be a little bit conservative given the source.
18
Any idea how much these trials cost to run? Who, other than the drug maker, would you expect to pay? The government? The patients?
1
Who else do you think is going to fund a drug study if not the manufacturer?!?!
I'll give you a hint... practically no one.
Sure, maybe NIH will fund a study once in a while for something developed in-house, but otherwise, the vast majority of drug studies are funded and carried out by the manufacturers as part of the development process (both the R and the D in R&D). That's why it's so expensive to bring drugs to market. These are the studies that inform when and how drugs are used and they are required for FDA approval.
I get your natural skepticism, but please educate yourself before you cry conspiracy. That a drug like this could now be a first-line therapy means that people will be able to get the drug earlier in their disease course, before they've wasted precious time and energy taking older, less efficient and less safe chemotherapies.
4
It is so sad to see comments from people that haven’t had to experience cancer and believe that it is all fixed and rigged to large Pharma. 6 months ago I lay in a hospital bed with tumors in my lung, liver, adrenal glands, femur, skull and sinus (origin of my cancer) and my wife and I were preparing power of attorney and discussing with medical team hospice options. That same week I started Nivoluamb, our Hail Mary option as we called it a then. But as a father of two kids under 4 years I was going to do anything and everything possible. I was lucky to have great insurance that covers it all after my deductible. I’m alive today because of this wonderful drug. Six weeks after planning for hospice care I went back to work and have been working 5 days a week for the past 5 months. I know things can change in a heart beat, but I got another shot. It may not work for all, and the medical community knows this and are working to make it successful for others. I was told there was a 13% chance of success with risk of serious side effects, I said bring it on. Maybe I’m lucky, almost no side effects and all tumors have shrunk. I still do treatment every two weeks and long may it continue.
176
What a wonderful story. Best of luck in your continued treatment.
35
Thanks for wring, Good Luck!!
12
I'd like to know how these immunodrugs work in lung cancer patients who also have autoimmune disorders, like rheumatoid arthritis that require immunosuppressants.
7
I think that would disqualify someone from the clinical trial.
5
"One study on the economic burden of lung cancer estimates that the overall costs, from diagnosis to a maximum of two years thereafter, to be about $46,000. The study found that the main cost drivers were hospitalization (49% of costs) and outpatient office visits (35.2% of costs), with a monthly initial treatment phase cost of $11,500 per patient."
Now add $100,000 per year.
We have over 7 billion people on this planet. And we will all die of something.
Can we learn to face our mortality with peace and serenity? We need age limits on these expensive medical treatments.
11
Julie...that’s a stunningly heartless comment. You should hope that you never are struck with a disease like lung cancer. My wife died two years ago from this disease. We tried many treatments, but the disease was relentless. She had many years ahead of her with me, her children, her grandchildren, et. al.
The disease caused her unrelenting pain,,but, perhaps you think that she should have just sucked it up and skipped those costly pain killers.
Oh, I suspect that you’re thinking, “she shouldn’t have smoked”. Well,,she never did, nor did I , but cancer got her anyway.
69
Patrick ,we are with you 1000 percent.God bless your family.peace
18
Bill...thanks a bunch.
6
How can we justify the costs of these new medications when many people can’t even afford to by basic medical services, let alone a medication that costs $100,000 a year which only works in a select set of patients and can cause awful side effects? So many of the new medications being advertised are horrendously expensive and are continuing to drive up our country’s medical expenses. The prices that the drug companies charge must’ve reigned in before we all go broke.
We as Americans need to accept that dying is another aspect of life.
13
Tracy....another one. See my comments above to Julie. My advice to you? Don’t get sick.
22
But it is true.....
2
Now the federal government needs to negotiate lower prices for these drugs, 100K per year is way too much.
16
As I understand it, these new immunotherapy drugs also can have some horrific long term side effects. Though I truly hope that science and medicine can find cures for this disease, I do wish they would keep their superlatives to themselves, so that those who are not helped by new therapies, or who have less than great responses are not crushed by the news. Opdivo and Keytruda are a great and wonderful step, but keep the drum beat low for now. Oncologists and their patients can assess the efficacy of using these "miracles" without having to survive the false hope with their failure.
11
This article and many others related to immunotherapy fail to mention the serious side effects of the treatments. My 80year old father was stage 4 melanoma - he was still active, taking walks, playing his violin, gathering with friends and family. Excising the melanoma on his scalp was no longer an option..... 2 Key Truda treatments came with severe side effects - colitis and after the 2nd one dormant tumors “flared” in his lungs....he died within a week. It might be a miracle for some, but to those considering this treatment, especially the elderly seriously consider your quality of life
16
the docs don't get to say how the media covers things
5
My mother was enrolled in a combination immunotherapy trial when her lung cancer returned. The trial nearly killed her. Her body is alive but her cognitive abilities are challenged. While there is no cancer in her body, she's not herself. I am so very proud of her contribution to science. I also wish scientists considered the quality of life of those who receive additional time on earth.
27
Thanks for taking such a measured approach to this. Your mother may not have had the best outcome but her contribution may help (tens?) of thousands of people in the long run.
Considering the potential upside and her own risks, I find that highly admirable and believe more of these people should be noted/rewarded for their contribution when drugs turns out to be successful.
14
Scott Pruitt is dong a lot to generate new causes of cancer.
