NFT: The War Against Cancer: How are we really doing?

a manageable condition, as opposed to a curable one. Depends on the cancer, of course, and how early it is caught in many cases. Reading Steve Jobs' bio, his doctors felt that advances in microbiology would eventually allow cancer specialists to target specific cancers, and adjust medications as the cancer changes.

One year since being diagnosed with stage 4 liver cancer. At the time of his diagnosis, he was told he had 3-6 months. He had the good fortune to live near some of the top specialists in the world at Duke University Hospital, and now a large portion of the tumor has been successfully removed, they've been able to shrink the part that remains, and he's gaining weight for the first time in almost two years. Even ten to fifteen years ago, he'd likely be dead by now.

that is incredibly awesome.

He's not home free by any means, but according to the docs his chances of beating the disease have improved dramatically.

I was diagnosed with prostate cancer a couple of years ago, went through the deal at Memorial Sloan-Kettering, and seem to be cancer-free now. There are freaking prostate cancer factories all over the NY area now and they all do a pretty good job so far as I can tell, using various methodologies. Prostate cancer is well known medically.

On the other hand, a good friend aged 57 just died from ocular melanoma, a rarer form of cancer for which they don't currently have a cure.

Thats awesome. Wish him well

I can't even comprehend getting the bad news one day that there is virtually little to no hope only to see a reversal of fortune and reason for hope....that's just awesome.

Great to hear. Good luck. The survival rates for prostate cancer are indeed pretty incredible today

we are no more than 15 years away from turning the vast majority of cancers from death sentences into manageable chronic illnesses.

Two key challenges have always been early enough detection (e.g., with cancer of the pancreas, that is the main challenge) and the individualized nature of a given tumor or set of cancers in a given human. Everything I am reading suggests that with massive improvements in early detection, combined with individualized genomics and the use of autoimmune techniques and engineered cells, progress over the next 10-15 years will be very rapid.

An example linked.

Quote:

New data from the University of Pennsylvania and The Children’s Hospital of Philadelphia reveal that an immunotherapy, named CTL019, helped 90% of children and adults with acute lymphoblastic leukemia (ALL) who had failed to respond to prior treatments or relapsed multiple times achieve remission.

Stories like this being repeated in the medical press with rapidly increasing frequency.
Link - ( New Window )

seems that early detection is a big factor in fighting cancer. My Dad was diagnosed with esophageal cancer 4 years ago. Had his esophagues removed and his stomach is up by his chest. Pretty amazing stuff. The surgery was done with a small incision in his neck. Unbelievable. He had it at New York Presbyterian.

improvements made along the way.

Unfortunately, there will be some countervailing trends.

While the success rate in treating cancers will increase, the rate of cancer acquisition will likely also increase (i.e., more people fully treated, but more people getting cancers), as people respond accordingly.

Preventive measures will no longer be seen as "cost effective", and they can live lifestyles that will lead to more cancers.

But, that's a tradeoff people will be, rightfully, willing to take. We already see it with Obesity and Diabetes (to a lesser extent heart disease). We will, at some point, see it with much more severe diseases.

From an investment point of view it is difficult to figure out where to go because there will be some homeruns coming. The thing is so many of these are showing promise regardless of who the winners end up being.

It appears right now that the key is Immuno-Therapy. There have been major successes in reinvigorating cytotox T cell responses by inhibiting co-inhibitory checkpoints (e.g., CTLA4, PD-1, LAG3, etc) and the combination of these therapies with each other and with more classical anti-angiogenesis and anti-tumor drugs will show great benefit. Tumor eradication/cure is key. These therapies all have side effects which are tolerated b/c cancer is life or death. Although, perhaps we will find something that can control tumor growth long term setting up a maintainence therapy type model some day. It's an exciting time.

They will help some of the diseases that we have had the least amount of answers for (such as melanoma) but they won't work on all cancers. Some cancers present very few outward signs of being different from normal cells and therefore the immune system (even when hyped up on new immunotherapies) have a very hard time recognizing them. The CTL019 that is mentioned above allows us to target certain cells directly but this is also not super specific.... you basically program a Tcell to kill off any cell that expresses a certain protein and although cancer cells may present more of a certain protein, normal cells also express some. This leads to a lot of side effects and some difficulty finding the right target to limit other toxicities. For instance in the case noted for ALL, those patient will live without any b-cells, possibly forever, depending on how long the new Tcell clone lives within their body.

