Provenge is a new treatment for prostate cancer and is one of the new generations of cancer fighting drugs that uses “autologous cellular immunotherapy” - which, regardless of the science behind it, sounds impressive.

This uses the body’s own immune system, or  “your own immune cells that have been trained to seek and attack prostate cancer cells” to quote the website. It is the product of work such as that done by Ralph Steinman (see post A Laureate’s Successful Failure) and the brave new world of cancer vaccines.

Should be wildly successful and making the manufacturer (Dendreon) rich wouldn’t you think?

But Dendreon stock has been more lead balloon like than my retirement portfolio in the last month. It has dropped by 67.4%.

Poor promotion, out of control overhead have been charges leveled. But one of the big issues is, even though Medicare has recently opted to cover Provenge, it costs $93,000 for a course of treatment.

It is a prime example of what we can’t afford.

I guess if I was the one with the prostate cancer, this may be an expensive straw I would want to grasp at. But society as a whole - a society that is going bankrupt, in large part because of the cost of medical care, which in turn is costing so much because all these clever researchers are coming up with ever more fancy, expensive treatments - cannot afford it. Or not unless they are willing to pay an ever larger proportion of GDP toward healthcare (The prediction of the Congressional Budget Office is that just federal spending on Medicare, Medicaid and other medical stuff is going to escalate from 5.5% to 12% of GDP by 2050).

Someone, somehow has to put a lid on it.

It’s called “rationing”  - or “death squads” if you want to be emotive.

And when there’s a treatment available that has the potential to save someone’s life, it’s very hard to tell them “no, sorry”.

I wonder what would happen if you told all the researchers their main goal was not innovation, but cheap treatments? 

 Pancreatic cancer is in the news. First Ralph Steinman, now Steve Jobbs. It’s a bad actor. Hard to diagnose as it tends to present with rather non-specific symptoms. And very inaccessible and surrounded by a lot of vital organs that get in the way when you want to blast it with radiation or cut it out.

But what I can’t help wondering is why did they get it?

Our local Unitarian church vegetarian group (it all sort of goes together that vegetarian/vegan, tree hugger, hippie, Unitarian thing) showed the movie Forks Over Knives the other day. This makes the case that, not just vascular/heart disease is caused by our crappy, meat based, fast food, diabetogenic, ghastly industrialized diet. But that our diet is causing us to have cancer as well.

Well I don’t know what kind of diet Steinmann and Jobbs had. But I wonder about the stress thing. Is this the price of being a successful CEO or Nobel prize laureate.

That you literally work yourself to death? 

 If you were unkind, you could argue Ralph Steinmans’s cancer treatment isn’t so hot.

Ralph Steinman 

It was announced he had been nominated for the Nobel Prize for medicine, but four days before it was awarded, he died of pancreatic cancer - despite using his own treatment (producing a quandary for the Nobel committee incidentally, as to whether he could still receive the prize).

His achievement was the discovery of Dendritic Cells - cells that recognize antigens, and present them up to the “Killer T Cells” of the immune system (you could be forgiven for thinking you were playing some violent video game) prompting them to turn on the cancer and destroy it - in some cases.

A Dendritic Cell

The action of the Dendritic cells is a bit like giving blood hounds the scent (others have likened Dendritic Cells to a “most wanted” poster - is it that doctors are really just seen as a form of law enforcement?).

Normaly the Dendritic Cells are only available in fairly small numbers in the body. But you can do the whole thing in vitro. Extract them in the blood, expose them to antigen derived from the cancer, rev up their reproduction with an immune cell stimulator, and inject them back into the patient - and Bob’s your uncle, they nail the cancer. Or that’s the idea.

At Stanford, other workers tried this technique on non-Hodgkin Lymphoma who had failed conventional therapy. In the first series of six patients, two had complete remission according to the Stanford website. Impressive.

Doing this all outside the body is not without it’s technical problems. The next goal is to find a way to enhance the number, and antigen recognition activities of Dendritic Cells in vivo.

This is all part of the utopian cancer vaccine dream.

Instead of the current way of loading the body with toxic chemicals (chemotherapy) that kills your body as well as the cancer (especially sensitive stuff like your bone marrow and your immune system), you produce a vaccine that has been “shown” your cancer so it will specifically target that.

Or more utopian still, produce a vaccine that will destroy all cancers - and eradicate this scourge, in the same way we have cured smallpox by vaccination?

Unlike Martin Luther King’s dream - which the Republican party’s response to having a black president has proved is not yet fulfilled (but excuse me, I’m getting off the point and political) - the cancer vaccine dream has been realized. At least to some extent.

Provenge is an example of this brave new world (though not without it’s problems - see post Can We Afford It?). This is a new treatment for prostate cancer that works in a similar way, stimulating the immune system to attack the cancer. And can perhaps be seen as part of Ralph Steinmann’s legacy.

“Ralph worked right up until last week,” according to Michel Nussenzweig, a collaborator of Steinman’s. “His dream was to use his discovery to cure cancer. . . . . It’s a dream that’s pretty close.”

The unkind take is to chastise him because his treatment didn’t save his own life (Steinman started a clinical trial at Rockefeller University in which he was the only patient). It may well have prolonged it though.

One should applaude him for winning a Noble prize and sympathize with his family. And also question if this is the price of being a Nobel laureate - see post The Success of Pancreatic Cancer