50
Yep, having dire thoughts disconnected from reality is a core part of mental illness and depression. Depressed people only see bad and create a distorted perception of reality where everything will work out negatively.
In public the Trump administration has used populism and bold, sometimes outrageous, statements to sell it's messages. And despite the fact the real world examples of their abuse of power have been rare, especially when compared to a) previous administrations expansion of executive power and b) the worst case scenarios that media constantly trumpeted for the last year and a half, it's not surprising so many Americans suffer from this mental illness.
I've found the best cognitive therapy is to ignore the words coming from blowhards, ignore the media who feeds off hypothetical worst case scenarios that are rarely realize (see the countless weather prediction for major storms)...and instead look at the actual results. Look at what has actually changed via law, policy, and actual behaviors.
When you do that and take a honest look at the world vs a couple years ago you'll quickly find that things are hardly any different from before. It's really not all that bad. The status quo has largely been maintained. Only the fools who bought into political tribalism thinks otherwise.
It'
2
This study did not prove that combination therapy with chemo and immuno was superior. Both study cohorts were receiving chemo. No company dares run a study without using chemo because oncology docs make a LOT of money administering chemo drugs in their offices, and they will make the decision on prescribing the new immunotherapy drugs. And no mention of the side effects from chemo, which are truly horrific? This study showed immunotherapy added to current practice of giving chemo was more successful than chemo alone in extending life, not that their combination was superior to immuno, alone as that was never evaluated. It is important to remember that some pharmaceutical companies also deliver these type advancements while other flood the markets with opioids. Nice work Merck.
12
You’re right that the missing piece of the puzzle is whether immune therapy plus chemo is better than immune therapy alone. However, it’s a bit cynical to suggest that the only reason that chemo is included is because docs make money infusing it.
There is a scientific basis for adding chemo. Certain types of chemotherapy can alter the immune microenvironment and thereby enhance the activity of immune therapy drugs. The cell killing induced by chemotherapy may also release additional antigen into the bloodstream, offering more targets for immune system cells.
And conventional chemotherapy is quite well tolerated. It doesn’t always have horrible side effects, though a relatively small proportion of patients will have severe toxicity.
8
Not sure where in this article you are reading that the authors claim immunotherapy alone is what was studied. I'm also not sure why you find this study design to be inadequate. This study did show that combination immunotherapy with chemo is superior to chemo alone.
'No company dares run a study without administering chemo drugs because' that runs counter to basic medical ethics. Chemotherapy is standard of care. These studies are designed to show whether or not the Standard of Care + Drug X improves survival. Perhaps take off the tin-foil hat?
8
"No company dares run a study without using chemo because oncology docs make a LOT of money administering chemo drugs in their offices, and they will make the decision on prescribing the new immunotherapy drugs"
This is incorrect in an important way: it would be unethical and illegal to run a clinical trial on a new drug without providing "standard of care" treatment. It would also be insane to treat a patient with a new drug and deny them a proven therapy, even if (like platins) that drug was imperfect.
13
Considering that Vitamin C affects the immune system and that the immune system appearts to be related to cancer, maybe Linus Pauling's work should be revisited.
6
it has been, and found useless.
8
This is great news but well covered elsewhere earlier. There is a glaring omission in the article, ie no mention of pancreatic cancer, which is more lethal (fewer than 10% survive to 5 years) than lung cancer. The same gene mutations are present in both cancers.
6
Pancreatic Cancer killed Steve Jobs.
Since this was an article on lung cancer, it’s not surprising that pancreatic cancer wasn’t mentioned. But the sad truth is that despite the existence of similar mutations, immunotherapy just hasn’t shown any consistent benefit in pancreatic cancer patients.
12
But he declined even the traditional drugs for some other process.
2
Has anyone ever wondered why we continue to use things like chemo and radiation as a treatment, when they clearly cause more problems? Dr. Dean Ornish has worked with cancer patients and has a proven record of reversing cancer with diet, and lifestyle changes, yet you don't hear about this in the mainstream media. There's a reason they big Parma, and their bulldog, the FDA, are after vitamin shipments, because it's competing with their pocketbooks. If you have Netflix, take a look at Food Matters. it's an eye opener. Also check www.Ornish.com.
8
snake-oil/diet will not cure cancer, although a good diet and exercise will help reduce your risk.
11
It’s because he doesn’t have a (scientifically and reproducible) proven record that he isn’t mentioned in mainstream or medical literature.
1
The last person to talk to me about Dean Ornish has a brother-in-law with cancer who lo and behold changed his mind about the family flirtation with "natural medicine" when he was diagnosed and then went to be treated successfully at Memorial Sloan Kettering. Where are Dean Ornish's "proven record or reversing cancer with diet, and lifestyle changes" except in the heads of those who believe in his professed magic. No studies. No data. No nothing. The line to his firm would stretch from there to the North Pole and back if he could truly "reverse" cancer. I sincerely hope neither you nor anyone in your family gets this dread disease, but hope even more that if you do, you seek good medical care. Barbara Bush is in the news these days. Read about her daughter who died of leukemia at a very young age. All the money and knowledge in the world in those days could not save these children. Now, 90% or more of those children treated for this awful disease live normal lives with normal life spans. Thank you, "Big Pharma," thank you, FDA, thank you researchers, thank you hospitals, thank you to all who take care of these children and worked to find ways of treating them.
