Viewing a single comment thread. View all comments

JamesIgnatius27 t1_jd435zd wrote

I read the actual paper.

It achieved complete remission with hematopoietic recovery in 18 of 60 (30%) patients, and remission without hematopoietic recovery (so still likely need a bone marrow transplant) in another 5 of 60 (8%), and "morphological leukemia free state" (leukemia treated, but not cured?) in 9 of 60 (15%). So very positive results in 32 of 60 (53%).

There was no response in 19 of 60 (32%), worsened disease in 7 of 60 (12%), and 2 of 60 (3%) were not reported on.

This drug only works on KMT2Ar and NPM1 variants of leukemia, which make up about 10% and 30% of all leukemias, respectively.

The rate of complete remission for the KMT2Ar is normally 9% with usual treatment, but 33% with the drug in this trial.

The results for survival time were written in a slightly confusing way, but I think the median survival time was 7 months for all patients regardless of remission status. I have no idea why they didn't split up the survival curves between those in remission vs those not in remission.

TLDR: Incremental improvements that might help increase remission rates in some leukemia patients with 2 specific gene mutations comprising 40% of leukemia cases, but it's not a miracle drug.


Llamasxy t1_jd4z0ct wrote

Wow, this is amazing. I fucking hate cancer, it has taken so many loved ones away. This is a huge step in the right direction.


Optimal_Pineapple_41 t1_jd5s9lc wrote

First time I’ve read the “actually looked at the article” top comment and it made me feel hopeful. Not as much as the headline tried, but not as little as I expected.


MCHENIN t1_jd64naj wrote

Never believe the cancer headlines. They are usually one or more of the following:

  1. Hypothetical
  2. Misrepresented
  3. Not yet tested in humans
  4. Years and years away from actual approval

CaptainBegger t1_jd6bgub wrote

Described every post I've seen from r/futurology


tattooedplant t1_jd9doo2 wrote

It’s kind of depressing to read the posts there regarding medical advancements because of that. It’s like “oh this new med seems great even tho it likely won’t come out in the next 15 years!” Then, even after it does, it would be so expensive and practically out of reach for the average person until it goes generic. There are several newer meds I’d love to try, but they are just so expensive for those of us in the US even with insurance.


JamesIgnatius27 t1_jdnbn6y wrote

If it makes you feel any better, the 5-year survival rate for all cancers combined has increased from 50% to 67% in the last 50 years, and there has been significant improvement in every single cancer category (except uterine cancer) which implies that the improved treatments have not been restricted to only a few rich people, but that therapeutic improvements have been more widespread.


2tempt t1_jd6coh2 wrote

they're also always posted here and not r/science


RrtayaTsamsiyu t1_jd6liox wrote

  1. Something reserved for rich people e.g. "Study found people with stress free lives live longer"

corrado33 t1_jd7zoh4 wrote

Cancer is essentially the "final boss" for humans.

If any one human manages to avoid death from other sources for long enough, they will eventually die to cancer just due to how the human body works.

Cancer is basically just "there's something wrong in how your cells are reproducing and the body can't take care of it like it usually does." And all humans reach that point eventually.

It's just very unfortunate that some of us reach it well before others.


Accomplished_Locker t1_jd6fq3a wrote

I started crying. My dad died 31 years ago so I keep up with this stuff. This is such great news moving forward, I hope for a day no one has to lose anyone to at least cancer…


Kingdarkshadow t1_jd7a4aw wrote

My grandpa died 2 months ago with prostate, lung and spinal cord cancer.

News like this agaisnt cancer warm my heart.



Pedantic: KMT2A-R (lysine’s amino acid abbreviation is K, MethylTransferase 2A - Rearranged). For the hematologists and oncologists from a while ago, KMT2a used to be called MLL. Nasty disease.

KMT2a is about 4-5% of acute myeloid leukemia in adults, maybe 20% in kids (but kid AML is rare, their leukemia is mostly ALL, although KMT2a can also be rearranged in ALL, because MLL stood for “mixed lineage leukemia” cause it couldn’t seem to make up its mind which type it was). Sorta don’t think it shakes out to an actual 10%, but if you look at the cases where people do badly it’s enriched.

NPM1 is a common form of AML, 30% seems about right…just for AML. But when you factor in CLL, CML, and other forms of leukemia, it’s not 30% of all leukemias.

TL;DR: this works in a disease where not much works. Percentages are hard when the denominator isn’t made clear, and this is especially true here because there are a lot of leukemia subtypes.


