Prof Charles Swanton, from Cancer Research UK, congratulated the prize winners, saying: "Thanks to this groundbreaking work, our own immune system's innate power against cancer has been realised and harnessed into treatments that continue to save the lives of patients. For cancers such as advanced melanoma, lung, and kidney, these immune-boosting drugs have transformed the outlook for many patients who had run out of options.<doc-sep>For the first time ever, we’re living in a moment when many of our most promising medical advances are far out of reach for the vast majority of people who could benefit from them. And nowhere is that truer than for cancer immunotherapy, the fast-moving field of cancer treatment research that was honored on Monday with the Nobel Prize in physiology or medicine. Immunotherapies are a cause for great hope in treating many types of cancer, including melanoma, lymphoma, and lung, kidney, and bladder cancers. They stimulate the immune system to help the body attack cancer from within. And unlike chemotherapy or radiation, which kill off healthy cells, immunotherapies are much more targeted, even in patients with late-stage disease. With these drugs, doctors have watched deadly tumors melt away, and patients who were supposed to die go into remission for years. While amazing turnarounds aren’t seen in everyone or for all cancer types, J. Leonard Lichtenfeld, the deputy chief medical officer of the American Cancer Society, told Vox that immunotherapies have oncologists using a word they aren’t used to trotting out: cure. “When I was treating patients with melanoma in the 1970s, some of those drugs we used back then are still backbones of treatment for metastatic melanoma 40 years later,” he said. “Then along came the immunotherapies, and they truly changed the landscape of treatment.” But these incredible advances and the promise of cancer cures also come with eye-popping price tags that reach well past $100,000 per patient. People who need cancer immunotherapies too often hit a cost wall and can’t afford to pay for them — and it’s a problem that’s growing worse, Ezekiel Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania’s Perelman School of Medicine, told Vox. “What we’ve seen over the last two decades is the cost of cancer drugs go through the roof,” he said. “Every year, the introductory price seems higher and higher and higher.” The rising costs of new drugs not only mean that individuals can’t access them; they’re also unsustainable for our health system. The average cost of cancer drugs today is four times the median household income Getting a cancer immunotherapy treatment costs more than a house in many cities in the US, more than putting a few kids through private college. The average cost of cancer drugs has increased from $50,000 per patient in the mid-1990s to $250,000 today. That’s four times the median US household annual income. Immunotherapies in particular often cost more than $100,000 per patient. Doctors now use immunotherapies in combination, which means those costs can quickly double or triple. For some of the newest immunotherapies, the price tag is even steeper: When you include the value of the medical support necessary to deliver these treatments, a price tag of $850,000 per patient is not unheard of, according to Emanuel. “The drug companies say that they offer significant discounts to many patients, but because they won’t release this data, the list price is all that we have to go on,” he wrote. This chart from Peter Bach, a researcher with Memorial Sloan Kettering, says it all. (Keep in mind that the y-axis here is logarithmic, not linear. Scientists sometimes use logarithmic scales to make big number sets manageable. But if Bach had plotted the prices on the y-axis at a linear interval, the cost curve would look much steeper.) Patients with health insurance can be denied coverage for immunotherapies, even when it’s recommended by their oncologists. But even when they aren’t, the list prices are so high that the copays can be exorbitant. A patient might face a 25 percent copay, which means they’re getting the drug at a 75 percent discount. When the price tag is upward of $10,000 a month, that leaves patients on the hook to cover at least $2,500 per month. And that’s prohibitive for many people. These drugs cost so much in America because companies can charge that much This brings us to the next question: Why do these drugs cost so much? To get to the bottom of it, Emanuel had an interesting thought experiment in a recent Wall Street Journal op-ed. Drug companies typically argue that the cost is related to how much they had to invest in research to develop the drug. The CEO of Novartis, maker of the immunotherapy drug Kymriah, said the R&D costs of the drug were about $1 billion. But Emanuel didn’t buy it: That’s certainly a big investment, but it is much less astounding when compared with the drug’s anticipated revenue. Based on Kymriah’s list price, treating just 2,700 patients would allow Novartis to recoup its entire investment. Even with significant discounts for many patients, it wouldn’t take many treatments to turn a considerable profit. ... Producing the immunotherapy requires more than three weeks of laboratory manipulations for each individual patient. But according to researchers at the University of Pennsylvania, the total cost for removing, reprogramming and infusing the cells into each patient is less than $60,000—just one-sixth of the $373,000 price tag. Production costs do not seem to be driving the stratospheric drug prices. So he came to the conclusion we have arrived at Vox many times: The drugs cost this much because in America, drug companies are allowed to charge that much. And they reap handsome multibillion-dollar profits as a result. In other countries, governments exert much more influence over the entire health care process. That allows them to negotiate directly with drugmakers. The government sets a maximum price that it will pay for a drug, and if the company doesn’t agree, it simply loses out on the entire market. The United States, by contrast, has long taken more of a free market approach to drugs. Pharmaceutical companies can haggle over prices with a variety of private insurers as well as selling to the government. What’s more, Medicare, the government program that is the nation’s largest buyer of drugs, is actually barred from negotiating drug prices. That gives pharma much more leverage.