13
Why in the world have the consumers (patients) accepted the 'costs too much to test' excuse while passively accepting the traditional: radiation; chemo; and then try stuff, that might actually be substantively effective?
In fact, it might be far more medically effective to authorize genetic assay, and treatment strategy up front for all cancers, prior to invasive surgeries and other 'procedures' that new data indicate might actually promote the spread or aggressive mutation of cancers. Surgeons often advocate resection when feasible - but is it for the best?
Similarly, the profit extraction motives for super-pharma companies like Bristol Myers-Squibb or, in this case, Merck, encourages the "go slow approach" that preserves profits from 'established courses of treatment,' offered in chemo and 'low-dose radiation' therapies that have negligible results in reversing progression, arresting progression, or progression free survival.
Studies like this, join the 'new immuno therapy' but, require, the accepted chemo - joining them in conjunction with drugs already generating profit.
Blanket administration of steroids for chemo - immuno suppressants- goes hand in hand with chemo and might actually act against immuno stimulative drugs! Meanwhile they 'build demand' from the ever hopeful patients for the drugs the sponsor studies are promoting. Nothing wrong with that, but why not support 'blanket population testing' instead of guessing and projecting?
4
I hope that this kind of novel immunotherapy may be also applied to GBM, which so far has proven impossible to be beaten by any of the clinical trials around the country. And, I also hope that the polio vaccine for treating the GBM is discarded and that this group concentrates on looking for promising immunotherapies to attack this lethal kind of brain cancer.
2
Keytruda/Pembrolizumab was approved in the US in 2014. How can a patient have survived eight years? The drug was not available eight years ago.
https://www.drugs.com/history/keytruda.html
5
I read it as eight years since their diagnosis with stage 4 lung cancer.
1
Gabi, a patient could be given a drug as part of a study before the drug is actually approved by the FDA.
13
perhaps the patient participated in the Phase II or Phase III clinical trials
4
In May 2016 I had surgery to remove a tumor from my colon. The oncologist said recurrence odds were 30% and recommend chemotherapy. By then I was 4 months into a keto diet and I had already researched cancer as a metabolic desease, the Warburg Effect (Nobel prize in Physiology 1931) and Dr Thomas Seyfried’s work. So I said no chemo, thank you. After 18 months of keto, intermittent fasting and recently extended fasting I had a colonoscopy and a radio test: both were negative. There is no trace of cancer in my body. And I keep all of my hair! No need for crazy expensive drugs with nasty side effects or poisonous chemo o radio therapies because glucose restriction kills cancer. Notice how keto and fasting are both free as in no money for big pharma and never ending cancer research though. Maybe that’s why you will not read about this in the news.
13
You me surgery got all the cancer, and you're very lucky it hadn't metastasised. The quack diet treatment had nothing to do with it, you were cured with surgery. That is if you're really "cured". Time will tell if you've made the right decision, or a tragic, fatal error. For your sake, I hope the surgery really was 100% successful, because the dietary-cure fantasy is just that - fantasy.
21
So you were in the 70% and your anecdote is worth 0%
26
Tumor in your colon is very misleading. Tumor can be a lesion that is excised with no abilty to spread, tumor could be metastatic disease. Colon cancer, Stage 1-2, is one of the few cancers that actually can be fully cured with surgery, no chemo, no radiation. In those cases, chemo and radiation is suggested to be certain that we kill every cancer cell.
8
I'll do you one better, patients will Live even longer than that if they didn't smoke at all, or at least quit,
How about that, and I'm not even a doctor.....
4
That's true, but about 20% of all lung cancer patients have never smoked per Memorial Kettering website.
16
How about that? Ok, smart guy, how about my wife? Never smoked, nor did I, never drank, did everything right. Lung cancer killed her. Try having a little bit of empathy, and don’t assume that everyone who has lung cancer smoked.
15
Many people never smoke and still get certain types of lung cancer.
1
It’s sobering, and in fact enraging, to think of the cost to society of treating lung cancer—
Especially when large pharmacy chains like Walgreens unbelievably continue to sell cigarettes. [CVS has mercifully stopped.]
A physician MD
17
The costs of lung cancer are enormous. The emotional costs, psychological costs, physical costs. But when we talk about financial costs and economic costs...we often have it backwards. Sure, smokers and obese people cost a lot to treat while they are alive. But they die younger and therefore don't usually live long enough to develop some really expensive and long lasting illnesses like Alzheimers. Non-smoking healthy folks live longer, which means more health care expenditures. https://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html
The fact is, the American health care system is broken not because of clinical trials and because of selfish smokers. It is broken because of the way Pharma, insurers, hospitals and physicians are reimbursed. It isn't about the demand side -- what patients are doing or not doing -- it is about the supply side. Health care pricing is farcical in the US.
8
With all due respect, the headline, "Lung Cancer Patients Live Longer With Immune Therapy" is misleading and only tells half of the story. The flip side of that headline should read, ". . . and the cost of immunotherapy is more than $100,000 a year".
12
I am presently on this study taking pembrolizumab for stage 4 Lung Cancer. I am very grateful for the support I'm receiving. I can tell you, I feel better than I have been and look forward to qualifying for my 4th treatment this week. This seems very promising and am indebted to those who are doing the research for this disease. I understand this will not be a cure for me but, I am hopeful it will be someday for someone.
