- "TAR-200 is a miniature, pretzel-shaped drug-device duo containing a chemotherapy drug, gemcitabine, which is inserted into the bladder through a catheter. Once inside the bladder, the TAR-200 slowly and consistently releases the gemcitabine into the organ for three weeks per treatment cycle."
- Phase 2 Clinical Trial
- 85 patients with high-risk non-muscle-invasive bladder cancer
- "treated patients with TAR-200 every three weeks for six months, and then four times a year for the next two years"
- 70/85 patients—the cancer disappeared and still gone 1yr later in almost 50% patients
- FDA granted TAR-200 a New Drug Application Priority Review
My dad had his bladder removed. Cancer came back 18 months later and he was gone 4 months after that. It sucks.
Plus, I regret that he had to live with a colostomy bag for that time. His quality of life probably higher if they do the other option (name escapes me).
Do cancers have a tendency to come back with better drug resistance if it's not fully eliminated? at least a resistance to the drug that got rid of it the previous time?
People say this because it sounds right and dramatic, but if they knew and understood what cancer is, they'd understand why treating it is so hard.
For those unconvinced, cancer is your own bodies cells gone rogue and trying to kill you. Now, this happens all the time. Luckily, our immune system is awesome and catches it.
Cancer is when your immune system does not catch it. it's invisible, indistinguishable from your skin cells or your lung cells. Its not like the flu or pneumonia - there is no foreign body, there is no attacker. Its you.
So then treatment means we need to kill living, actively reproducing cells in the human body. Well, a fire can do that.
The trick is, how do you kill the cancer cells, which your own immune system cannot even distinguish as cancer cells, but not harm your normal cells?
Turns out that's very hard and very grueling. Chemo is very effective, but you still lose your hair and damage just about all your organs in the process.
And, for the record, we do have "one off" cures for cancer - surgery. Just cut it out. The trouble is cells are microscopic and there's billions of them. Rarely will they be so perfectly contained you can get them all in one go. No, you miss some, and they sit there, growing, until the cancer is detectable again. And they move, they use your own blood and lymphatic system as a highway.
Though this reads as though the implied message is preaching the suppressed cure conspiracy theory so I'll respond to that interpretation.
What you're missing the competitive factor of this. If your drug strings your patients along while your competitor releases an effective cure, guess who's getting all the business? Look to Sovaldi and Keytruda for recent examples.
I wish I could find the article, but there is a clinic somewhere that ran trials where they deliberately wouldn’t treat the cancer too aggressively. Instead they experimented with treatment frequency but with control being the aim instead of elimination.
The theory being that they could keep it at bay indefinitely and lower the chance of selection pressure kicking in. The thought behind their approach is that they wanted their patients to die of something different than their cancer.
yes they are resistant to that line of therapy once it stops working.
Sometimes that resistance carries over to other lines too. For example, Enzalutamide doesn't work for prostate cancer if you were already treated by abiraterone.
Some important things not mentioned in this press release (not to detract from the idea of new treatment approaches of any sort):
- All patients had their tumors surgically removed before they were started on treatment. Thus the trial wasn't testing cure so much as delay of recurrence.
- These were very superficial tumors, meaning they were growing on the very surface of the inner bladder, just like skin tags. These aren't the ones that kill people. Patients with superficial bladder cancer who don't respond to BCG can be treated for quite a while just by having the tumors surgically removed whenever they recur (using a minimally-invasive procedure known as a transurethral resection of bladder tumors, TURBT).
- Fun with words: the press release called this a clinical trial, but it's not -- it has no controls, no real statistics, no randomization, none of the things that make up the usual standard in medicine. The authors of the paper call it a "study", which is basically a research experiment. They don't use the word "trial" at all in the paper.
Having said all that, I still look forward to seeing a proper trial.
My father currently suffers from bladder cancer, he's currently in palliative care, he's in Ukraine. If there are any medical professionals here, could someone provide an advice - is there any chance to get him access to TAR-200?
You may want to look at this study. Its preapproval expanded access. There is an email and phone numbers for the company which is running the study. Usually the further along the drug trial is they more the loosen the criteria. Wouldn't hurt the ask if its suitable for your father.
No, the trial is closed to new participants. Check the company website to see if they are having international trials or are open to compassionate use.