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environmental pollution and smoking down to 0. As a public health area, it's far too costly.

The same can't be said about cancer. Though eliminating cancer is unlikely, the costs are borne by private individuals.

Cancer is winning. Check the obits.

In comment 11936896 Marty in Albany said:

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Better than the War on Drugs
Worse than the War on Cancer

I was diagnosed with lung cancer back in 2004. I had the upper third of my right lung removed. So far so good, nothing has returned.

My dad had died of lung cancer back in 1963 so I was pretty scared when I was first diagnosed.

However mine was caught on a CAT scan I was having for another problem I had at the time..

I was very very lucky.

In comment 11937131 deadkurtrulz said:

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Cancer is winning. Check the obits.

Death is undefeated. And cancer is a relatively common cause of death. But we now live in a world where studies have shown most people diagnosed (all be it very slightly above 50 percent) will still be alive *at least* a decade after diagnosis. Thats a substantial amount of progress which has been consistent over decades and shows no sign of slowing, in fact the opposite is true. That number is rising every year.

Very interesting stuff about immunotherapy.

Jjgm, happy to here all is doing well. Best wishes to anyone else going through something either themselves or with a loved one

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it was cool to smoke, have your pack of smokes in the sleeve of your t-shirt. I believe actors were payed to smoke on screen, the Army had smokes in your K-rations and the Marlboro Man was cool on television. 95% of the guys I hung out with who smoked are dead now.
I should qualify my statement. For some reason my friends that smoked pot are still alive. NO LIE.
I smoked a pipe and cigars. I was in stage 4 lymphoma but am cancer for 10 years.

the "cure" looks like and will continue to look like a "chipping away" rather than one emphatic breakthrough. Mostly involving "educating" our own immune systems to fight the affliction as it (our IS) does so many others. A family friend, who is a rich and successful MIT-grad engineer, quit his lucrative job and is now devoting his life to curing along these immuno lines the more stubborn "solid tumor" cancers like pancreatic.

Even as treatments have advanced and given way to much more favorable prognoses, what sucks is that you still have to go through chemo and/or radiation which (while some of the drugs have gotten slightly more manageable) is still just brutal. And of course can itself cause cancer or other serious long-term problems. At least the pot is good.

Cancer has devastated my family. Young grandparent and an even younger Aunt dead. I got picked off before I even turned 30 (annoying news as someone who was in ripped good shape at the time and ate absurdly healthy), although thankfully am still around.

I know there are many BBI'ers who've dealt with it or are dealing with it, and I echo the well-wishes. I remember specifically a younger BBI diagnosed with skin and another one with pancreatic. If you two are reading this, I still think of and am pulling hard for you.

Died of Uterine cancer. Mom and paternal Aunt survived breast cancer. Have passed since but it was rough. 2 maternal Aunts died of colon cancer. Ex wife went through breast cancer. Sat w her on that chemo center for 4 months. Thank God for early detection but she still went through hell. Having to shave her head was fucking horrible.

We are doing better than ever but late detection makes the cure almost worse than the disease.

Suposedly all. Bodies have cancerous cells. It's when they replicate. I in no way enjoy my every 5 year colonoscopy or getting my yearly prostate exam but with family history and having seem family and friends die I work out like crazy for a 48 year old. Eat relatively clean and go to the doctor.

Even in you guys in your 30s need to think long term. It's hard whine we are young but as my mom used to remind me. We get one body. No redos.

Thats great to hear. Hope all continues well

overseer, i never knew that. Very cool to see you doing well and best wishes going forward

Lauderdalematty... youre right. Im in my early 30s and do a pretty crappy job on this front. I live an active lifestyle but i do several things that surely elevate my risk, including but not limited to virtually never seeing a doctor for anything ever, literally havent been to one in a decade. Im still dumb enough to think it cant happen to me, at least not now. I am a total hypochondriac on behalf of loved ones though, if there is such a thing as being a hypochondriac on others behalf

The good news is that she is cancer free so far.