47
I always enjoy reading stories about real hero's in our society who put in painstaking hours and sacrifice so much for the well being of other people. How great would the world be today if more people had the same desires and attitudes towards helping humanity.
16
Any adult that is still smoking in 2018 really needs a lesson in some self-control, the evidence is infallible an overwhelming that this will kill you and give you cancer, why do people still smoke, I don't get it
15
Science has landed a car on a comet, can completely control retroviruses like HIV, and now is making great strides on an extremely complex problem in molecular biology like cancer, and yet:
we worship movie stars, evangelical bs artists, and rock stars = bread and circuses 2.0
25
If you can use Moore's law as a metaphor, New Targeted combination cancer therapies are being developed every day. My advice is to google search such trials and try to get on one and the cost will assumed by the pharma company and research hospital doing the research.
I did this 4 years ago to get on an immunological trial for stage 4 kidney Cancer that spread to my lungs.
As a result, I am in good health and am typing in this comment today.
29
Where did you do your treatment?
1
It's early yet, but 11 comments have been posted, and only one thanked the researchers responsible for this magnificent achievement. Dr. Gandhi spent poorly paid, grueling years pursuing her education. Her colleagues did the same. These men and women are now well paid and respected, but society won't reward them with the billions of dollars and fawning press coverage given to babyfaced "tech" entrepreneurs and their swaggering brethren in investment banking. Too many Americans subscribe to the ideology that money defines a man's worth, that education is slightly suspect, and that rich people know everything. We need to grow up.
209
Don't forget all the scientist that spent 14 and 16 hour days in the lab discovering these molecules.
At least Dr. Ghandi is paid a physician's salary.
Those scientists often toil on complete obscurity and certainly don't make anywhere near what a physician makes. Even the ones that work for the pharma companies don't make anything like what an attending physician in a world class institution makes.
Please don't forget to thank them. They're the ones who've spent up to a decade or more getting their PhDs (vs 4 years for doctors) and then they still have to do the scientific equivalent of a residency and fellowship (post docs).
These men and women are real heros who only do it for the love of science and to bring cures to patients.
9
I know Dr Gandhi personally--a very nice woman. You are right about her work ethic.
2
Max makes excellent points. Though I will add that many who fought the good fight for years at NIH against entrenched and stubborn surgery and radiation partial old guard, left eventually to seek their fortune in biomed, where many of them now as enjoying the fruits (often indirectly) of their sacrifice and labor as youthful interns and researchers.
The best cure for lung cancer is to never smoke cigarettes. That being said any headline in the NYT that reports good news on the cancer front, especially one that involves a whole new treatment option is very encouraging. We need more scientists more than ever, I hope their are scholarships for scientific geniuses. Immunotherapy is the answer, but obviously we are at the beginning of the beginning. Let us hope that somewhere in the world those who will discover the breakthrough that will end this scourge that has taken so many beloved from us has the chance and opportunity to get to that intersection with fate. This person, or people can come from any corner of the world, even those beset by war and violence. I hope those scholarships are out there that will open the doors to knowledge, let us hope that small minds , minds who only see religion or skin color do not set up the barriers created by ignorance, we are one human race, maybe one day we will understand this, and all the barriers of progress will be taken down . Together we can solve any problem and overcome any hardship.
4
I wonder how many people, if any, know that Cuba created a vaccine to prevent lung cancer. They have shared it with every country in the world EXCEPT THE USA!
How many people in this country are dying needlessly in part because we have a ridiculous posture with Cuba plus our country's government is owned by Big Pharma that profits greatly from cancer treatment medications.
5
This is not exactly true...it is being studied in the US...it is not a preventative vaccine!
8
I am currently being treated for Stage IV lung cancer by the incredible oncologists at NYU and have received seven Keytruda infusions that seem to working ok for the time being. When I inquired about the Cuban vaccine, I was told there’s no positive proof that it works at all. It is currently in clinical trial at the Roswell Institute.
13
Exciting times in cancer treatment.
The underlying challenge is how to reduce the costs of creating, testing and increasing access to innovative drugs and treatments.
Think about it: in a country where the median household income is below $50,000/year, how can paying out way over $100,000 /year to extend a single person's life be balanced against other needs? ( a friend had treatments for a form of cancer - miraculously covered - which cost far more). Insurance companies DO NOT pay out more than they make.
Development is expensive, requiring time and the expertise of many: but how expensive? DO we have the best model? And how can costs of development be diluted? Is the possibility of unlimited profit on blockbusters necessary to get drug developers on board?
8
I am a physician with a background in statistics. Unless you are intimately familiar with statistics (which even many doctors are not) this article could lead you to believe the study shows that the effect of this drug is significantly greater than it proves. The Study does not prove that double the number of people were cured of cancer, And will live long, happy lives. In fact, all it has proven is that 20% more people live to 10 months after taking this drug. Theoretically people could only live an average of three months more with this drug, while having more side effects at a cost of $100,000 a year.
I am very excited to see the follow-up studies which I hope will show increased cure rates and significantly longer survival. I wish this comment thread allowed me to explain the difference between absolute and relative risk and median and mean, but obviously I do not. I encourage you to look it up yourselves.
43
Thank you, Doctor. Many people submit to these therapies with the unrealistic hope of years of life when it is only a few more months. We can stretch reality with the carefully selected use of statistics. People fear death more than using all their life savings for a few more months of life.