JamesIgnatius27 t1_jd504ov wrote

Thanks. It says in the article 30% of AML for NPM1, I misread it. Also 5-15% of "acute leukemias" for KMT2A rearrangements.



30% for AML seems good.

If you look at the metric of pathologist workflow and number of times we have to present at tumor boards…KMT2a leukemias are often a lotta work. Induction chemo often doesn’t work well. They recur all the time. They can be 20-30% of pediatric ALL that doesn’t respond to CAR-T (cell based therapy seen in the news for dramatic effect and obscene cost). If you could precondition patients with this type of leukemia before CAR-T more might be eligible.

Many of the patients aren’t healthy enough for a haircut either, so any treatment that doesn’t often kill em in the process (marrow transplant) is especially good.


JamesIgnatius27 t1_jd54p2c wrote

I appreciate your knowledge on the subject!

I have a biology PhD but I'm not a cancer specialist by any means. I just try to read the actual science whenever an article like this gets posted to reddit to give a more realistic assessment of the findings.



Reddits lucky to have someone like you summarize this stuff!

You’d get a kick out of KMT2a. The protein is..3700? residues, has a heap of domains, and gets cleaved into two, something like a 320kD and 180kD. The pull-down assays bring down a ton of things where many of the proteins correspond to mutations seen in cancer. Crystal structure was apparently a challenge.


Jesta23 t1_jd65dd2 wrote

I want to add some context to the term complete remission. I was almost killed because of the misunderstanding of it.

In Leukemia, a Complete remission is an outdated metric. Many years ago we had limited ability to detect cancer cells in bone marrow. If you run that test and dont see any cancer cells then it is termed as a complete remission. This sounds wonderful, and many drug companies use this as the basis for their reporting because it makes their drugs look better than they are.

Today, there are tests that can see cancer cells thousands of times better than a complete remission. What we as laymen would call a "complete remission." is actually called MRD negative in leukemia. Any study that does not mention MRD status of the patients is not reporting the full facts and using the term Complete remission as publicity to get investments.

EDIT: since someone pmed me to ask, When I was diagnosed I was given the option of several treatments. The one the doctor wanted me to accept was presented as "99% of patients on this plan have a complete remission in 6months, and it has far less side effects than these other treatments. So obviously I accepted that one. 99% chance of being cancer free? low to no side effects? fuck yeah sign me up doc!

After reading all night I discovered the real terminology in leukemia and found that the treatment I just signed up for had a 99% complete remission rate, but only a 47% MRD negative rate, and a 34% 5 year survivability rate.

While another option had no reported complete remission rate, because its a shitty outdated metric, but had a 88% MRD negative rate, and a 77% 5 year survivability rate.

The option that I was nearly tricked into accepting is far cheaper, and since I had just lost my job (due to being sick.) they were looking to save money.


Yaxoi t1_jd5pxp6 wrote

Blessed be those who read the papers


sigrunrun t1_jd6c3zd wrote

Complete remission without hematopoietic recovery (CRi) means we don’t see leukemia in the bone marrow (<5% blasts) but their blood counts (white blood cells, platelets) are not back to normal due to the chemo side effects. The patient essentially no longer has leukemia so we call it a win. It does not necessarily mean that patients will have to have a bone marrow (stem cell) transplant in order to be “cured.” That is driven by a whole host of other factors not surprisingly is largely risk vs. benefit. Stem cell transplantation is very costly and toxic and many patients can not even find a match.

MLFS essentially means there’s no leukemia in the bone marrow but something still isn’t quite normal in the blood or marrow depending on which definition you use. For example NCCN criteria says that CRi your platelets and white cells are abnormal but your hemoglobin should be normal. If your Hgb is too low then you would be MLFS.

I agree it’s not a miracle drug by any means, but patients who are getting this most likely don’t have any other options so for them even a small percentage of success at prolonging their lives even a few 7 months is worth it. A 53% response rate is VERY good for adult AML - we still don’t really know how to “cure” it.

I hate click bait articles but this is unfortunately what is needed to get people (investors) excited in funding cancer and medical research


Altirix t1_jd6o5ke wrote

Still promising. It's unlikely there will ever be a single miracle drug tbh. Cancer is a collection of diseases.


Hampsterman82 t1_jd6u9lm wrote

shrugs no... Maybe not a miracle but more than tripling the percentage in full remission is a darn good treatment improvement.