<doc-sep>James P. Allison and Tasuku Honjo have been awarded the Nobel Prize in chemistry for their discovery of a type of cancer treatment that harnesses a person's own immune system, the Nobel Assembly at Karolinska Institutet announced this morning (Oct. 1). "By stimulating the inherent ability of our immune system to attack tumor cells this year’s Nobel Laureates have established an entirely new principle for cancer therapy," the Nobel Prize Foundation said in a statement. Allison, who is a professor at the University of Texas MD Anderson Cancer Center, Houston, was studying a protein called CTLA-4 that inhibits a person's immune system by putting the brakes on the actions of T cells. He realized that if he could release that "brake," the immune system would wreak havoc on tumors. Allison developed this idea into a new type of cancer treatment. Meanwhile, Honjo, who is now a professor at Kyoto University in Japan, discovered a similar immune system-braking protein. Called PD-1, this protein, he found, functions as a T-cell brake but via a different mechanism than CTLA-4 uses. Honjo's research led to the clinical development of treating cancer patients by targeting that protein. Whereas both proteins have proven to be effective targets for treating different types of cancer, PD-1 has shown stronger results for the so-called immune checkpoint therapy, according to the Nobel Prize Foundation. Targeting PD-1 has shown positive results in treating lung cancer, renal cancer, lymphoma and melanoma. And more recently, scientists have found that combining the two targets can be even more effective in cancer treatment, particularly in combating melanoma. Honjo and Allison will split the Nobel prize amount of 9 million in Swedish krona, or $1.01 million. Originally published on Live Science.<doc-sep>James Allison and Tasuku Honjo won the Nobel for identifying two different brakes on immune system A revolutionary cancer treatment pioneered by the winners of the 2018 Nobel Prize for Medicine has been hailed as the future of fighting the disease -- and it has fewer devastating side effects than chemotherapy. While chemotherapy destroys cancerous cells along with normal cells -- often with toxic and debilitating effects on a patient -- immunotherapy unleashes the body's immune system to target tumour cells. James Allison of the US and Tasuku Honjo of Japan won the Nobel on Monday for identifying two different brakes on the immune system which, when turned off, allow the body's defence system to attack cancerous cells faster and more effectively. Allison was one of two scientists to discover the blocking effect for one such brake -- or checkpoint inhibitor molecule -- called CTLA-4 in 1995. Honjo discovered another, PD-1, around the same time. Once these brakes were identified, researchers were able to work on how to turn them off and get T-cells -- white blood cells -- to start attacking. "The goal is to neutralise these molecules, among them CTLA-4 and PD-1, and these are what the recipients of the Nobel prize have been working on," said Pierre Golstein, emeritus professor at the Marseille-Luminy Immunology Centre. "We neutralise these and the white blood cells can get to work on the cancer cells." Sheena Cruickshank, an immunology lecturer at the University of Manchester in Britain, said the therapy has "enabled us to harness the power of the body to help heal itself". "A lot of conventional cancer therapies are about destroying cells and can be quite damaging, but this is much more targeted and much more specific because it's enabling our immune cells to come in and actually kill the tumour cells directly," she told AFP. Booming fieldNDTV The therapy has only been used on patients for a few years, and is less effective for certain cancers such as pancreatic and brain cancer. But 800 clinical trials were in progress worldwide and more than 30 drugs under development as of June, according to the American Cancer Society. And the pharmaceutical industry has heavily invested in research in the field. The US Food and Drug Administration has already approved a number of immunotherapy treatments, including some targeting PD-1. "The booming field of immunotherapy that these discoveries have precipitated is still relatively in its infancy, so it's exciting to consider how this research will progress in the future," said Charles Swanton, Cancer Research UK's chief clinician. Golstein, whose team first identified the CTLA-4 molecule in 1987, said the results have been very promising. "Immunotherapy is now possibly the most important recent discovery for cancer therapy in general, as an alternative to chemo," he said. "For example, immunotherapy can control between 20 and 50 percent of certain advanced melanomas, which is something considering that situation would have been a death sentence not too long ago." But it's also not totally harmless, he added. "Activated immune cells can cause certain auto-immune complications in certain organs, but we can control those," he said. A study released in June tested a form of immunotherapy against chemo for non-small-cell lung cancer, the most common lung cancer worldwide. It found that the drug Keytruda (pembrolizumab) -- which famously helped former US president Jimmy Carter stave off advanced