The bad news is that chemo itself can be as bad as any disease. My mom can barely walk because the chemo attacked her heart and she now has congestive heart failure. Her calves are the size of Jonas Seawright's because of the fluid accumulation that her heart is not strong enough to remove.

So "cure" rates don't tell the whole story.

There is a lot of "feel-good" energy around cancer "cures"--and we are making progress--but sometimes the cure is almost as destructive as the disease itself.

The Emperor of All Maladies by Siddhartha Mukherjee

Wonderfully well written, accurate, understandable for the general public; should answer many of the questions asked here and provide both a stark, realistic picture of where we came from with regards to cancer discovery and treatment, the incredible hubris and great failures of the latter half of the 20th century advancements and the cautious hope we all should have for the future.

However as someone said, death is undefeated. I know and take care of plenty of octogenarians and nonagenarians who have welcomed their cancer. Deciding whether to die from a chronic cancer vs. progressive dementia/memory loss is not something anyone has ever planned for and it's falling more and more to the children of these patients to make these decisions.

The cost of ignorance is astronomical and whether you hate socialized medicine/obamacare or not, we're all in this boat together. It's never to early to start thinking about these issues. Hope you all have a chance to read the book.

to be made on illness and death...sorry somebody had to say it.

productive.

I always joke about ice floes, but the reality is that the population of older folks is increasing at breakneck speed. Tons of these folks don't have the means to retire and have little to no savings. They're also more expensive to employ than some desperate kid straight out of college.

I know this thread is for the most part aimed at younger folks and cancer. The reality is that (at least for 200-2003 data) the median age for cancer onset (all types of cancer and sex/race of people) is 67 years old.

IMO, it's a hell of a dilemma, but something we're going to have to face at some point.

This .gif goes on to estimate future population by age, but just watch the shift as technology, standard of living, and healthcare improve over the years:

Congrats to all of you survivors. Despite what my previous post may read like to some of you, it is really nice to read about.

I'm 29 now and got a physical this past January and asked my doctor how often I should be getting a physical at my age and he told me, typically every 5 years.

The randomness of cancer is what gets me, it can hit anybody, no one is immune from it. I was reading about the 29 year old with an inoperable brain tumor who is opting to die. So young and to get hit with that is just awful.

I have no background in this and have not studied this, but I do wonder if some cancers are over diagnosed and maybe do not require treatment. As technology improves, things can be detected sooner and sooner, but are all cancers spread aggressively, is it possible that some can be dealt with without the thread of it spreading? Again, I don't know...just thinking out loud.

In comment 11937422 MarshallOnMontana said:

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Thats great to hear. Hope all continues well overseer, i never knew that. Very cool to see you doing well and best wishes going forward Lauderdalematty... youre right. Im in my early 30s and do a pretty crappy job on this front. I live an active lifestyle but i do several things that surely elevate my risk, including but not limited to virtually never seeing a doctor for anything ever, literally havent been to one in a decade. Im still dumb enough to think it cant happen to me, at least not now. I am a total hypochondriac on behalf of loved ones though, if there is such a thing as being a hypochondriac on others behalf

We all have to live a little and I sure out my body through a lot in my 20s but I started to be much smarter around 35. I used to lift 5 days a week but I wasn't in great shape My cardio was so so. It's so easier in Some ways to worry about others. Go see a doctor. You need a base line. I work in the dialysis field. People's kidneys dont just shut down. Bad health can creep up on people. Heck every year you can add 3-5 pounds and after 5 years you now can be over weight.

avoid the risk factors and get routine screenings and you have a chance to improve your odds. I'm sure everyone can spit out an anecdote or two of someone who might still be here had they gotten their routine screening or ignored signs of trouble and the disease got too far ahead of them.

Like someone else said - some of it depends on cancer type. former co-worker with non-Hodgkins lymphoma had last rites performed at least twice - went to Seattle for some type of marrow treatment and has been in remission for well over a decade. another co-worker had a asbestos related cancer - helicopter crew chief ingested brake dust (think that was what they traced it to) they gave him 4 years, he may have made it to 6.

and then there is the $ angle

definitely some rates of cancer spread quicker - for example, there are some prostate cancers DRs. may just monitor, others have to be treated aggressively.

keep up the good work!