MrMunday t1_jd6v06l wrote

Thanks for reading and writing such a precise summary


AdminsHateThinkers t1_jd72b4v wrote

I feel like we're getting close and then the next step will be having to refine it for every individual type.


LooseEndsMkMyAssItch t1_jd82l1k wrote

Making huge strides in the right direction, fyi the goal is to eventually remove Chemo as a need at all. Biologics are making this possible and I cannot wait to see what the future holds.


vintage2019 t1_jd5l2b0 wrote

What’s the baseline recovery rate for people with similar conditions?


bigwill6709 t1_jd66ywp wrote

Just some helpful context here for those reading your comment: this trial was done on patient with relapsed AML (it came back after having gone away) or refractory AML (meaning the cancer never actually got to remission). The standard treatment for relapsed/refractory acute leukemia is a bone marrow transplant, which is pretty toxic (more so than most standard chemo). Success rates of transplant are much better if you can get in remission prior to transplant. So having a drug that can help get people into remission is a big step forward.

Regarding the outcomes mentioned, there are many ways to try and measure if someone is in remission. Morphological remission just means when they looked at the bone marrow under the microscope, they didn’t see leukemia cells. The better measure of remission is MRD (Minimal Residual Disease), which is a test using a different method called flow cytometry that looks at individual cells and the markers they produce to find cancer cells. If MRD is negative, that’s considered better than morphological remission.


Impossible_Garbage_4 t1_jd6agjy wrote

Hey man, 30% full recovery of 40% of leukemia patients ain’t too bad. 12% of all leukemia patients get a cure. Further 3% get a cure with the medicine + a bone marrow transplant. Those are good numbers compared to 0%


TheMetaGamer t1_jd7ciuy wrote

> worsened disease in 7 of 60 (12%)

Does this mean the leukemia worsened or the drug actually worsened the leukemia? They are definitely two different situations. It’s very possible that these people had very aggressive cancers and it slowed them or just had no effect but continued deteriorating.


That_Shrub t1_jd80dyd wrote

Yeah I don't love the misleading headline. And it's a small study, with a relatively small success yield.

But imagine being one of those 18 people -- certainly a miracle drug to them.


captainjackass28 t1_jd4vfbp wrote

Basically a clickbait article. It’s a nice thing to have developed but no cure.


JamesIgnatius27 t1_jd4yli4 wrote

It's always that way.

As a scientist, we work extremely hard only to be undermined by reporters who cause the public to lose faith in scientists.

Scientist: Our clinical trial for a new therapy saw 18 of 60 patients get complete remission. We would have expected about 6 of 60, so this is an improvement.

Clickbait article: New therapy sees cancer VANISH in 18 patients.

Scientist: 😥


Scientist: 😞


captainjackass28 t1_jd4zfzv wrote

Yeah shitty reporting has basically destroyed science especially now that nobody reads beyond a headline. Scientists are the unsung heroes of the modern world.


1pt20oneggigawatts t1_jd5fckl wrote

As a critical thinker, I've seen enough of these articles to be jaded and not take them seriously. If it's real, it will pass shitty internet article and at least get to TV. For instance, the fifth person cured of AIDS in history just recently happened.


IFuckingShitMyPants t1_jd5m7m9 wrote

Wait, really?

How'd they do it? I thought it was terminal


fiendishrabbit t1_jd5rw77 wrote

It's uncurable, but I wouldn't call it terminal. Given that the treatment will reverse AIDS into HIV and where almost all HIV carriers* will die of something entirely unrelated to them being HIV carriers.

*In countries with reliable medical care.


minuteman_d t1_jd4yk37 wrote

It doesn't seem like that - the numbers still seem really good if YOU had that one special type of cancer, it would mean that you had a significantly better chance with this treatment.

I don't think that a cancer cure will come in the form of one treatment for ALL (which would be very nice), but it's going to be attacking specific forms and variations.


Pjpjpjpjpj t1_jd5jkm3 wrote

>It’s a nice thing to have developed but no cure

Narrator: The pill literally cured cancer in 30% of patients.


captainjackass28 t1_jd5utvt wrote

A very specific form of it for people in very specific circumstances. Obviously you didn’t read the article.


Pjpjpjpjpj t1_jd5vzp4 wrote

I read every word of it, and several other write ups on it.

There is no treatment on earth that cures every form of cancer.

Every cancer treatment is for specific types of cancer.

This treatment results in complete remission with no need for bone marrow transplant in 30% of patients. And another chunk of patients have complete remission but still require a transplant. It is a cure for 1/3 of people with this type of cancer.