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More popular press coverage of immunotherapy for cancer
Topic Started: Apr 17 2018, 01:20 AM (209 Views)
jon-nyc
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Cheers
https://www.nytimes.com/2018/04/16/health/lung-cancer-immunotherapy.html
In my defense, I was left unsupervised.
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Klaus
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Quote:
 
After a median follow-up of 10.5 months, the estimated rate of overall survival at 12 months was 69.2% (95% confidence interval [CI], 64.1 to 73.8) in the pembrolizumab-combination group versus 49.4% (95% CI, 42.1 to 56.2) in the placebo-combination group (hazard ratio for death, 0.49; 95% CI, 0.38 to 0.64; P<0.001). Improvement in overall survival was seen across all PD-L1 categories that were evaluated. Median progression-free survival was 8.8 months (95% CI, 7.6 to 9.2) in the pembrolizumab-combination group and 4.9 months (95% CI, 4.7 to 5.5) in the placebo-combination group (hazard ratio for disease progression or death, 0.52; 95% CI, 0.43 to 0.64; P<0.001). Adverse events of grade 3 or higher occurred in 67.2% of the patients in the pembrolizumab-combination group and in 65.8% of those in the placebo-combination group.

This sounds very encouraging, but not like a game changer.
Trifonov Fleisher Klaus Sokolov Zimmerman
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Mikhailoh
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Still a pretty big jump in survivability. More promise than anything else we have seen.

Wish they'd hurry up...
"I have strong feelings about gun control. If there's a gun around, I want to be controlling it." Clint Eastwood, Pink Cadillac
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Klaus
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But when the popular press talks about "survivability" they usually mean something like "living another 30 years cancer-free", which is very different from "live 4 months longer".

I have a colleague who is doing research on cancer immunotherapy tailored to the genes of the respective patient. They often have papers that celebrate median survival rates that are one or two weeks longer. I'm not saying this isn't valuable research; of course it is, and weeks eventually add up to months and then to years. But progress is slow; there are no miracles.
Trifonov Fleisher Klaus Sokolov Zimmerman
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Mikhailoh
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Well. You are a downer this morning. :lol2:

I guess it depends on whether it is your four months.
"I have strong feelings about gun control. If there's a gun around, I want to be controlling it." Clint Eastwood, Pink Cadillac
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bachophile
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Klaus
Apr 17 2018, 03:59 AM
But when the popular press talks about "survivability" they usually mean something like "living another 30 years cancer-free", which is very different from "live 4 months longer".

I have a colleague who is doing research on cancer immunotherapy tailored to the genes of the respective patient. They often have papers that celebrate median survival rates that are one or two weeks longer. I'm not saying this isn't valuable research; of course it is, and weeks eventually add up to months and then to years. But progress is slow; there are no miracles.
usual endpoints in oncology clinical trials are progression free survival (PFS) and overall survival (OS) and calculating the hazard ratio (a fancy term which just means comparing the relative difference in survival between two arms, for example a hazard ratio of 0.5 means the the control arm will have half the median survival as the test arm)

however, whats much more interesting to see when the survival curves plateau . thats where u can see the real effect of a treatment...sustained effect.

Posted Image

if u r PD-L1 positive, (bottom curve) then anti PD-1 therapy like pembro can have really marked effect, with the curve plateauing at maybe 25-30% as opposed to sinking into oblivion, meaning u can conceivably have a large number of long term survivors, which for metastatic lung cancer is i unheard of.

so yes, anti PD-1 is making a huge change in the paradigm of cancer therapy. (not measured in 1-2 weeks, but 1-2 years) thats a big deal. and possibly, even cures, something simply not conceivably possible in the chemo only era.

so things are changing rapidly, but never quite fast enough.

but yes a game changer.

Edited by bachophile, Apr 17 2018, 08:11 AM.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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bachophile
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Posted Image

for example....

kaplan meier curves and their analysis are the basis of all cancer drug trials
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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Klaus
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bachophile
Apr 17 2018, 08:10 AM
with the curve plateauing at maybe 25-30% as opposed to sinking into oblivion
The data in that curve doesn't show that the there is a sustained plateau, though. It stops at 20 months. For instance, at 22 months it could jump to 0.
Trifonov Fleisher Klaus Sokolov Zimmerman
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bachophile
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חot long enough follow up. But most immuno trials show a long flat sustained response.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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jon-nyc
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Klaus thinks like a CS guy. He just wants someone to go in there, fix the bug, and be done with it.
In my defense, I was left unsupervised.
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