The findings of the study are incredibly exciting and represent the advancement of biologic and immunotherapy and modern medicine. However, the key part of the study that is not emphasized as much in this article is the importance of the “median survival” but also mean survival, the latter of which are not mentioned. All the study tells us is that 20% more people survived to 10 months when taking the drug at a cost of $100,000 a year. If follow up shows the drug results in only several extra months of life, the quality of which are lower due to increased side effects, we have to ask ourselves if the billions of dollars spent on this drug are really worth it.
Nearly all other first world countries use cost-effectiveness in deciding whether to pay for a drug, however the FDA does not. This is one often – ignored reason that our healthcare is so much more expensive. Many studies talk about “statistically significant increases in survival” when the actual increases are only several months. We never ask ourselves, “what is the worth Of a month, or a year, of human life” when making healthcare decisions because this is obviously a very uncomfortable question.
I truly hope that these drugs result in truly significant increases in long term survival, however, I also wish that more attention would be paid to what we are actually getting for our money.
39
Hi Zack
Unfortunately, the success/results of all current drug treatments in this category of cancer are measured in months. Although, I agree that more attention should be paid to qualitative questions.
10
it should be noted that these drugs are used for other cancers. it may be "only a few months" for specific ling cancers but for other types - like my own stage 3/4 melanoma it is in years. Two years later and Im still cancer free.
You can discuss if the $100,000 is worth it but when you are faced with dealing with it personally, discussions of cost become irrelevant.
10
I am an 11 year survivor of Stage 4 NSCLC. I had a craniotomy (to remove the mets to my brain), chemo and radiation that miraculously chased my cancer into hiding. Since I had platinum based chemo, I can never have it again, so look forward to an alternative therapy if it comes back.
I am sad reading some of these comments, that the stigma surrounding this disease is still so high. I've lost both smoking and non-smoking family members to this disease. 20% of those affected are never smokers. A large percentage (like myself) are former smokers. Consider that many boomers smoked in as young adult lives, quit and went on to live a healthy lifestyle, only to be struck down with this awful disease 20 years later. And then have people dismiss your suffering because they consider it "self-inflicted".
I am happy that some new therapies are being developed. This cancer is more deadly but receives less funding than colon, breast, pancreatic and prostate cancers combined. I am hopeful that at some point the research and funding will become more balanced, and that the stigma is lifted.
120
I was diagnosed with Stage 4 NSCLC 14 months ago. And like you I had metasticies in my brain. The primary was a 4cm mass in my lower left lung. The craniotomie was successful and a short Cyberknife treatment helped as well. Shortly after surgery I visited my oncologist. She entered the exam room with a huge smile, waving the pathology report, excited that my pathology results demonstrated a high PD-L1 marker and that I was a candidate for immunotherapy rather than chemo.
Since that day in February of 2017 I have received infusions of Keytruda every three weeks. My lung mass is, according to a recent PET/CT, 'barely perceptible' and is no longer FDG Avid. Happily, other than hypothyroidism, I have endured NO side effects. Other than the normal anxiety related to such a diagnosis, I have lived a fairly normal life. I have internalized my oncologists sage advice...I'm not dying, I'm living with cancer.
And that is the future. Not eradication, rather the goal will be chronic disease management. As Siddhartha Mukherjee points out in his brilliant book, The Gene, there are so many contributing factors to the occurence of this disease that looking for a silver bullet may be a fool's errand.
Also, I'm lucky to have a good health plan that did not protest the course of treatment. However, I am currently unemployed and my COBRA benefits run out soon. Hopefully, I'll be able to find an affordable plan on the New York exchange.
95
I agree it is frustrating reading some of the comments. I was diagnosed about two months with stage 4 lung cancer. I've never smoked a cigarette in my life.
(I still have stage 4 cancer, but it's a different, very rare kind I've been told more recently. But I still did the research when I was told I had stage 4 lung cancer and realized about 20% of the patients have never smoked.)
8
Drug companies would prefer a maintenance regime to a cure: then they can sell their drugs forever
1
"They cost more than $100,000 a year..."
So let me get this straight? Let's say I have lung cancer. Either I can't work, or I'm working less, so I don't have $100,000 per year. In fact, my wife and I only earn about $100,000 per year together before taxes. So who is going to pay for my ultra-expensive life-extending care? In fact, like most such breakthrough, these new drugs won't be available to most people.
22
You have to get elected to Congress. That's the only way to get affordable insurance that really covers you. Funny, but that's how it works . . .
8
My husband was diagnosed with stage 4 NSCLC on his 85th birthday. He was a retired Professor of Pathology at UCLA and USC. Immune Therapy was offered but he refused all treatments due to his age and the the horrific side effects he observed on older patient when he performed autopsies on their bodies. He died 9 months later at home .The writer of the article did not mention the age of the patients who were selected for the trial and the need to perform autopsies as part of the clinical trial. Until Oncologists include autopsies they would never know if the targeted therapies did in fact fail or that it succeeded in destroying the tumor. My husband died a dignified death at home without the ravages of the treatments.
69
He made the right choice. I would make the same choice. These treatments are primarily about making money and nothing else. All of us need to think about how bankrupt we are leaving our families when we choose ultra-expensive treatments like this.
