Food for thought: Curing Cancer Isn't Really Worth All The Trouble

Worth a quick read......

Per GOOGLE: Curing Cancer Isn't Really Worth All The Trouble
http://www.businessinsider.com/google-curing-cancer-isnt-really-worth-all-the-trouble-2013-9

Breast cancer drug everolimus 'biggest advance in years'

Maybe mTor therapies WILL have a big impact after all...

Breast cancer drug everolimus 'biggest advance in years'

telegraph.co.uk | Sep 7th 2012

Up to 8,000 women a year could benefit from everolimus, say specialists, after a trial indicated it could "stall" advanced cancer for about four months longer than persisting with the same treatment.
Three in four women with advanced breast cancer have a form of the disease that is spurred on by the female sex hormone oestrogen.
Many drugs try to block cancer cells from taking up oestrogen or lowering hormone levels, thereby slowing or stopping tumour growth.
However, in time cancer cells work out how to negate the effects of the drugs, become resistant, and tumour growth resumes. Chemotherapy, which can have extremely debilitating side-effects, is usually then the only option.
Everolimus, marketed by Novartis under the brand name Afinitor, is intended for post-menopausal women whose cancers have developed resistance to 'hormonal' treatments.
It works by targeting other proteins in cancer cell, which control how it works and grows.
The drug is so recent that trial results, comparing 485 women given the drug and 239 given a dummy pill, are still coming out. However, after 18 months the differences are already marked.
Among those given a dummy pill and exemestane, which helps prevent oestrogen uptake, tumour growth was stalled by 3.2 months on average. But among those given everolimus and exemestane, it was 7.8 months.
Professor Stephen Johnston of The Royal Marsden Hospital in London, said the impact was so large that it was "changing the natural history of the disease".
He described everolimus as potentially the most significant breakthough for advanced breast cancer since the discovery of drugs that lower oestrogen levels, in the mid 1990s.
Estimating it could help up to 8,000 women a year, he said: "Everolimus has the potential to redefine the way this common form of advanced breast cancer is treated, and importantly offers women an effective alternative to a chemotherapy regime".
There are possible side effects, notably inflammation of mouth tissue, rash, tiredness and diarrhoea.
But Dr Rachel Greig, of the charity Breakthrough Breast Cancer, said the drug was an exciting development.
She said: "Everolimus is one of the biggest advances in breast cancer treatment in many years.
"This drug could make a massive difference to thousands of patients with advanced breast cancer.
"While this is by no means a cure, it could give patients several extra months of good quality of life with their families.
"Everolimus needs to be assessed by Nice but we are strongly backing it to be made available for those who need it."

Original Page: http://www.telegraph.co.uk/health/healthnews/9548828/Breast-cancer-drug-everolimus-biggest-advance-in-years.html
Shared from Pocket

'One in six cancers worldwide are caused by infection'

Cancer as a communicable disease? Whoah!

We've known that the HPV virus (really the HP virus, but that sounds strange) causes cervical cancer, but I definitely didn't appreciate how large of a proportion of cancers are caused by infections (17%). Given that there's a lot about cancer that we don't know, plus stories like the one quoted above from the BBC, and the current story of the Tasmanian Devil facial tumors being spread through infections, one has to wonder if the much more than 17% of cancers are caused by infections.

The counter point is that cancer rates tend to be higher in the first world, and the first world tends to have more cleanliness/less communicable disease, and therefore likely less instances of the spread of infectious disease. Hmmmm.

The good news here is that there are effective vaccines for two of the infectious cancer-causers (HPV and HBV.) Perhaps this is another argument for Bjorn Lomborg's point of view that in lieu of investing in anti-global warming measures, we'd make the world a much better place by investing instead in global health.

NOT in biotech's robust future

The main theme of this blog is that massive innovation currently underway in the biotech industry will improve health care globally and create exciting businesses. The hallmarks of this "molecular future" will be personalized medicine, genomics, and broad digitally-enabled technologies, such as DNA sequencing, arrays, and multiplexed assays.

