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Anchor lead: Why do CAR-T cells cause so much excitement? Elizabeth Tracey reports

What in the world is a CAR-T cell and why is everyone so excited about them? Turns out these engineered cells have been recommended for approval by an FDA panel to treat advanced leukemias in children, who otherwise have no option left. Liz Jaffee, a cancer expert at Johns Hopkins and president elect of the American Association for Cancer Research, says their utility may go far beyond that.

Jaffee: A lot of science still needs to go into CAR-T cells to make this therapy something that will be of benefit to many different patients. The most important thing right now is to identify the best targets on cancers that differentiate the cancer from a normal cell of origin.  :16

Jaffee notes that one side effect of treatment remains problematic.

Jaffee:Even though the toxicity of this long term is the loss of B cells, all your B cells, well, why is that a problem? Well, B cells make antibodies and antibodies fight infection. We do have to be very careful with these patients because they are going to be susceptible to infection.  :16

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can new cancer drugs be brought to clinical use faster? Elizabeth Tracey reports

How can drugs in development be brought to people who need them faster? That question is of particular importance in cancer, where the promise of new interventions, most especially immunotherapy, are tantalizingly close. Liz Jaffee, a cancer expert at Johns Hopkins and president elect of the American Association for Cancer Research, describes a recent visit to Capitol Hill to inform lawmakers.

Jaffee: It’s about how do we move because we’ve got lots of different agents that are being developed, how do we now move these combinations into patients safely and also quickly. The types of models of drug development we were using for thirty years they just don’t pertain to cancer drug development now. We start the therapies, a new therapy a few patients are already responding, so we can move these therapies in a few years to approval rather than in ten to fifteen years. :27

Jaffee notes that combination therapies are of particular promise in cancer therapy, and these too require a different research and approval process to bring them to those who need them. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: For women with one type of breast cancer, using two agents improves survival, Elizabeth Tracey reports

Women who have breast cancer classified as HER2 positive because of the types of proteins found on the cancer cells may consider being treated with two antibody drugs rather than the standard one alone to improve their survival. That’s according to a study published in the New England Journal of Medicine. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the results.

Nelson: Women who had breast cancer that could be treated with surgery adding trastuzumab to pertuzumab was there any benefit? And if you look overall at three years this is a real testament to how far we’ve come I would argue. 94.1% with pertuzumab added to trastuzumab versus 93.2% cancer free survival. That’s astounding, so there is a measureable benefit, it’s a small one but you’re starting to get up someday hopefully we’ll cure everyone with breast cancer but you’re starting to get up very very high.  :31

Nelson says the strategy is just one example of using more than one drug at the same time to target cancer cells. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can you reduce your risk of a second stroke or TIA if you’ve had one? Elizabeth Tracey reports

Your chance of having a second stroke or transient ischemic attack if you’ve already had one remains increased for up to five years after the event, a recent study of thousands of people revealed. Rebecca Gottesman, a stroke expert at Johns Hopkins, says risk factors for both having such an event initially as well as recurrence are well known.

Gottesman: If you have hypertension and you have a stroke you should most definitely be treating your hypertension. If you have diabetes and you have a stroke or a TIA you should be treating that. This reinforces the long term consequences either associated with the underlying risk factors for stroke or TIA or from stroke or TIA itself. I think the message is the same whether it’s related to the event itself or the underlying risk factors for the event, which is these are risk factors we know how to control, there are medications for, we know that there are lifestyle changes that can affect some of these, and this study reinforces the importance of trying to control some of those risk factors.  :31

Gottesman notes that lifestyle factors such as smoking and exercise are also modifiable and should be taken into account when developing a strategy for reducing cardiovascular disease risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Even after surviving a stroke or TIA, risk remains, Elizabeth Tracey reports

If you’ve survived a stroke or a transient ischemic attack, abbreviated TIA, you may think you’ve dodged a bullet, but a recent study suggests that’s not the case, showing increased risk that continues years after the event. Rebecca Gottesman, a stroke expert at Johns Hopkins, interprets the findings.

Gottesman: People who had stroke or TIA who survived in the first few months after their stroke or TIA had a higher rate of recurrent stroke, death, or readmission to the hospital over the first year they noticed more than a doubled increased risk, that continued up to three years and five years after their stroke or TIA. Although these data are important we know that stroke and TIA increases risk for another stroke and increases risk for death. We don’t know from these data whether the association they see is due to the stroke or TIA itself or due to the risk factors that led to that stroke or TIA in the first place. :34

Gottesman says the study does underscore the imperative to control known risk factors for TIA and stroke. At Johns Hopkins, I’m Elizabeth Tracey.

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sick-child-photo-020647220_iconmThis week’s topics include complications of aortic valve surgery, effectiveness of nasal flu vaccination, testing for Epstein Barr virus and nasopharyngeal cancer, and hepatitis C treatment.
Program notes:
0:31 How effective is the flu vaccine?
1:31 Reformulation of nasal type
2:27 Studies to find out why nasal isn’t working
3:12 Epstein Barr virus and nasopharyngeal cancers
4:11 Over 20,000 subjects
5:12 Screen about 590 to find one cancer
5:42 Primary care and hepatitis C treatment
6:42 Group of patients hardest to treat
7:42 Effective training
8:00 Aortic valve replacement and stroke
9:01 MRI and other side effects
10:31 End
Related blog:https://podblog.blogs.hopkinsmedicine.org/2017/08/14/nasal-flu-vaccine-ineffectiveness/
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Anchor lead:  Who should really be screened for a host of common cancers? Elizabeth Tracey reports

If you’re a woman, should you have screening mammography? If you’re a man, how about screening for prostate cancer? Increasingly, people are told, especially as they age, that having screening may not result in a benefit and very well may result in harm. Yet a recent study shows that older people are reluctant to abandon the practice. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says it really comes down to whether a cancer is likely to be harmful.

Nelson: As you are able to detect cancers when they’re smaller and smaller and smaller, what you begin to find is cancers that are small and were never going to become big. Were never going to threaten one’s life, the survival for them is of course very long because they were never going to threaten you life to begin with. So a second consequence of screening when you can detect things when they’re very small is you start to detect things that were of no threat. And thus the only threat that you posed is the threat of trying to treat them, and whatever the treatment consequences were.   :29

Nelson says research is increasingly identifying potential ways to discern harmful cancers from those that aren’t likely to be a problem. At Johns Hopkins, I’m Elizabeth Tracey.

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