10
@Nona Horowitz
Your comment was as moving as is was an important to the overall discussion of this article. There is something to be said for the quality rather than the quantity of one's remaining time on this earth. I understand, emotionally as well as cognitively, why your husband chose to forego all treatments. Your comment broke my heart. Deepest sympathies on the passing of your husband.
12
Thank you Marge for your kind words. My husband who was a brilliant scientist and physician knew that all these targeted , chemo and radiation therapies will destroy his his body and brain which he used till the day he died. He wrote and published articles to the end, enjoyed reading and listening to music and most of all interact cogently with family and friends.
7
I would be a memory now if it were not for the willingness of my doctor at Yale to fight to get me on immunotherapy for my high mutational load uterine cancer over two years ago, after cytotoxins failed. There have been many side effects but they are manageable. Other comments that mention the need for tumor testing to help determine potential effectiveness are correct. And community based physicians need to study up on side effects, they mimic other conditions. To those doctors, DON'T rely on pharma dog and pony shows to get your CME on this.
12
Since the majority of lung cancer patients are smokers, tobacco companies should pay for the $100,000 cost of immune therapy.
102
Susan, not necessarily the case. Here is why lung cancer often gets a bad rep. Increasingly many non-smoker women are getting lung cancers.
Good to have a breakthrough like this as it allows us as the family of cancer patients to know where to look for a glimpse of hope.
14
This is a very flawed argument. In reality, a large number of lung cancers are seen in patients with no history of smoking. Lung cancer patients get lot of bad PR unlike say breast cancer.
18
And since obesity is the #1 cause of health care expenses in the country, Coca-Cola should chip in on costs to treat diabetes, hip/knee replacements, heart surgery, etc.
6
I have been diagnosed with Stage 4 NSCLC. Started on the therapy(Opdivo) with the VA, as I am a veteran. The therapy costs $50 a visit, my co-pay, and I have had two treatments. I feel better than when first diagnosed(and given 6 months to live) and have noticed a significant reduction in the size of the supraclavicular lymph node that signaled the physicians that I had a problem. Minimal side effects. I am optimistic that I will be here a year from now, and hopefully 3, to celebrate my 70th birthday. No chemo or radiation, by the way. 30% match on genetic markers.
155
Jeri - congrats & good luck. And thank you for providing an object example of why Trump needs hands off of the VA - and why in NSCLC, among other cancers, immuno should be looked at as the most productive and least risk first line therapy v. last in line; after weakening the subject with surgery, surgical biopsy, low-dose radiation, etc. You also indicate that your 'genetic markers' have been assayed. The $64 question is what level of testing they were subject to - I am guessing it was just the PDL-1 test based on the "30% match" on "genetic markers" you are alluding to. But, there are a lot of genes and many genetic markers, some more sensitive to certain types of tests and testing than others. It is even possible that you have certain mutations that could be tested for that might indicate specific sensitivity that would make your NSCLC more responsive to particular targeted treatments in conjunction with Novimulab (Opdivo).
10
Just curious, Do folks receiving immune-activating drugs find they are not getting the flu or colds or other illnesses so often? What's the specificity of the immune response triggered? What are the side effects like? An allergic reaction? Best wishes!
1
WOW! Your post is the best news I've heard all morning. So very happy for you Jeri. May your progress continue and may you have many happy, healthy years to come. I am thrilled for you!!! Thank you for sharing these wonderful news.
3
Every time we treat a person with a new therapy, we learn a little more, and everyone benefits. Restricting this expensive treatment to only those who can afford it is counterproductive. The rich and poor share the same human biology, so we should figure out how to pay for this knowledge together.
126
Having a family member who participated in a cancer study, you are wrong about who pays. It’s not “the rich”, the drug company covers the cost for the treatment in conjunction with the insurance companies. The cost of the drug and the study is mostly borne by the drug company and sometimes the CDC, cancer hospitals and NIH. Same goes for the post treatment follow ups, which are actually more thorough once you are in a study.
You need the studies bc insurance companies will only cover for the great majority once it becomes standard protocol based by two or more studies.
30
And who do you think funds the CDC, the NIH? Tax payers! and Hospitals? These are non profits and that get benefits from our tax dollars...Drug companies get enormous government support via NIH and DOD funded contracts... These drugs have been paid for by tax payer money significantly. Don't now make the treatment so out of reach to the people who helped foot the bill - in very large measure...
4
Erica,
Actually, the government pays for only a very small proportion of drug development costs.
I don't have the latest Trump numbers but I can tell you that the last year Obama was president his budget included around $25B for ALL science funding (combination of NIH and National Science Foundation). That includes funding for basic science in all fields from geology to molecular biology. I'd be surprised if the kind of science you're referring to that supports medical treatment development got any more than $10-15B of that $25B pie, and a lot of it went to basic science, not actual drug development.
In contrast, large pharmas spend $5-10B EACH on R&D each year. In other words, Merck and BMS alone probably spent more that year than the entire US government.
Yes, there are some avenues by which government funded efforts eventually turn into medicines, but they wouldn't even make it out do the starting gate without all the pharma company science, research and investment.
2
Every time the results of a new study emerges extolling the virtues of yet another drug or treatment in which “the odds of survival can greatly improve for people with the most common type of lung cancer” my heart breaks a little more because my mother died of lung cancer 40 years ago and no such treatment was available but my soul continues to smile because of the tremendous hope these new drugs offer those individuals suffering from lung cancer.