Marshall, obviously you didn't know. But, I just got home from a wake for our friend's husband who died as a result of inoperable brain cancer and this is the first thread I saw.

with Multiple Myeloma. I was in stage 3 of 3 at the time of diagnosis.

Unlike most cancers, where there's somewhat of a set protocol of treatment, myeloma doctors (specialists) differ vastly in course and beliefs of treatment procedures from one to another. As with anyone, each cancer patient differ and react or have special circumstances in their cases, and thus treated differently to their specific situation. However, as I found out, basically with myeloma its moreso on the patient to decide to course of treatment on account of the varying views held by these specialists.

Some myeloma specialist/oncologists believe of treating one for the better quality of life moreso than treating for a cure (which myeloma is uncurable). Whereas, like the Myeloma Institute in Arkansas, is based on treatment of patients as for a cure. Which hold many risks. I did all research of the disease, because A.) I had no idea what Myeloma was and B.) for deciding was course of action or direction I wanted to take because of the differing views. I took the initiative to research anywhere from studies, cases, causes of myeloma, varies treatment procedures, specialist in the field..the best and their philosophy, affects of the treatments, prognosis and survival rates of similar to my circumstance, and so forth.

Luckily, I was already in the area of two of the top specialists in the field of Myeloma, and came from the Myeloma Institute in Arkansas, right here in NJ at John Theurer Cancer Center in Hackensack. My doctor even has developed a few of the lastest novelty drugs for myeloma. I was not only aware of him prior during my research but was directed to by another oncolist upon my diagnosis.

His protocol for my specific treatment was a tandem autologous (own stem-cells from harvest) SCT (stem-cell transplant). My last SCT was back on Super Bowl Sunday feb of 2012. I had been in remission for about a year and half until recently (my last visit in sept showed my m-spike had rose to 1.0 - which now requires me for maintenance therapy of Kyprolis. I had secondary damage to organs such as my heart and kidneys from the myeloma, which along with a resistant chromosomal deletion of T(4;14) which puts me in the high risk.

I have been told that what usually gets you in the end is, not the myeloma itself but the secondary affects such as damage to heart, kidneys, infections, or pneumonia. I'm recently went from stage 3 to 4 of 5 in kidney failure. Along with having damage to my heart with onset of heart failure.

Basically, now my treatments are in the Quality of life rather than for a cure. Originally the life expectancy 4-5 yrs ago for myeloma (stage 1, no organs affected) was anywhere from 3-5 yrs with a few outliers. Now, as they are continually a step ahead with development of new novelty drugs being and on verge of being approved frequently, there has been a prolong of survival rate. Now it has risen (pending cases) to of 10 years or so. The longest survival to date has been of 30 years, but had myeloma of reaching stage 1 and no organ affected. The youngest case (which originally myeloma was common people of 60 yrs or older in its beginnings and more common) is of a 17 year old. I was originally given a prognosis of 3-5 years at diagnosis. I am now approaching 3 and half years of survival (not knowing prior though how long or the onset of my cancer had been going on). I had one remission period, 2 relapses (one now, and one just after my 2nd SCT).

Though I always believe theres a cure for myeloma just on the horizon, and believe I'll be cured every waking day. I see myeloma patients that I have known amd met by via of this disease, who are worse off and invalid (where some have had their spines collapse and cemented, and etc)than myself. I continue to pray hard for them everyday now. And, to some who where going well and suddenly deteriorated unexpectedly and had passed on. In fact, while being in isolation for a month during my first SCT, I witnessed 3 people succumb to this cancer. I continue to fight and never will give in.

You have an awesome attitude. I first heard of that disease when the yankees old pitching coach mel stottelmyre was diagnosed, which was almost 15 years ago now. He is still alive today. Im not sure about the specifics or stage of his case at diagnosis, but i wish you just as well

Sorry for your loss, matt m.

And again, best wishes to anyone dealing with the disease or connected to anyone who is.

I have no experience with Cancer. My experience is with high blood pressure and its treatment. My MD told me If He had the medicines to treat my father he would have at least lived to my age of 82. Pop died at 74

It is why I have hope that cancer patients' will have the same opportunities I have had with the new drugs that are now out and coming in cancer treatment

Let us pray for Cancer treatment and the MDs