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Big News in Cancer, Versus Big Talk About It

We have two very different stories about the progress of cancer therapy this morning. We’ll start with the good part: the American Cancer Society says that death rates from the disease in the US dropped in the 2016-2017 period by their largest recorded percentage. This is unequivocally good news, and is attributed to advances in treatment – specifically, the advent of immunotherapies and of various targeted agents for lung and skin cancer. It may come as a surprise to some, but these death rates have actually been falling since the early 1990s at about 1.5% a year, a good part of which can be attributed to the decline in smoking. But the 2016-2017 decline bumped up to 2.2%, which has never been seen before. (There are some interesting conclusions to be drawn from the incidence and mortality figures considered separately; that’ll be the subject of a whole separate post).

When I talk to folks outside the research field, for several years now I’ve been saying that the oncology treatment landscape really has been changing. That has been clear to those of us on the inside, and here are the numbers to prove it. People are walking around today – going to work, watching their children grow up, making reservations for dinner with their spouses and friends – who would have been dead ten years ago with the same diagnoses. I believe that the data will continue to show this effect going forward, because we’re still making progress. It’s an interesting question whether the 2.2% decline represents a “bow shock” of new therapies hitting a large population for the first time, and perhaps we’ll be able to distinguish that in the coming years.

Now, though, we turn from the real-world results to the world of big talk. I wrote here three years ago about Patrick Soon-Shiong and his talk of his “Cancer Moonshot 2020” that he began publicizing in 2016. The phrase “covered in heaps of glittery hype” showed up in that post, among other unkind phrases, so now that it’s 2020 already, perhaps it’s time for a look at how things are going. Not well.

Four years later, independent medical researchers say they’ve heard virtual radio silence from Soon-Shiong’s initiative. And a review by STAT of clinical trial listings, research presentations, and press releases suggests the effort has fallen far short of its major goals. . .The initiative’s website went dark this past spring, and its social media accounts haven’t been active in nearly three years. Its original Twitter account — abandoned after the initiative changed its name in 2017 — is now littered with dozens of posts promoting free Amazon gift cards.

That whole Stat post is well worth a read. I especially liked the part where its author, Rebecca Robins, contacted 17 of the people who were quoted in the original 2016 press release showering praise on the whole idea, and found that none of them seemed to be available for comment. That tends to happen with these things – longtime observers may remember FDA commissioner Andy Eschenbach talking in 2003 about “eliminating death and suffering” from cancer by 2015, and people didn’t return calls about that one, either. It’s not just cancer, either: in 2013, then-Prime Minister David Cameron was talking about a cure for Alzheimer’s by 2025, and good luck getting him to go on the record about it these days.

This kind of high-level hand-waving about major medical problems that just has to be recognized, avoided, and discounted when it shows up. I’m all for ambitious goals – honestly, you should see the sorts of things I’ve been working on over the last ten years – but what I support is getting to work on them, not holding press conferences where you discuss how great your press release is. And how great a person you are for telling everyone about it. Clapping your hands and wishing for great results doesn’t get you very far – use your hands instead to put on a lab coat and pick up a flask or an Eppendorf vial. Use the time you’d spend coming up with a spiffy acronym and read the damned literature instead. Try to think up some useful experiments; that’s a lot better use of your brainpower than designing a logo for your initiative’s glossy web site.

In other words: the people who spend lots of effort telling you about the great things they’re going to do usually get lapped by the people who are actually working on the problems. How much of that drop in the cancer death rate is due to Patrick Soon-Shiong?

35 comments on “Big News in Cancer, Versus Big Talk About It”

  1. don't need the money that bad thanks says:

    Of course you don’t like it, you’re not one of the insiders that will cash out on the IPO or acquisition.
    It’s funny, we have all these “industry experts” and “scientists” posting on stock trading web sites, talking about cartoon stories for mech of action as though it’s proven.

    Yet…..

    we never have anyone follow up on all the “billion dollar” deals that never amount to anything. Companies paying hundreds of millions for grape juice, glucose assay tech supposedly turned into diabetes “cures” by elizabeth holmes (smart cells) imitators, etc etc etc.

    Like I’ve said all along, most scientists are just too desperate for a paycheck to dare use their common sense, they’ll play along with anything as long as there is money for them. If they speak out about snake oil they are slandered and lied about…ruining their careers.

    Pay attention investors

    1. Blue Sky says:

      The good investors do pay attention to all this. And they do exist, they’re just rare. As are good professional anythings. 🙂

  2. Ren Hoeg says:

    Amen to all of the second to last paragraph!

  3. Synthetica says:

    Speaking of Hype Anniversaries Derek maybe you should revisit this one from 5 years ago: “The end of synthesis” https://blogs.sciencemag.org/pipeline/archives/2015/03/12/the_end_of_synthesis

    There are none of these machines in any major pharma company that I am aware of and the chemistry conducted during drug discovery has not advanced due to any of the data reported in that paper despite the enormous press coverage and lavish praise for what amounts to a peptide synthesizer for Suzuki couplings.

    Let’s revisit again in another 5 years and see if its still the same situation, shall we?