The hefty cost of $100,000 a year for these drugs is overwhelming for many, if not most people. Not sure if my insurance company would cover that expense. However, if I or my husband were in need of this treatment, we would take the money out of our savings (if necessary) as well as shoulder any potential side effects that may result from these drugs. I consider ourselves extremely fortunate because we have a few bucks put aside and our health is presently very good.
I do find these articles extremely frustrating and crushing. Groundbreaking treatments like immunotherapy is available and patients with non-squamous non-small-cell lung cancer “should receive it as early as possible after the diagnosis is made”, but if the person’s insurance company will not cover the cost of immunotherapy, then their hopes of survival begin to waver if not fade. This scenario is almost as cruel as the disease itself to know a treatment is available but the cost is practically unattainable by most.
64
@Marge Keller, very sorry to hear of your mother's poor outcome decades ago, pre-hospice and pre-immuno therapy the NSCLC prognosis was entirely grim and helps frame the fatalism with which this prognosis is still approached. Don't, however, be misled by the $100,000 a year quote the Big Pharma industry keeps floating out there.
The $100,000 cost is what the FDA has so far approved based on their crooked and skewed evaluation of what 'development costs' should allow drug companies to charge to 'recoup' an 'appropriate return' on investment in research, ignoring the fact that we the taxpayers have often funded the bulk of such true research with our taxes. On top of this, ignored in the mix is the fact that existing 'first line' approved treatments for NSCLC include various forms of surgery, radiation, and chemo all running into the thousands of dollars, which if displaced or replaced by first line immunotherapies will find costs simply shifted with far superior results.
11
FDA does not consider the cost of a therapy in the approval process - their focus is on safety and efficacy. If you're looking for cost-benefit analysis to drive approvals, go check out NICE in the UK.
2
But, the FDA does have a say in recommending what drug companies are allowed to consider when they set prices - unless they take the aggressive position of 'letting the market' decide - which looks like the Trump way. Though Trump in practice will give twitter support to every position on this depending on his convenience, limited understanding, and non-existent interest or attention span. He has "Good Genes" so this doesn't matter.
4
I recognize the cost is outrageous. But this is just the beginning of adjunct immunotherapy treatments. There are 50,000+ patients in trials for different kinds of cancers. Genetic testing isn't just pharma, its a technology applied across the board. There will be high throughput costs initially, but those will decrease. Pharma will try to squeeze obscene profits, but immunotherapy will be harder for them to herd into their corral. It really is a game changer.
38
Yeah, and I really see my insurance company paying for this and I have pretty good insurance provided by my employer. FYI, I am being sarcastic.
In all seriousness, I understand that research like this isn't free and I don't expect Big Pharma to give it away, but very few people could afford that, even the hyper-libertarians who don't think people deserve health coverage if they can't pay for it. Or maybe they were self-denying super-savers who could pay for this for 2-3 years. What's gonna happen when their kid or spouse or they break their leg and are out of money?
24
In fact, "Big Pharma" (misleading term in general, because many new drugs are developed by "Small Pharma," which doesn't sound scary enough for those who excoriate the bad in the pharmaceutical industry, but don't compliment the good) DOES give these new therapies away. Clinical trials supply new drugs for free and pay for the testing and many of the associated new visits. And the pharmaceutical companies have free or low-cost for these hugely-expensive drugs both for those with insurance and for those without (for those with, they offer to pick up the co-pay, for those without who are low income, they offer the medicines for free).
5
While that is true, I remember when it was reported that Vice President Biden and his wife were contemplating selling their home to cover cancer treatment for their son. If our vice-president and his wife cannot afford healthcare then I pity the average Joe.
3
Only by an advanced assessment/analysis of a patient's particular tumors' genetic make up, including mutations and 'drivers' can an intelligent and informed treatment strategy be formed.
Currently, this is not how the process works, and this is responsible for shortening the likelihood of progression free survival for millions of patients, in exchange for insurance industry profit.
The effective genetic assay testing costs a few thousand dollars per patient. It is currently considered "a second opinion" v. the gross diagnosis performed from biopsies and PET scans currently that provide only the general metabolic information that "there is cancer activity, and it is in stage, I, II, IIB, etc. up to stage IV.
The mystification of 'staging' is only a gross diametric that guesses at where the metabolic indications are that a cancer has or has not spread from an original lesion.
The testing for the presence of PDL-1 protein is far less determinate of the effectiveness of immune treatments such as Keytruda and Novimulab than speculation from earlier studies initially indicated. Yet, again, thousands, if not millions of patients were rebuffed or deferred on that basis.
New indications are that metabolic oncogene activities can determine the results for such readings, and more importantly that other mutations and tumor drivers might have far greater bearing on results, sometimes dramatically.
As Yogi correctly diagnosed, "it ain't over 'till it's over.
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Somewhat true, but the two lines of treatment are not mutually exclusive. And, in fact, analogous to the findings of this study in which immunotherapy combined with traditional chemotherapy had strong efficacy, it may turn out that immunotherapy combined with mutation-associated targeted drugs will also have a strong effect.