FWIW I can recommend Bundeswehrkrankenhaus Berlin, very good urology clinic there. Not sure if there's any chance for you since it's another country, but they're rather accepting and I'd say once there's patient with a life-threatening condition in their emergency they'd rather put them through the CT and into their surgical room rather than waste time. I feel a little shocked that your father is under palliative.
Very sorry for your loss. An uncle had bladder cancer about 15 years ago, and while he survived, it began a very steep decline that led to his passing in 2022.
My father had bladder cancer, which was caught relatively early as the cancer had not yet spread beyond the bladder wall.
The doctor performed a rather uncomfortable surgery (the pathway for a man is not pleasant) and then injected the TB virus into his bladder, which is apparently an effective treatment for this type of cancer.
It's been 20 years now, no recurrence. Think he was treated at Dana Farber in Boston.
Having gone through what was likely a life saving treatment he has become, ironically, anti-western medicine -- don't blame him, having a surgical implement shoved up main street doesn't sound like a walk in the park :)
This is relatively common with experimental therapies in trials, and thus shouldn't be interpreted as the final say on its usage.
Part of the reason why is that it's difficult to convince patients or providers to reach for the experimental treatment in trial before the current standard of care. Many first-line treatments began as second/third-line or salvage treatments before experiencing line promotion or (if surgery is involved) neoadjuvant promotion. Keytruda is a good example of this progression in action.
Only those patients were admitted to the trial, so the effectiveness of the treatment on later-stage muscle-invasive disease is unknown. That it's scoped to patients who are BCG-unresponsive ("previously resisted treatment") makes the breakthrough more significant, not less.
This "drug" is a weakened form of the bacterium, which apparently stimulates immune response. So I guess it works for both TB and bladder cancer just by getting your immune system to notice something is amiss?
I can explain. BCG infects the actual epithelial cancer cells inside the bladder, triggering Th-1 response (production and release of cytokines by activated CD4 T cells).
The cytokines induce an inflammatory response, which I turn activates other immune system cells such as CD4 and CD8, NK cells and macrophages.
The immune cells then attack the bladder cancer cells, hopefully destroying them, thus "fighting cancer".
One of the things I learned going through my own treatment (prostate) was that everyone's cancer is different. Which makes sense if you think about the variability in malignant cell growth.
So something that cures half the patients and only requires an office or outpatient visit every few weeks (no surgery, no radiation) is astounding. This result will likely lead to further research using this approach.
More than half would be nice, but: these tests were run on "individuals with high-risk non-muscle-invasive bladder cancer whose cancer had previously resisted treatment." One could expect that it would be even more effective on patients whose cancers were not resistant to treatment.
That's one way of looking at the glass half empty.
If half of people get rid of cancer for 1 year that is still outstanding - ESPECIALLY if the majority of those remain cancer free for quite some time after.
The most obvious, naive approach is banking blood & marrow prior to treatment. However, there's a need to clear metastatic cells (CTCs) or train the immune system to find and kill them so that it doesn't reintroduce CTCs upon retransfusion.
"New treatment eliminates bladder cancer in 82% of patients" - current HN title (matches article)
I don't like headlines like this because they lack any necessary context. Knowing that a treatment eliminates cancer in 82% of patients isn't data unless we know more or already experts in this field. For all I know the previous treatment was 99% effective but just cost more or something. PR-style headlines very often use misleading statistics to get attention, so this wouldn't even be surprising.
- What was the previous treatment's success rate? Was it 22% or 81%?
- What are the other tradeoffs? If the previous treatment was also 82% maybe this one doesn't cause incontinence, or maybe it's non-invasive?
How you should make a title:
"New treatment eliminates cancer in 82% of patients, a major improvement"
"New treatment is first non-invasive way to eliminates cancer in 82% of patients"
"New treatment way to eliminates cancer in 82% of patients - without causing incontinence"
"New treatment eliminates cancer in 82% of patients without radiation"
yes, that was my entire point. why are you having so much trouble with this?
The title doesn't have enough information to inform us whether reading the article is worthwhile. If I actually read the article or not doesn't change whether the title has enough context to inform us whether we would want to read it. How are you not getting this?
This is 81% CR in patients who had already had recurrence and progression after front-line treatment, so neither of your concerns about the headline are relevant to the actual story.
The former point you made simply isn't addressed by the study, and the latter point effectively increases the percentage of patients that can be put in full remission; you're right, it's not 82% of all NMIBC cases, it's a superset of that number.