melanoma that had spread to his brain -- helped lung cancer patients live four to eight months longer than chemo. Not for all cancers However, Karl Peggs of the University College of London said the therapy is not for everyone. "We know that some patients have a very low chance of responding... those with little evidence that these pathways are actively restricting the immune system, or those with cancers that are less heavily mutated," he said. While in theory it should work for most forms of cancer, it's most effective on those with the highest numbers of mutations such as melanomas, lung cancer and smoking, he added. And it has sometimes been met with too much enthusiasm by patients. In the US, some have reportedly asked their doctors to immediately use immunotherapy instead of traditional treatments like chemotherapy, even when they are more effective. After his big win on Monday, Allison warned that immunotherapy will not replace all other cancer treatments. Instead, it is "going to be part of therapy that potentially all cancer patients will receive in five years," he told a press conference in New York. Honjo, meanwhile, said he wanted to continue his research "so that this immune therapy will save more cancer patients than ever".<doc-sep>
Two immunologists — one from Texas, one from Japan — have been awarded the Nobel Prize in physiology or medicine for their pioneering research in cancer therapeutics. Their work is already saving lives and making it more likely that some cancer patients with advanced disease can fully recover. James P. Allison, 70, is the chair of the department of immunology at MD Anderson Cancer Center in Houston, Texas. Tasuku Honjo, 76, is a distinguished professor at the Kyoto University Institute for Advanced Study in Japan. Working in labs on different continents, both have made key discoveries over the past half-century that advanced the field of immunotherapy for cancer, a disease that still kills millions of people every year. They will share the $1 million prize, which was announced by the Nobel Prize Committee in Stockholm this morning. Allison and Honjo’s research led to the rise of immunotherapy drugs; immunotherapies stimulate the immune system to help the body attack the disease from within. “The seminal discoveries by the two Laureates constitute a landmark in our fight against cancer,” the Nobel Committee said in a statement. Until very recently, most cancer patients only had a few options for treatment. They could get chemotherapy or radiation to try to kill the cancerous cells, or they could have surgery to cut out the cells. Yet these treatments can be blunt instruments, killing healthy cells along with cancerous ones. They also carry devastating side effects, and often fail in patients with late-stage disease. Immunotherapy provides a new hope. Doctors have witnessed deadly tumors melt away, and patients who were supposed to die go into remission for years. These responses aren’t seen in every patient — only about 15 to 20 percent appear to benefit from immunotherapy, and we still don’t understand why. But very sick patients with cancer receiving chemotherapy just about never experience these kinds of amazing turnarounds. The new treatments can also be much more precise, targeting cancerous cells only instead of healthy tissue. That’s what makes immunotherapy so exciting — and Allison and Honjo’s work so important. Allison and Honjo made discoveries that led to one of the most promising types of immunotherapy Right now, many different kinds of immunotherapies for a variety of cancers are in clinical trials. These include treatments that use engineered viruses — HIV, measles, smallpox — to reprogram immune cells to destroy cancer. The types of immunotherapy that appear to be most promising at the moment — the ones that really have the medical community excited — are called “checkpoint inhibitors.” These harness the T-cells, a type of white blood cell known as the soldiers of the immune system, to attack cancer. Allison and Honjo made key discoveries about checkpoint inhibitors that eventually led to the approval of numerous cancer checkpoint therapies for market. One of the first approved checkpoint therapies was ipilimumab (brand name Yervoy), an intravenous infusion that came to market in 2011 and targets a protein called CTLA-4. Allison studied CTLA-4. “He was one of several scientists who had made the observation that CTLA-4 functions as a brake on T cells,” the Nobel Committee said in a statement. “Despite little interest from the pharmaceutical industry, Allison continued his intense efforts to develop the strategy into a therapy for humans.” By 2010, some patients with advanced melanoma saw their cancer disappear when using drugs that emerged from this research in clinical trials. “Such remarkable results had never been seen before in this patient group,” the committee said. Meanwhile, Honjo discovered PD-1, another important checkpoint inhibitor. He “eventually revealed that it also operates as a brake,” the Nobel Committee said. “Therapies based on his discovery proved to be strikingly effective in the fight against cancer.” Indeed, drugs targeting PD-1 — such as nivolumab and pembrolizumab (which Jimmy Carter used for his cancer and prolonged his life) — have been approved for the market. These drugs can treat advanced melanoma and lung cancer. The PD-1 targeting approach has also shown promise in a variety of other cancers, such as kidney and bladder cancers and Hodgkin lymphoma. Elusive and costly cancer cures While the discovery of immunotherapies for cancer is the most exciting thing to happen in oncology in the past half-century, we’re still a long way from curing the disease. The dramatic progress in immunotherapies has been the simple fact that these drugs work extremely effectively for some periods of time in some patients for some cancers.