[HN Gopher] Moderna Melanoma Vaccine Cuts Death Rate in Half
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Moderna Melanoma Vaccine Cuts Death Rate in Half
Author : boiler_up800
Score : 243 points
Date : 2023-12-14 15:18 UTC (7 hours ago)
(HTM) web link (www.reuters.com)
(TXT) w3m dump (www.reuters.com)
| YellOh wrote:
| This is very neat! The effect has only been observed up to three
| years out, but this seems like it could become a pretty cost-
| effective option?
|
| Also, misc side note: I keep reading the words "Madonna" and
| "Cults" in the title even though they're not there. Was very
| confused when I first clicked the link.
| seydor wrote:
| Can't unsee
| ceejayoz wrote:
| A friend's kid had a specific rare childhood melanoma that, when
| Googling, showed a 90% mortality rate. Thankfully that number is
| apparently before recent immunotherapy advancements, but it was
| pretty terrifying. This article is a happy click for me.
| edc117 wrote:
| A little bittersweet for me, lost an uncle to this about 10
| years ago...but still happy and a little inspired, proud of our
| species. I really hope ours is the last generation(s) that have
| to suffer through that awful disease.
| briane80 wrote:
| Great news, and with the 92% effective covid vaccine, Moderna are
| really killing it.
| orwin wrote:
| Weirdly, while this is not the first time i read about this
| vaccine, this is the first time i read an explanation about how
| it work.
|
| Seems to be a tad expensive, but also generalizable. Hopefully it
| can replace hormone therapy for breast cancers, and be extended
| to all common cancers.
| fnordpiglet wrote:
| Didn't see any pricing information? Sadly all incentives are to
| not make it less expensive and to simply extort the
| institutions on the payment side and give rebates to everyone
| who doesn't have an institution to back them. Much of medicine
| is intentionally expensive to prop up revenues (and indirectly
| profits while maintaining a defensible percent of revenues
| margin).
|
| But maybe not here - Moderna got a lot of experience with mass
| scale production in the pandemic. If they orient it here we
| could see biopsy based / pre surgical vaccination of cancer at
| mass scales which would require scaled out pricing.
| s1artibartfast wrote:
| Current personalized cancer "vaccines" arent really
| comparable. They typically cost millions and require the a
| team of scientists to harvest your cells and create tailored
| biologics to treat you.
|
| Even if you strip out the profit motive, you still have huge
| amounts of skilled human labor
| fnordpiglet wrote:
| Yes, but that's the beauty of industrialization. As scales
| grow, manual skilled processes become automated. I'm not
| asserting todays mRNA based on a sequence of a single virus
| genome is comparable - but that the process of
| industrializing as a skill is in fact a skill in an
| enterprise that once perfected can be applied to more
| complex domains.
|
| The profit motive is reflected more in terms of keeping
| high revenue producing processes inefficient to justify
| higher profits with the same margin. Medicine is replete
| with examples of processes that can be dramatically more
| efficient and widely available, but are not optimized
| because it reduces profits by reducing gross revenues. High
| margins invite scrutiny, high revenues invite investment.
| gattr wrote:
| Hopefully, in a few decades: got cancer? Go for a biopsy,
| wait a week for a personalized vaccine. Even if some
| cells survive, mutate and start growing again, just
| repeat the procedure. Cancer becomes a somewhat annoying
| chronic illness.
| DiscourseFan wrote:
| Well, let's hope that repeatedly injecting people with
| mRNA over the course of a lifetime doesn't create other
| problems--I guess if the alternative is death, then
| there's nothing else one can do anyway
| bawolff wrote:
| Is there any reason to think it would? mRNA is naturally
| present in the body, and also gets broken down pretty
| quickly.
| s1artibartfast wrote:
| I agree with the march of progress and the hopeful
| commodification of new technologies. I also agree that
| there are a number of counterproductive incentives
| driving up the cost of healthcare. Regulatory capture and
| lack of payment controls means efficiency is not
| rewarded.
