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Comment by ramraj07 | Hacker News Reader

Just because this approach works doesn't mean this is the only approach out there. I sincerely believe that this thought has singlehandedly retarded progress towards more generic cancer treatments. Immune checkpoint inhibition is a clear proof that you could make one drug that could attack a wide swathe of cancers. Heck even chemo is proof of that. If this is the research you want to focus on, please go ahead. But don't tell the public the continuous half truth that every cancer is unique with no commonality with any other cancer. They all literally share the same DNA, they can't be that different. Consider the possibility that the entire cancer research community is just too dumb to discover globally effective drugs. Unless you can mathematically prove its impossibility I'll say let's not make that statement.

Signed, a guy who spent most of his PhD studying cancer.

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You’re both kinda right, personalized or targeted cancer therapy is definitely an incredibly promising field and the early results in various cancers are promising. Most notably in disseminated disease.

Simultaneously, one of the largest criticisms of osimertinib in resectable NSCLC has been that some oncologists got overexcited about the DFS results and patients have been unfortunately not receiving the traditional standard of care adjuvant therapy (old school platinum based drugs) which have a proven overall survival benefit (until today osimertinib did not, it now possibly does).

Targeted gene-directed therapy is cool but conventional chemotherapy is still really important.

ICIs are magic when they work.

Why shouldn't he tell the public that every cancer is unique? It's technically true, much in the same way it's technically true you studied cancer but have for years been working with entirely unrelated fields to the advancement of cancer research. You're as much of an authoritative figure on this topic as a random person on the street.

Technically true is how most science education got screwed up in every field of science. We went from educators like Carl Sagan and Feynman who would take great pains to make sure they don't just tell technically true statements to most researchers today blatantly saying misleading technically true statements for a living to get grant money. Every second grant and paper nowadays literally starts with a disingenuous generalizing statement about whatever thing they're studying (xx gene has implications for cancer or whatever). No one says anything because it's technically true but everyone knows it's practically bs. After doing this for decades they start believing their own koolaid.

And thanks for trying to question my expertise. Please look up the no true Scotsman fallacy and see if that may apply here.

> They all literally share the same DNA, they can't be that different.

They share the same DNA in the sense that every cell in that body does. But the different types of cancers have different mutations per cell type and the increasingly precise identification of those is the basis of the recent new treatment options. Histological classifications become less and less relevant, instead mutations and subtypes of mutations give directions for treatment paths. So I think that statement is a bit confusing.

There are also cancers where the root cause is not a cell suddenly stopped functioning properly out of nowhere but instead the rootcause is a virus/chemical (that may or may not still be present in the body/cells).

> Histological classifications become less and less relevant

What do you mean by "histological classification" because every interpretation I can think of is very incorrect.

I meant that every cancer diagnosis is done by a pathologist who describes the looks of the cell/tissue and is trained to assign a cancer classification to it. This is currently changing to genetic testing where the underlying mutation (that is causing the tissue changes) is identified. AFAIK the tissue classification is still the gold standard for most cancer types, but I am positive that this will be completely replaced by the new methods. Medicine will not put the cells under a microscope anymore but into a DNA analyzer instead.

That's incorrect.

If you mean diagnosing the type of cancer (e.g. clear cell renal cell carcinoma) we've already been using molecular markers for over a decade now.

Since you mention "describing the look": mitotic rate and local staging (depth of invasion, lymphovascular invasion, perineurial invasion) matter far more than any DNA/type of cancer and this isn't changing at all nor will it ever change.

> They all literally share the same DNA, [...]

Do you mean this literally or figuratively? Isn't one of the serious problems with tumors that the mutation rate inside them goes through the roof? (And then they eventually figure out how to be metastatic?)

Even a highly mutated cancer will have Less differences than you have from your neighbor so..

Yeah, that guy is wrong. Cancers have many different mutations.

Isn't there a high chance that research aimed at one type of cancer will end up transferrable to other types? Either the actual treatment/drug, or at least the methods and approaches to designing the treatment.

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