    1. NotHF says:

      My opinion remains that the use case for these machines is limited. Convenient if you need to do the same reaction a lot, but not really beyond that. It’d be interesting to see a retrospective on Burke’s machine, the Jamison one, and whatever it is Lee Cronin is on about.

      1. t says:

        Amen…all three are cute technologies in search of a solution to something. There needs to be a couple of orders of magnitude advances in automated reaction optimization and above the arrow predictions to enable these machines to function as true universal, autonomous synthesis machines (not to mention the numerous challenges with solid, slurry, and liquid reagent handling). Simply replicating a recipe that took years to develop for a synthesis and adapting it to an automated reaction platform is not really useful. I’ll be impressed when I can just input a chemdraw for a never reported molecule and the machine will select the route, experiment with conditions/reagents/step order/isolations, and get me some product.

    2. SOTF says:

      The cartridge-based automated synthesiser from Synple Chem approaches the problem from a different angle to these other machines and is being used my medicinal chemists in major pharmaceutical companies, as well as supporting CROs. Novartis recently presented their user perspective on it at the Automated Synthesis Forum in the UK.

      1. T says:

        Nope… failed our tests

  4. Fragmites says:

    And what’s better than curing a cancer? not getting it in the first place:

    https://theconversation.com/cervical-pre-cancer-rates-down-88-in-decade-since-hpv-vaccinations-began-first-findings-113610

    Along with declines in smoking, another help

    1. Lazy guy says:

      Neither of these help dropping death rates from cancer

      1. Michael says:

        Umm, yeah they do. If fewer people get cancer, then fewer people die from it. What you mean is that they don’t affect the mortality rate of people who actually do get it, but that is different from the total death rate.

  5. PR says:

    “How much of that drop in the cancer death rate is due to Patrick Soon-Shiong?”

    Possibly some. He attached good old paclitaxel to albumin, which gave it some availability advantages over plain paclitaxel.

    1. David Young, MD says:

      It is difficult to ascertain how much better NAB-paclitaxel was from regular Paclitaxel in terms of efficacy. Even with premedications, there were still some patients who experienced anaphalactoid reactions to Paclitaxel from time to time. They didn’t occur with NAB-paclitaxel and premedications were not necessary. One had a sense that there was some better efficacy, but it might not have been much and randomized controlled studies did not always demonstrate improved efficacy. I am disappointed in the fundamental idea of NAB-paclitaxel, in that the albumin binding drew the drug closer to the tumor cells. One would think that “in principle” one could formulate a number of cytotoxic drugs with NAB and improve efficacy. I had images of a dozen new products on the market starting in the year 2005. But it did not happen. NAB-Docetaxel was a failure in a large trial and a number of other NAB-drugs never made it to Phase III. Therefore, the concept failed (as have many others, as you all know). Nevertheless, Abraxane made P.S.S some 7 billion dollars.

      1. PR says:

        Considering that paclitaxel was given dissolved in castor oil, an engine lubricant, it’s laudable to provide a somehow milder version, Abraxane. That it doesn’t have better efficacy is too bad, and not that surprising. Is that small advantage (less tox, fewer side effects) worth $7 billion? Probably not. Other, more effective drugs could have been developed with that money.

        But to be fair, while Patrick Soon-Shiong makes charlatan-like claims, he is, in fact, one of “the people who are actually working on the problems”. Abraxane could have been a complete failure and waste of effort and money. And healso has skin in the game with Nantkwest and other ventures.

        1. Nate says:

          Hang on there. Taxol uses polyethoxylated castor oil (“Kolliphor EL”), not castor oil. Quite different, and should be noted here on a blog with chemists and other pharma professionals. While I would prefer not to inject polyethoxylated castor oil in my veins, if I had cancer I would accept said injection if my insurance plan would not reimburse the more expensive Abraxane over the now generic and cheaper Taxol formulation.

          1. PR says:

            OK, my bad, it’s not castor oil and it’s not used as lubricant. But to David Young’s point, there are patients who experience severe anaphylactic reactions to Kolliphor EL. Replacing it with albumin while maintaining efficacy is small but real progress. And it’s expensive now but in few years it will be off-patent, generic and cheaper. Patients will be better off. Patrick Soon-Shiong helped cancer patients. He still shouldn’t be giving false hopes with his “Moonsh…ts” procalamations.

  6. Anon says:

    Great news. How do you pare it with your yesterday’s headline..”Evading Chemotherapy, Bacteria-Style?” We should not take success for granted!

  7. Wavefunction says:

    The news is good indeed, but I think it does hide the fact that the vast majority of cancer patients have their lives extended by a few months at best, and this average figure has not changed in the last twenty years. There’s a power law distribution in cancer therapy efficacy, with a small number of cancers benefiting from therapies for a small number of patients. In addition, the media often exaggerates the reach of single-mutation treatments like Gleevec which work well in very early stages for a very specific kind of cancer. Much of this is because of the lack of translation from in vitro and animals models to humans along with a very reductionist single target-focused approach. A great book that discusses why we sorely need to take a much more patient-derived approach to cancer treatment is Azra Raza’s “The First Cell”.