|
| It is similar to the California energy market, where
| electric providers are fixed, and rates are set by the
| sate on a cost plus basis. It should be no surprise that
| electricity production costs are multiple times higher
| than other states if manufacturer profit is capped at 8%.
| bawolff wrote:
| industrialization usually requires making the same
| product for everyone. E.g. back in the day everyone had
| custom fitted shoes, now we choose from pre-made sizes.
|
| Its not entirely clear such tailored processes can be
| easily automated.
| fnordpiglet wrote:
| This, coupled with mass sequencing of individual cancers and
| pathogens, feels like the generalized way forward in medicine.
|
| I wonder how they identify the targets in each genome. Is there
| an optimizing expert system? Generative AI?
| chrisamiller wrote:
| The short answer is, we sequence their genomes, identify
| mutations that change a protein sequence and are highly
| expressed, then run those all through suites of algorithms that
| predict how well they'll be presented to the immune system.
| (mostly neural networks trained on far-too-sparse experimental
| data). This prediction is the hard part right now - we still
| don't understand enough about how the immune system identifies
| and interacts with these altered peptides to do really accurate
| predictions of which ones will be most effective. Throw in that
| these tumors are actively suppressing the immune system in
| various ways, and it's complicated! There is lots of research
| going on, though, and lots of promising early results, like
| this one
| CoastalCoder wrote:
| I'm guessing that this vaccine is only used post-diagnosis.
|
| Anyone know if there's talk of using this profilactically, like
| the HPV vaccine? (I realize that viruses != cancers, but IIUC hpv
| can sometimes lead to cancer, which is why I thought to ask.)
| sbelskie wrote:
| "The vaccine is custom-built based on an analysis of a
| patient's tumors after surgical removal. The vaccines are
| designed to train the immune system to recognize and attack
| specific mutations in cancer cells."
|
| Looks like their is a level of personalization going on that
| requires actual existing cancer.
| packetlost wrote:
| Damn, I knew mRNA vaccines were the pretty much the end game
| for vaccines, but holy shit this is cool.
| DiscourseFan wrote:
| Well, not really, what (mass) mRNA trials have shown is
| that they don't deliver long term immunity, and each time
| you give someone an mRNA booster the immune reaction gets
| more severe, until the point at which it might give them
| serious long term side effects or even, in severe cases,
| kill them. It doesn't actually make sense in _most_ cases
| to use mRNA over traditional vaccines--but they have been
| producing fascinating non-prophylactic immunotherapy
| treatments with mRNA, where triggering a severe, and
| specific, immune response would lead to positive results
| (like with specifically targeted cancer treatments).
| Spooky23 wrote:
| As someone who just lost the love of my life to
| complications of metastatic melanoma, I'd encourage you
| to tune out the naysayers and nonsense around these
| treatments.
|
| Melanoma in particular heads to the brain often and is
| difficult to treat. 10-15 years ago, it was a death
| sentence. Today, 60-70% of qualified patients will
| survive 5 years or more thanks to immunotherapy. A chunk
| of the 30-40% are folks who have difficulty tolerating
| the therapy, have poor response, or other complications.
| In my wife's case, complications from brain surgery
| delayed treatment and the combo of mets and immunotherapy
| response created a bad situation.
|
| Today, about 50% of melanoma tumors have a BRAF mutation,
| and a medication that can delay growth and buy patients
| time to get better in order to get treatment. In my
| wife's case, that wasn't an option.
|
| COVID demonstrated that these vaccines bend the death
| curve, reduce severity and offer positive immune
| response. If that were available early this year, the
| chances are my wife would be alive, finishing her second
| course of immunotherapy.
| mikeyouse wrote:
| I'm unfamiliar with anything in this line of research --
| the Covid mRNA vaccines haven't provided longer-term
| immunity, but that's not at all due to the mRNA, but due
| to the nature of coronaviruses, how quickly they mutate
| and how many different mechanisms they have for cell
| entry. "Traditional" vaccines were actually performing
| worse for Covid19.