My point was that the title didn't contain enough context. The examples of 'improved' titles were purely demonstrative of titles that have some extra context to motivate what is special about this treatment - as in they are just made up to show what a good title would provide to give more context. You are missing the point completely.
My (non-AI) Summary:
- "TAR-200 is a miniature, pretzel-shaped drug-device duo containing a chemotherapy drug, gemcitabine, which is inserted into the bladder through a catheter. Once inside the bladder, the TAR-200 slowly and consistently releases the gemcitabine into the organ for three weeks per treatment cycle."
- Phase 2 Clinical Trial
- 85 patients with high-risk non-muscle-invasive bladder cancer
- "treated patients with TAR-200 every three weeks for six months, and then four times a year for the next two years"
- 70/85 patients—the cancer disappeared and still gone 1yr later in almost 50% patients
- FDA granted TAR-200 a New Drug Application Priority Review
- Johnson & Johnson manufactures TAR-200
Unfortunately the recurrence rate after 1 year here is still quite high. Good progress, but not a cure yet.
Bladder cancer has a notoriously high recurrence rate, unfortunately. (I worked for years in NMIBC molecular diagnostics.)
My dad had his bladder removed. Cancer came back 18 months later and he was gone 4 months after that. It sucks.
Plus, I regret that he had to live with a colostomy bag for that time. His quality of life probably higher if they do the other option (name escapes me).
Say more? You've got some domain expertise on this story and I assume an interesting story to tell!
FFS, I'm a physician and I had to look up that the acronym. Have mercy on people: NMIBC = non-muscle invasive bladder cancer.
Right but the first time in a message board thread you have to type "non-muscle invasive" you learn the acronym real quick. :)
Only a small percentage had a recurrence that progressed to later-stage muscle-invasive illness, though.
Do cancers have a tendency to come back with better drug resistance if it's not fully eliminated? at least a resistance to the drug that got rid of it the previous time?
Emphatically so, yes
Return customers generate more profit.
People say this because it sounds right and dramatic, but if they knew and understood what cancer is, they'd understand why treating it is so hard.
For those unconvinced, cancer is your own bodies cells gone rogue and trying to kill you. Now, this happens all the time. Luckily, our immune system is awesome and catches it.
Cancer is when your immune system does not catch it. it's invisible, indistinguishable from your skin cells or your lung cells. Its not like the flu or pneumonia - there is no foreign body, there is no attacker. Its you.
So then treatment means we need to kill living, actively reproducing cells in the human body. Well, a fire can do that.
The trick is, how do you kill the cancer cells, which your own immune system cannot even distinguish as cancer cells, but not harm your normal cells?
Turns out that's very hard and very grueling. Chemo is very effective, but you still lose your hair and damage just about all your organs in the process.
And, for the record, we do have "one off" cures for cancer - surgery. Just cut it out. The trouble is cells are microscopic and there's billions of them. Rarely will they be so perfectly contained you can get them all in one go. No, you miss some, and they sit there, growing, until the cancer is detectable again. And they move, they use your own blood and lymphatic system as a highway.
Not if the same thing can't be used to treat them again.
Cynical take, but not wrong.
Though this reads as though the implied message is preaching the suppressed cure conspiracy theory so I'll respond to that interpretation.
What you're missing the competitive factor of this. If your drug strings your patients along while your competitor releases an effective cure, guess who's getting all the business? Look to Sovaldi and Keytruda for recent examples.
The competitor with the effective cancer cure will take all the business.
For some cancers yes, for other cancers, no. Sometimes resistance to therapy is a matter of time, not prior lines of therapy.
I wish I could find the article, but there is a clinic somewhere that ran trials where they deliberately wouldn’t treat the cancer too aggressively. Instead they experimented with treatment frequency but with control being the aim instead of elimination.
The theory being that they could keep it at bay indefinitely and lower the chance of selection pressure kicking in. The thought behind their approach is that they wanted their patients to die of something different than their cancer.
yes they are resistant to that line of therapy once it stops working.
Sometimes that resistance carries over to other lines too. For example, Enzalutamide doesn't work for prostate cancer if you were already treated by abiraterone.
This was for a high risk cancer that was already treatment resistant.
This is an unusually effective treatment with remarkably smaller side effects.
If it is this good, it will probably start getting used more broadly.
