You're right, but something we need to realize is that many cancers take years to kill, or cure, so while in cancers like pancreatic the benefits may be clear quickly, others might take a decade or more to actually determine the benefits. Hopefully Drs. and patients will have choices, if they choose to go with DCVax-L and products like Poly-ICLC and Keytruda, and forgo certain costly chemos, insurance will agree to pay at least what they'd have paid for the SOC.
I'm not suggesting that all chemo can be eliminated, what I believe is the Drs. can make determinations of what they believe will be best for their patients. I expect that in certain cancers different therapeutics will work better than the ones that work in GBM, Drs. will work to determine what works best.
I frankly don't know if, or how much, Dr. Liau and others who worked on the GBM trial will participate with the use of DCVax-L in other none brain related solid cancers. I feel that they should have a voice because of their experiences, but Drs. with expertise in those specific cancers should lead the trials.
When I was initially diagnosed with leukemia, I immediately worked with the oncologist who treated me after I was treated for sebaceous carcinoma found by my dermatologist, and found I had a kidney cancer which was dealt with. He wasn't an expert in leukemia, but started me on the protocol that was suggested for it. It called for eight specific courses of chemo, but after four of them a catheter infection delayed treatment, and during the delay I spoke with the heads of hematology at both UCLA and City of Hope, I was on Gleevec, an oral chemo at that time while the infection was being treated. It was very fortunate, both experts wanted to see how I progressed on the Gleevec and suggested that I might not require the other four rounds of chemo. Both also told me to go for stem cells on achieving remission while my oncologist thought I shouldn't do it, if I came out of remission, he said they'd get me back in then do the stem cells. I was shown that achieving a second remission was often far tougher, and often it didn't happen. Furthermore at three years, if I remember correctly, 70% were coming out of remission, it may have been lower, but it was significant. Had I not had the catheter infection I'd probably have had the additional courses of chemo, instead it was pill chemo, but I switched from Gleevec to two others most of the time before the stem cells. Heavy chemo is done just prior to stem cells as your own immune system has to be wiped out prior to the new stem cells taking over. I had a 12 point match, which is as good as it gets, but I still have issues caused by the donor stem cells, like an allergy to many sun tan lotions.
I bring this up because I'm certain that other experts would have treated me differently and in fact I met a man my age who came to City of Hope because the Mayo Clinic wouldn't do stem cells because of his age. I actually only recently learned that I was one of the first in my 70's to get them at my age at City of Hope, but UCLA and Cedars Sinai both would have offered them. Now City of Hope is doing it for patients in their 80's. The reason hospitals shied away from older patients was thought to be higher mortality numbers, City of Hope has excellent numbers while including us seniors. I continue to be checked by COH roughly quarterly and enjoy my visits with my Dr.
I suspect that in much of the world I'd not have been offered stem cells at all unless I seeked them out myself. My point is that treatment will be very different throughout the world. Even if DCVax-L is readily available some Drs. will only consider using it where labels say it should be used, whereas some may use if in practically every solid cancer case, even if no basis exists for doing so. We keep hearing about people with GBM using other products, one reason is not knowing about it at all, the other is it's unavailability unless you go to the UK and have the funds to acquire it. In most of the world it ought to become the SOC for brain cancers rather quickly after the initial four approvals, as for other cancers it will vary dramatically both based on the country and it's policies on off label treatment, and based on the Dr. and their belief that it can be of benefit to their patient. It will take years before Drs. really know how best to use DCVax's and where they're most, and least effective.
Gary
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