|
| I'd be curious to read more about long-term immunity
| issues if you have some links?
| JAlexoid wrote:
| Way before we had COVID bring out mRNA based vaccination
| to mass media, I learned about mRNA as a treatment for
| various cancers.
|
| Moderna's research pipeline has been full of cancer
| medications, which seem to be very promising.
| SamBam wrote:
| Do your statements have any sources? And are those
| sources anything other than the difficulty in targeting
| the fast-evolving covid virus?
| FpUser wrote:
| Sounds very unaffordable for general public. Hopefully I am
| mistaken.
| kstrauser wrote:
| Everything's unaffordable at first. It only gets better
| when enough people are using it that we get economies of
| scale.
| mrguyorama wrote:
| Which is why modern insulin is super cheap to the end
| user right?
| ksenzee wrote:
| It is, in countries that negotiate price. The US is doing
| the equivalent of walking into a market where everyone
| else is negotiating, and taking the vendor's first sky-
| high offer.
| blackbear_ wrote:
| Cancer is a bit more difficult due to its high mutation rate,
| but yes people are thinking at that:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525885/
| sys32768 wrote:
| ~20 years ago a young father on my block had a mole on his neck
| that ended up being a fatal melanoma. He otherwise looked so
| healthy.
|
| He said it might have been from sunburns when he was in the Boy
| Scouts.
|
| I will never forget the look on his face when I spoke with him, a
| look of bewilderment wrestling with anger.
|
| His wife teetered with grief and confusion, trying her best to be
| strong while trying to bear the sickening reality that nobody
| could have prepared their family for.
|
| I always get an annual dermatology checkup now because of him.
| ejb999 wrote:
| Please explain to someone that has never seen a melanoma - this
| person had a single 'mole-like' mark on his neck (presumably
| small?), and that alone killed him? or was it 'mole-like' and
| eventually got so big that it killed him?
|
| Having a hard time understanding how something so small, and so
| easily removed can kill someone.
|
| I have so many 'moles' on me, I wouldn't even know what to look
| for.
| askonomm wrote:
| I just go to a dermatologist once a year who scans my moles.
| Totally worth it.
| teruakohatu wrote:
| Just like many cancers, the cancerous cells spread and
| destroy vital organs.
|
| Yes they can be removed, but if the cancer has already spread
| then it may be too late.
| ejb999 wrote:
| so it can be visually very small, and still kill you?
|
| Just like an iceberg I guess...
| pohl wrote:
| The concept you want to understand is metastasis. When a
| cancer metastasizes, it sends out cells that become cancers
| elsewhere in your body. One day just just have a little
| melanoma, the next day it sounds out cells that become
| cancers in other organs: your lungs, your liver, etc.
|
| Some skin cancers, like basal cell carcinoma, never
| metastasize. Melanoma is one that will.
|
| https://en.wikipedia.org/wiki/Metastasis
| SOLAR_FIELDS wrote:
| There are plenty of sources online to tell you what to look
| for, but my dermatologist sticks with "pink and brown makes
| you frown". Irregularly shaped with strange combination of
| pink and brown is a flag to watch out for.
|
| I've had a couple basal cells (the way less scary one) and
| the easiest way to identify those is just look for a pearly
| pimple that won't go away.
| rafaelero wrote:
| That's amazing news. Even cooler when you realize that Keytruda
| was already a relatively effective treatment!
| bkummel wrote:
| Sounds like an important breakthrough!
|
| Side note: in the article, I find it a bit inappropriate that the
| first paragraphs only talk about the effects on the stock prices
| of both involved companies, before going into details of the
| research and how the vaccine works...
| BurningFrog wrote:
| That's how financial news is structured.
|
| Science news go in the opposite order.
| leetrout wrote:
| Wear sunscreen.
|
| Get your moles checked.
|
| My dad died in July 1996 from a nasty mole on his back. He would
| ask me to scratch his back and I remember being 8 or 9 years old
| and having to scratch around it as it was near the seam of his
| tank top (which likely aggravated it daily). And would make
| comments about it being "gross". We just didn't know what we know
| today.