Some important things not mentioned in this press release (not to detract from the idea of new treatment approaches of any sort):
- All patients had their tumors surgically removed before they were started on treatment. Thus the trial wasn't testing cure so much as delay of recurrence.
- These were very superficial tumors, meaning they were growing on the very surface of the inner bladder, just like skin tags. These aren't the ones that kill people. Patients with superficial bladder cancer who don't respond to BCG can be treated for quite a while just by having the tumors surgically removed whenever they recur (using a minimally-invasive procedure known as a transurethral resection of bladder tumors, TURBT).
- Fun with words: the press release called this a clinical trial, but it's not -- it has no controls, no real statistics, no randomization, none of the things that make up the usual standard in medicine. The authors of the paper call it a "study", which is basically a research experiment. They don't use the word "trial" at all in the paper.
Having said all that, I still look forward to seeing a proper trial.
Edit: wordsmithing.
My father currently suffers from bladder cancer, he's currently in palliative care, he's in Ukraine. If there are any medical professionals here, could someone provide an advice - is there any chance to get him access to TAR-200?
There are EU trials as well. Perhaps contact your physician, insurance or Johnson & Johnson directly.
https://euclinicaltrials.eu/ctis-public/view/2023-507685-10-...
To be honest, chances are slim to none. But worth a try.
You may want to look at this study. Its preapproval expanded access. There is an email and phone numbers for the company which is running the study. Usually the further along the drug trial is they more the loosen the criteria. Wouldn't hurt the ask if its suitable for your father.
https://clinicaltrials.gov/study/NCT06877676?intr=TAR-200&ra...
So sorry to hear this, I wish him the best.
No, the trial is closed to new participants. Check the company website to see if they are having international trials or are open to compassionate use.
Thank you.
Thank you.
Pat Shoon Shiong had a cancer drug approved for targetting bladder cancer, don’t know whether Ukrainians can have access though.
1.look for clinicaltrial on https://clinicaltrials.gov/ .
2.See if your father qualifies for any
3. Enroll
4. Get B2 visa. All medical treatment is usually covered once you are accepted into the program.
good luck!
FWIW I can recommend Bundeswehrkrankenhaus Berlin, very good urology clinic there. Not sure if there's any chance for you since it's another country, but they're rather accepting and I'd say once there's patient with a life-threatening condition in their emergency they'd rather put them through the CT and into their surgical room rather than waste time. I feel a little shocked that your father is under palliative.
I really wish this was available earlier, because I just lost a family member to bladder cancer yesterday morning. :(
Always kind of bittersweet to read these breakthroughs in cancer treatment.
Very sorry for your loss. An uncle had bladder cancer about 15 years ago, and while he survived, it began a very steep decline that led to his passing in 2022.
So sorry to hear. My father passed from bladder cancer that metastasized 20 years ago.
That is tough, I’m sorry for your loss.
Thank you for the condolences.
Sorry for your loss.
My father had bladder cancer, which was caught relatively early as the cancer had not yet spread beyond the bladder wall.
The doctor performed a rather uncomfortable surgery (the pathway for a man is not pleasant) and then injected the TB virus into his bladder, which is apparently an effective treatment for this type of cancer.
It's been 20 years now, no recurrence. Think he was treated at Dana Farber in Boston.
Having gone through what was likely a life saving treatment he has become, ironically, anti-western medicine -- don't blame him, having a surgical implement shoved up main street doesn't sound like a walk in the park :)
That's not 82% of bladder cancers.
It's 82% of those whose bladder cancer is fortunately not invading the muscle, and after failing current standard treatments.
As I noted elsewhere in the thread:
(1) For this trial, patients with MIBC (as opposed to NMIBC) weren't in the cohort, so we don't know what the results will be with MIBC.
(2) "After failing current standard treatments" makes the result more impressive, not less.
To be clear, here is the rest of what the article title should be...
> ...for individuals with high-risk non-muscle-invasive bladder cancer whose cancer had previously resisted treatment
This is relatively common with experimental therapies in trials, and thus shouldn't be interpreted as the final say on its usage.
Part of the reason why is that it's difficult to convince patients or providers to reach for the experimental treatment in trial before the current standard of care. Many first-line treatments began as second/third-line or salvage treatments before experiencing line promotion or (if surgery is involved) neoadjuvant promotion. Keytruda is a good example of this progression in action.
