A cure for cancer: how to kill a killer
I work in oncology and with some of the people interviewed in the article. I want to emphasize just how exciting this stuff is and how wild it is to have patients who have a belly full of innumerable metastases, for whom 5-10 years ago we'd quote a few months' survival at best, and now on these new fancy drugs their tumors just <i>disappear</i>. It's incredible and up until now unimaginable for these late stage solid cancers. Similarly, to have people with leukemias who previously we use essentially 40 year old drugs, now we can fight and fight to keep alive long enough to get their T-cells harvested and re-engineered and re-infused and then (after nursing them through a cytokine storm) they emerge... with their cancer wiped out completely.<p>(The article blithely says "remissions measured not in extra weeks or months of life, but in lifetimes". It's a little over-reaching since we just don't have that much long term data yet; these therapies haven't been around for "lifetimes". As a result we often prefer the term "durable remission" to "cure".)<p>I also want to emphasize how <i>few</i> patients have this outcome. It sucks. It sucks to have ads on bus stops and TVs that say, "Ask your doctor about Keytruda", but when they ask me, I know it has such a tiny chance of turning them into that laughing family playing in the grass. We test for and hope for the genetic markers that indicate certain immunotherapies are more likely to work spectacularly, but the vast majority of patients don't have those markers. Similarly, most patients with leukemias or lymphomas do not respond to CAR-Ts.<p>We still try these immunotherapies, though, because there's often evidence of some modest better outcomes, and also sometimes you get lucky. I think I mentioned this on HN in some other context, but one of the breakthrough discoveries around pembrolizumab was because of a "Hail Mary" in late stage colorectal cancer; all the patients progressed & died in the study except for one, and she held the key to the genetic derangement that made that subset of cancer particularly sensitive to checkpoint blockade -- leading to FDA approval for pembro for all cancers with that derangement. As this article mentions, there is now a massive number of trials studying these therapies in various subsets of patients, or in various combinations and permutations with traditional therapy, because short of "cure" there's still improved survival which can often be very meaningful.<p>It's exciting. It's inspiring. It's frustrating & heartbreaking.