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@concerned - I am pointing out that the drugs targeted to mutation associated cancers could make a determinative difference and should therefore be tested for. Many patients might be otherwise lost who might otherwise be helped. I am not saying by any means that the two approaches are mutually exclusive, rather that it makes sense to put them in the most productive sequence.
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@jwp-Agreed. Tumor genomic profiling should be done earlier, and move towards standard of care. Sorry if I over-interpreted your first comment.
I understand the article is about treatment, but why not one mention of smoking.
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Smoking is the cause of many, but not all lung cancer. No one should ever smoke. But that is another article and story. This is about new therapy. This combination of immunotherapy is being researched for several cancer types including skin melanoma, colon cancer and some bladder cancers.
Cell typing, individual studies of single cell genes (single cell genomics) and Machine Learning are the methods used to further knowledge and immunology and checkpoint blocks are the agents used for clinical studies & treatment.
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Smoking is a cause of cancer for both smokers and nonsmokers exposed to tobacco smoke. Prior to widespread tobacco smoking lung cancer was virtually unknown. Radon gas is also a cause.
"It is estimated that about 90% of male lung cancer deaths and 75–80% of lung cancer deaths in the US are caused by smoking each year” "Hecht, S. S. (1999). Tobacco smoke, carcinogens and lung cancer. J. Natl. Cancer Inst. 91, 1194–1210.
@Whisk E. Chot - Washington, DC
I concur that not all lung cancers are attributed to smoking. My mother never smoked a day in her 63 years and yet she died from that horrid cancer.
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I think people should get the best medical care money can buy. But with insurance companies and some politicians looking to save money where is the funding going to come from for this new immunotherapy and all the candidates in the pipeline. Wake up and vote.
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Pecos - the money always is paid to preserve the status quo, and that includes profits. But, in this case, new therapies - immuno - also come from the same industry as 'accepted therapies' - the doctors and researchers looking for cures have a different set of motivations. Good science is what is needed, versus 'stacking the deck.' And questions should concentrate on methodology and goals studies such as this one.
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Great news no doubt. However the cost is astronomical at $100,000 per year! perhaps there can be research completed on how to lower the cost of these life saving and life prolonging drugs. also, need to identify the actual number of non small-cell, non-squamous cell tumors (do you mean only adenocarcinomas?) over the total number of diagnosed stage equivalent lung cancers before the jury is truly out.
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@RipVanWinkle - wake up! the "cost factor" is deceptive. First the "cost factor" of "things as they are now" is already in the hundreds of thousands if we factor in hospitalizations, surgeries, radiation treatments, and hundreds of other costs built into existing 'approved methods.' Secondly, if immuno-therapy prolongs 'symptom free survival' and allows for patients to return to work - where they can afford to pay for their insurance - how is that a greater cost that having them in live prolonging pain in a hospital bed? Unless you're a libertarian in favor of killing everyone else with the exception of yourself, it's hard to find many economical 'win wins' in the face of life and death. But dignity an quality of life over Hobbes' 'short and mean' has something to be said for it.
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When my father had lung cancer 10 years ago, the cost of his treatment easily was more than $100,000. This is not new. Hopefully, it is more effective.
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Your comment to me is "short and mean". Appreciate your comments to others as you sound well-educated on the topic but derogatory comments only have a place behind the anonymity of an online persona. Would you deride a colleague's opinions or concerns at ASCO in a public forum? Or a stage 4 NSCLC patient's skepticism in the face of terrible side effects and decision to choose hospice rather than bankrupt a family? Please be more thoughtful when you are unclear of your audience.
I am very relieved to read this news. I am on the treatment described, and have Stage 4 NSCLC. I have slight reduction in the metasteses and hope to see further improvement. Unbelieveable, but of course not yet a cure.
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The objective of immunotherapies at this juncture is "progression free survival," not 'cure' or 'total remission.' The public tends to discount this fatalistically - unless they are patients or their families - in which case it is far superior to hospice and imminent mortality. But, there are a lot of basic questions of science and national criteria and protocol that need to be addressed that clinically subject of hot debate.
How to measure cancers in radiology for example, where measurements tend to be linear as opposed areas of gross biomass of active areas, for example. There is a lot of room for plain old interpretive error in taking and conveying measurements in looking at images in PET v. CAT, v. MRI data, that is 'fudged' in the metrics going into these studies. These were among the objectives of the areas to be addressed by the 'moonshot initiative,' promoted under Obama and Biden that is now being attacked and undermined by Trump's - "business approach." Of course, we are all becoming familiar with his 'genius genes' in action.
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*To exact measurements of often poorly defined 'undifferentiated masses' with 'poorly defined margins' in radiology settings can be a challenging process and mystifying to the general public. But, a bio-mass in order to be volumetrically defined requires at least three measurements, and to be compared over time needs to be comparable to a volume measured from a similar position that is used as a 'baseline' to measure 'progression,' 'stability' or 'remission.'
To the extent this discipline is fudged or ignored studies of lesions are undermined. Cancers of the lymphatic or blood systems that rely upon centrifuge generated concentrations of 'samples' are vulnerable to similar 'softening' caused by ill-conformed study methodology.
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The objective of immunotherapies is to increase overall survival, not just progression free survival (although PFS is certainly a helpful endpoint). In fact, because of the way immunotherapy works, numerous trials have not shown progression free survival but later showed overall survival.
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Dr. Herbst said. “We’re making progress...And for that, Thank You.
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