    1. Derek Freyberg says:

      Do you have some numbers to support that first statement, Wavefunction?
      I agree that some new (last few years’) compounds have only limited survival benefit, often at considerable cost; but a quick look at cancer statistics – and I looked at ISD Scotland’s numbers for 1987-2007, https://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/All-Types-of-Cancer/, just because I found them first – show that survival times for several major cancers have been steadily rising over that time.

      1. Dionysius Rex says:

        Huge variations in incidence and survival between the most and least deprived sub-groups. Kind of expected, but wow!

  8. loupgarous says:

    Peptide receptor radionuclide therapy (PRRT) is helping the outlook of neuroendocrine cancer patients with distal metastases and/or inoperable tumors (e.g. metastasis to liver). Lutathera (lutetium-177 dotatate) was approved in January 2018, and presents a therapy for those of us with diffuse distal metastasis of neuroendocrine tumors.

    The 5-year survival rate (SEER) in people with distal metastases from carcinoid tumors drops to 67% from 97% for those with localized carcinoids (to mention perhaps the most common variety of neuroendocrine tumor). Thus, a systemic yet targeted approach such as PRRT in which the dotatate ligand causes the radioactive isotope it carries (Lu-177 in the FDA-approved version) to be taken up by neuroendocrine tumors with an affinity for somatostatin and related drugs is needed to increase survival rates in those patients with distal NET metastasis.

    I took part in the Lu-177 dotatate clinical trials beginning in 2014, when I had distal metastases to my liver from the initial tumor site between my heart and spleen. It’s been interesting, but I’m still here to talk about it with you. Hopefully, the 5-year survival rate for metastatic NETs will improve as chemoembolization, beam therapy and other nonsurgical approaches improve patient outlooks even for those of us for whom surgery’s not an option.

  9. sgcox says:

    Even Trump noticed it and took the full credit on Twitter !
    https://twitter.com/realDonaldTrump/status/1215287261606051844

  10. steve says:

    Trump seems to think it is all his doing. Patrick is small potatoes compared to the egomaniac in the occupied territory of the White House.
    President Donald Trump appeared to claim credit today for a record drop in cancer death rates that occurred the year he took office. Scientists say lower smoking rates, earlier detection and better drugs are responsible for a steady decline in cancer deaths since 1991.
    The president, who unsuccessfully advocated cutting $4.5 billion from the NIH budget last year, tweeted that U.S. cancer death rates are the lowest in recorded history, adding there is “a lot of good news coming out of this Administration.”
    https://www.politico.com/news/2020/01/09/trump-makes-misleading-brag-about-lower-cancer-deaths-096704

    1. Ken says:

      How does that old adage about roosters taking credit for the sun coming up go?

      1. steve says:

        I’m not sure but I somehow the term “cock-up” seems to fit both

    2. x says:

      I’m not a fan of Trump, but I really get tired of the histrionic whining and bashing coming from people who probably voted for the Democrat he beat in 2016 but didn’t complain about how she got nominated.

      1. steve says:

        Maybe it’s because he says one incredibly stupid thing after another. He’s responsible for curing cancer? What on earth does her nomination have to do with that? What REALLY is tiring is that some people need to bring her up every time people point out some incredibly stupid thing he says. He alone is responsible for making such an idiotic utterance and trying to make some type of moral equivalences every time is weak.

        1. x says:

          “What on earth does her nomination have to do with that?”

          Well, if the primary hadn’t been rigged to favor her, there was quite a good chance Trump never would have won, and the people who are whining about him now wouldn’t be. You would think the people who whine about Trump would examine the root causes of his election a little more. Maybe acknowledge the choices that led to this outcome. But no, it’s like human history started in January of 2017.

          Hm. What is it they say about history? Something about being doomed to repeat history?

          1. steve says:

            Nonsense. She won by over 3 million votes in the popular and only lost the electoral by less than 80,000 votes spread over three states. Now how about addressing what’s happening now instead of trying to make us all relive ancient history just to suit your political biases?

    3. SV-AUC says:

      Trump is just great at selling. It is just an interesting idea to claim everything good happens upon his doing and everything bad is caused by other people. How many voters will look into the reason of the drop in cancer death rates. A fun fact. The same thing happened in UK. The politicians in UK always claimed every good effect for themselves and blamed the EU for all bad stuff happening. This game went on for decades. In the end the voters got so brainwashed they voted to leave the EU.

  11. loupgarous says:

    “Now that 2020 is here, NantKwest is putting forth some new evidence for what it’s calling the “cancer breakthrough 2020”: one complete response in the expanded access portion of a Phase I trial. The patient, who had metastatic pancreatic cancer, saw the tumor metastasis resolve completely per CT/PET scans. According to Soon-Shiong, it’s the latest in a series of encouraging results involving tough cancers of the breast, lung, bladder and head and neck.”

    Ok, one data point, gathered out of protocol (compassionate use).
    That settles that. But Soon-Shiong sure can pick his moment. Now that FDA’s really cutting slack on efficacy, his path will be smoother.

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