|
| He was drying off after showering one morning and got blood all
| over the towel from the mole. He went to the dermatologist and
| was told he had malignant melanoma. This was in September 1995
| and he was in the ground before the middle of July 1996. Nine
| months to get his affairs in order. I remember driving around and
| seeing his old college pals (one of which I still see once a year
| or so for lunch to this day). I remember him buying a bag phone,
| a "car phone" so we could keep in touch as he drove from Eastern
| KY to Duke University for experimental treatments (I believe it
| was the one that led to the immunotherapy treatments used today).
| He told my mom even if it didn't help him he hoped it would help
| someone.
|
| I avoid the sun with the exception of the back of my neck and the
| top of my hands. He has no clue (nor do the dermatologists) what
| caused it but, like other posts mention, likely sunburns in
| childhood.
|
| I am so hopeful for this treatment and thankful for the progress
| made on the immunotherapy fronts.
| hammock wrote:
| >Wear sunscreen.
|
| Melanoma in adults is typically tied back to acute blistering
| sunburn events that happened before the age of 18 (as you seem
| to be aware). The most common sites of melanoma are chest and
| back in men and legs in women, areas that are more often than
| not covered by clothing and not in need of sunscreen.
|
| Cumulative sun exposure on the other hand causes the other
| types of skin cancer - not melanoma, which this vaccine is
| targeting.
|
| The most common chemical sunscreen ingredients cause cancer
| themselves and are wildly overdue for FDA review and removal
| (that has been held up for political reasons). For those who
| wish to wear sunscreen I recommend non-nano zinc mineral
| sunscreen such as Thinksport. Look for "non-nano" and zinc
| oxide (not titanium oxide, which is often nano in part and also
| a carcinogen) on the label.
| astockwell wrote:
| > The most common sites of melanoma are chest and back in men
| and legs in women
|
| > The most common chemical sunscreen ingredients cause cancer
| themselves
|
| Both of these statements are out-of-date.
|
| Recent studies show two different histological subtypes of
| melanoma for young adults vs older adults, each following a
| different common mode of presentation [1]. Melanoma in
| younger adults tends to present on the long limbs and is
| thought to have different contributing factors.
|
| Also "common chemical sunscreen ingredients cause cancer" is
| a common FUD trope. Sunscreen reduces cancer mortality, full
| stop. Each person's circumstances vary based on their daily
| habits, geography, and personal/familial history.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482997/
| loceng wrote:
| Re: 'Also "common chemical sunscreen ingredients cause
| cancer" is a common FUD trope. Sunscreen reduces cancer
| mortality, full stop. Each person's circumstances vary
| based on their daily habits, geography, and
| personal/familial history.'
|
| You didn't actually prove anything with your counter point
| here, as confident as you are - which is as confident to
| whom you're responding to.
|
| At this level of ideological-indoctrination, it seems each
| person would have to actually participate [run and observe
| them] in the trials to see if certain ingredients cause an
| increase in rates of cancer.
|
| How else do people indoctrinated into a belief, believing
| they simply know better - and must be right, than have
| people repeat clinical trials on animal models [or better]?
| Genuine question.
| loceng wrote:
| Re: "Melanoma in adults is typically tied back to acute
| blistering sunburn events that happened before the age of 18
| ..."
|
| With the practical advice to counter this being gradual
| increase of sun exposure to allow your body to build a deep
| layer of protection (tan) - of which sun screen will prevent,
| and then if you miss any spots and get full blast of sun for
| hours all of a sudden then those will be points of
| vulnerability.
|
| Pharmaceutical industrial complex: create-advertise the
| problem, sell the solution(s) = profit!!
| pdabbadabba wrote:
| Note that your quote from GP only relates to melanoma. They
| also said "Cumulative sun exposure on the other hand causes
| the _other types of skin cancer_. "
|
| Its there evidence that the incremental tanning you
| describe actually protects you from skin cancer and will
| not cause other cancers? If not, this seems like a very
| reckless comment.