But today - as a follow-on to last week's Top 10 Promising Cancer Drugs post - let's talk about one biotech 'innovation' that won't be powering growth or improving outcomes: cancer immunotherapy.

FierceBiotech collected the comments spawned by their original Top 10 article, and there was a surprising amount of positive commentary in support of cancer immunotherapies. (Sometimes referred to as vaccines.)

As bullish as I am on the "molecular future," I have the exact opposite feeling for cancer immunotherapy - partially due to my experience working at a cancer immunotherapy company in the late 1990's.

The concept of cancer immunotherapy is very appealing - train or otherwise get the patient's immune system to recognize and respond to a cancerous tumor as foreign, thereby empowering a non-toxic immune response. And, indeed, this has been shown to happen in various studies, dating back more than two decades.

An effective cancer immunotherapy could be extremely targeted with limited side effects. But the immune system is far, far more complex than anticipated and frankly humbling to most researchers. It is seductively simple to conclude that all one has to do is pick the right antigen to stimulate an antibody response (as in many immunological disease), but there are apparently many biological holes in this theory special to cancer. (For one, we're learning that cancer tumors are not homogeneous.)

Here's my rationale for immunotherapy skepticism:

1) There is a long track record of failure in this area.
2)  the core thesis is still lacking validation.
3) big pharma has virtually no investment in this research area
4) the regulatory approval path is not optimized for cancer vaccines.
5) cancer immunotherapy research is asset-intensive and effort-intensive. Pursuit of autologous therapies is particularly labor intensive. In contrast, 1 informaticist or 1 medicinal chemist is enough to launch a discovery/development program.
6) what little commercial effort in the area of cancer immunotherapy is being conducted by micro-cap companies. (I don't mean to denigrate any company successful enough to go public, but there is a load of history confirming that companies of this size and scale just don't have the assets/resources necessary to conduct pivotal research.)

In essence, cancer immunotherapy research has the challenge solving of incredibly complex disease biology using the an incredibly complex modality. In effect, cancer immunotherapy equals the complexity of cancer treatment squared, though with less pharma support.


Case in point: CEL-SCI (CVM). While spun out from the very credible Max Planck Institute and built on attractive scientific rationale, CEL-SCI has been chasing an immunotherapy solution ("Multikine") since 1983. Nearly 30 years later, CEL-SCI is a micro-cap, with a market valuation of ~$110M and likely insufficient resources to complete their Phase III trials of Multikine.

I really, really hope that CEL-SCI or the other cancer immunotherapy companies are ultimately successful, but my perspective is that there are more promising oncology technologies for pursuit and investment.






It should be pointed out, though, that there is an FDA-approved cancer immunotherapy - Dendreon's ProVenge for prostate cancer. Dendreon received FDA approval in 2010, but market response to date has been limited. It is unclear if the market's response to ProVenge is driven by technical skepticism, or by the complexities of creating and delivering an autologous vaccine.

Top 10 promising cancer drugs in development

FierceBiotech - an indispensible web site (sign up for their daily news summaries) produces an annual list of most-intriguing/promising late stage cancer programs. Here's this year's edition - it's definitely worth a read.

I was struck by the diversity of approaches. The target/technology list includes:

cancer stem cells,
the proteasome,
androgen receptor signaling,
immunotherapy,
antibody-chemo conjugates,
tyrosine kinase signaling, and
anti-angiogenesis

The good news is that there is a broad and diverse anti-cancer effort underway. The bad news is……there is a broad and diverse anti-cancer effort underway….meaning we still don't know much about how to fight cancer effectively. From a decade ago, a few anti-cancer technologies have come (stem cells) and gone (gene therapy), and some technologies have increased validation (anti-angiogenesis) while others have fallen (immunotherapy), but the nature of the list hasn't changed a great deal.

One possible lesson from this list of candidates: anti-sense/RNAi and HDAC drug development are not currently as promising as they each were 3-5 years ago.