Only those patients were admitted to the trial, so the effectiveness of the treatment on later-stage muscle-invasive disease is unknown. That it's scoped to patients who are BCG-unresponsive ("previously resisted treatment") makes the breakthrough more significant, not less.
There's an open access paper on the development of the drug here:
> https://www.sciencedirect.com/science/article/pii/S107814392...
> The standard treatment for this type of bladder cancer is an immunotherapy drug, Bacillus Calmette-Guérin,
Can anyone explain why the vaccine for TB works to treat bladder cancer?
This "drug" is a weakened form of the bacterium, which apparently stimulates immune response. So I guess it works for both TB and bladder cancer just by getting your immune system to notice something is amiss?
I can explain. BCG infects the actual epithelial cancer cells inside the bladder, triggering Th-1 response (production and release of cytokines by activated CD4 T cells).
The cytokines induce an inflammatory response, which I turn activates other immune system cells such as CD4 and CD8, NK cells and macrophages.
The immune cells then attack the bladder cancer cells, hopefully destroying them, thus "fighting cancer".
Source: Li J et al, NPJ Vaccines. 2021;6:14.
Turning it off and then on again works in a lot of surprising places
“almost half the patients were cancer-free a year later.”
One of the things I learned going through my own treatment (prostate) was that everyone's cancer is different. Which makes sense if you think about the variability in malignant cell growth.
So something that cures half the patients and only requires an office or outpatient visit every few weeks (no surgery, no radiation) is astounding. This result will likely lead to further research using this approach.
Yes my father died in 3 months after getting lutetium 177.
More than half would be nice, but: these tests were run on "individuals with high-risk non-muscle-invasive bladder cancer whose cancer had previously resisted treatment." One could expect that it would be even more effective on patients whose cancers were not resistant to treatment.
That's one way of looking at the glass half empty.
If half of people get rid of cancer for 1 year that is still outstanding - ESPECIALLY if the majority of those remain cancer free for quite some time after.
> remain cancer free for quite some time after.
OS is more relevant than PFS
If we wanted patients to survive long term, then maybe we could try a treatment that doesn't destroy their immune system in the process.
Invent it and your grandchildren will retire rich.
The most obvious, naive approach is banking blood & marrow prior to treatment. However, there's a need to clear metastatic cells (CTCs) or train the immune system to find and kill them so that it doesn't reintroduce CTCs upon retransfusion.
[flagged]
Eschew flamebait. Avoid generic tangents.
https://news.ycombinator.com/newsguidelines.html
"New treatment eliminates bladder cancer in 82% of patients" - current HN title (matches article)
I don't like headlines like this because they lack any necessary context. Knowing that a treatment eliminates cancer in 82% of patients isn't data unless we know more or already experts in this field. For all I know the previous treatment was 99% effective but just cost more or something. PR-style headlines very often use misleading statistics to get attention, so this wouldn't even be surprising.
- What was the previous treatment's success rate? Was it 22% or 81%?
- What are the other tradeoffs? If the previous treatment was also 82% maybe this one doesn't cause incontinence, or maybe it's non-invasive?
How you should make a title:
"New treatment eliminates cancer in 82% of patients, a major improvement"
"New treatment is first non-invasive way to eliminates cancer in 82% of patients"
"New treatment way to eliminates cancer in 82% of patients - without causing incontinence"
"New treatment eliminates cancer in 82% of patients without radiation"
Dumb question: why not rely on the article contents to provide context?
Do you read every article? How do you decide which is worth reading?
Before I slag them, I do.
I didn't slag the article? I gave constructive reasons the title could be better.
Apparently without reading the article!
yes, that was my entire point. why are you having so much trouble with this?
The title doesn't have enough information to inform us whether reading the article is worthwhile. If I actually read the article or not doesn't change whether the title has enough context to inform us whether we would want to read it. How are you not getting this?
This is 81% CR in patients who had already had recurrence and progression after front-line treatment, so neither of your concerns about the headline are relevant to the actual story.
I don't think you understand my point, i don't have two specific concerns lol.
The former point you made simply isn't addressed by the study, and the latter point effectively increases the percentage of patients that can be put in full remission; you're right, it's not 82% of all NMIBC cases, it's a superset of that number.
My point was that the title didn't contain enough context. The examples of 'improved' titles were purely demonstrative of titles that have some extra context to motivate what is special about this treatment - as in they are just made up to show what a good title would provide to give more context. You are missing the point completely.