| hammock wrote:
| Melanoma is far more deadly than the other types of
| cancers. If building a base tan can protect you from the
| acute blistering burns that are known to cause melanoma,
| it may be worth it
| r0m4n0 wrote:
| > Melanoma in adults is typically tied back to acute
| blistering sunburn events that happened before the age of 18
| (as you seem to be aware)
|
| I'm curious how this was studied. I feel like that's when
| everyone gets really bad sunburns because this has to be
| extremely hard to actually confirm. Doesn't everyone get
| sunburns when they were in this age category? It's when we
| are young and irresponsible, putting on sunscreen requires
| persistence on something that doesn't seem important in the
| short term (and arguably is a newer trend).
|
| I totally believe that sun damage on your skin causes skin
| cancer but studying your choices in your younger years to
| later years seems quite difficult to confirm through
| research. Wouldn't they need to confirm adults that were
| diligent about putting on sunscreen their entire life,
| including when they were kids?
| jncfhnb wrote:
| You are likely hurting yourself a lot more by avoiding the sun.
| aidenn0 wrote:
| > Get your moles checked.
|
| Tell that to my GP. Both my parents had melanoma, and they each
| had one additional type of skin cancer each. _Their_
| dermatologist is insistent that I get checked, but my GP doesn
| 't think it's necessary, so my HMO won't pay for it.
| mjcohen wrote:
| It might be a worthwhile investment in self-preservation.
| vkou wrote:
| Fire your GP.
| HumblyTossed wrote:
| They probably can't depending on insurance.
| vkou wrote:
| Insurance isn't a suicide pact that ties you to one
| particular, shitty GP.
| usea wrote:
| For many people it is. They cannot see another doctor if
| they want to continue doing things like eating food. If
| they're lucky enough to be insured at all.
| COGlory wrote:
| Could you explain the mechanism of this? I am unsure how
| this situation could arise. There are seemingly infinite
| GPs in-network on any insurances.
| vkou wrote:
| Is their GP the only practitioner in-network for them?
| Their network has one member?
| mschuster91 wrote:
| Depends if there are other in-network GPs in a range
| where OP can reasonably travel to.
| yeetawayhn wrote:
| And who are also accepting new patients.
| aidenn0 wrote:
| I'll try, but my 3 previous GPs, who were all better than
| my current one, are no longer in-network. Presumably the
| insurance doesn't pay well enough to keep the better
| doctors. It's a substantial amount of paperwork (both with
| the insurance and the new GP) with no guarantee things will
| be better.
| verve_rat wrote:
| Sounds like your GP isn't doing their job? Time to get a
| different one.
| smileysteve wrote:
| In the US, even with a referral, dermatology is not
| considered preventative, so high deductible POS plans are
| left to HSAs too.
| aidenn0 wrote:
| My HMO pays almost 100% of in-network care with a referral
| (there is a nominal per-visit co-pay), so that at least
| wouldn't be an issue there, as long as I don't run into
| silly things like "The facility you visited was in-network,
| but Person X who did some of your care was an out-of-
| network contractor" which has bit me for emergency care
| before.
| jandrese wrote:
| At the same time make sure you are getting enough sun exposure
| to avoid bottoming out your Vitamin D levels. Low Vitamin D is
| linked to a number of bone and muscle issues.
| ekianjo wrote:
| Low vitamin D is linked to weakened immune system and higher
| rates of cancers.
| victorbjorklund wrote:
| https://archive.is/wh409
| jseliger wrote:
| _The combination treatment has won U.S. breakthrough therapy and
| European Medicines Agency PRIME scheme designations, regulatory
| programs that aim to speed development of innovative treatments.
| Still, Hoge said that even with the new data it would be some
| time before the companies can file for approval of the
| treatment._
|
| These delays help fill graveyards in the meantime:
| https://marginalrevolution.com/marginalrevolution/2021/01/th....
| The tragedy goes mostly unremarked on, because the dead don't
| agitate or vote.
| icegreentea2 wrote:
| But also remember the other invisible graveyard - the people
| who aren't dead because they received ineffective treatments.
|
| I do agree that drug approval processes need to consider the
| negative cost of delay, but in this specific case, from further
| in the article we see:
|
| > Moderna is currently building a dedicated facility in
| Massachusetts to produce the vaccine at commercial scale, which
| it hopes to finish sometime next year.
|
| > "We need to make sure that we have that near completion
| before we could even contemplate asking for approval," Hoge
| said.
|
| And the reason for this is that you typically need to submit
| detailed manufacturing information as part of your new drug
| approval process. This allows the FDA assess how likely the
| drug you actually sell will provide the same benefits as those
| in the trial, as well as make sure you don't like... dunno
| forget to serialize stuff and ship out contaminated product.
| JAlexoid wrote:
| The approvals themselves are much less efficient, than they
| aught to be.
|
| In so many cases, the changes trigger a review of the whole
| process - rather than the changes.
| kxyvr wrote:
| This is great news. We can always use better treatments. I had a
| case of metastatic melanoma (III-A) in my early 20's and the drug
| of choice at that time was interferon, which was not a
| particularly pleasant experience. There were experimental
| vaccines at the time as well, so these new vaccines have been
| multiple decades in the making.
|
| As some unsolicited practical advice, yes, it's always good to
| protect one's self from the sun using long sleeves or sunscreen.
| However, melanoma can and often does occur in areas that does not
| receive sun exposure. This could be between your toes or inside
| your butt cheeks. As a result, it's worthwhile to have a
| dermatologist conduct a skin exam once a year. Normally, this is
| covered under a specialist visit for insurance and for many
| insurance plans this is a flat fee.
|
| Outside of a regular exam, any growth that has unusual size,
| shape, or color should be checked by a dermatologist, especially
| if it changes. My lesion was raised off the skin and red in
| color. It also changed and grew over time. If one can not
| immediately see a dermatologist, lacks insurance, or money for a
| visit, regular pictures of the skin blemish or growth can help
| track changes. If it changes, though, it really does require a
| dermatologist to look at it.
|
| Lastly, dermatologists can and do make mistakes. In my case, my
| lesion was dismissed as a benign nevus at first visit. When I
| revisted the physician six months later, it was larger and was
| finally biopsied to discover it was melanoma. It is possible that
| the cancer metastasized in the interim period, but we'll never
| know. That said, if one is concerned about a growth and the
| physician defers, it is very simple to tell the dermatologist
| that you'd feel more comfortable if we biopsied the growth just
| to be sure. You don't have to be mean and I've never been
| refused. At that point, they take a small sample of the growth
| and send it to the lab. Then, you know for sure. Normally, the
| sample is taken by using a razor blade and skimming off some of
| the surface. It's fast, easy, and while not painless, it is not
| particularly painful. Generally, this is rolled into my
| specialist visit fee for insurance, but they may send an
| additional billing code to insurance.
|
| Finally, dermatolgists can be difficult to schedule with.
| Honestly, their schedule is often filled with cosmetic procedures
| like skin peels and botox because it's so profitable. That said,
| any dermatologist can do a biopsy, so just call around to find
| one with an opening that takes your particular insurance.
|
| I apologist for the side talk. I often find the whole talk to
| your doc discussion regarding skin lacks details, so hopefully
| this helps. Great to hear that the treatments are progressing.
| s3p wrote:
| Thanks for the advice. I haven't had any type of skin cancer
| but will definitely keep this in mind since a lot of family
| members have had it in the past.
| deminature wrote:
| Two out of three Australians will be diagnosed with some form of
| skin cancer at some point their lives [1] due to the higher
| atmospheric UV. This is going to prevent a lot of unnecessary
| death. Modern medicine is fantastic.
|
| [1] https://www.phrp.com.au/media/media-releases/two-in-three-
| au...
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