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Triple-negative breast cancer is among the most serious types of the disease, because it lacks cell receptors that many treatments are based on. Now a new study shows that use of an antibody called pembrolizumab improves outcomes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They did a very large randomized clinical trial, very solid evidence. More than a thousand women randomized two to one to get the pembrolizumab along with chemotherapy, after the breast cancer was diagnosed but before any surgery or radiation therapy was done. This is the early data but at 36 months, almost 85% of these women are free of any evidence of disease, versus 77% of them that were free of any evidence of disease with the chemotherapy alone, the chemotherapy alone is effective it’s just not as effective as this combination. :30

Nelson believes these results will change practice in many women with triple negative breast cancer, especially as longer term results continue to come in. at Johns Hopkins, I’m Elizabeth Tracey.

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When it comes to whether you’re protected against Covid-19, either by immunization or natural infection, controversy has swirled around antibody levels and how good a predictor they are. Dorry Segev, a transplant surgeon at Johns Hopkins who has looked at these levels in transplant recipients, says a clearer picture is emerging.

Segev: We have learned over the last year a lot about what antibody levels mean. We can actually say quite comfortably today that antibodies correlate with neutralization, which correlates with clinical protection. One problem is that everybody’s looking for a line, and above the line you’re fine and below the line you’re not fine, and that’s never going to happen. More antibodies means more protection, period. But we do know that somebody with no antibodies, is not protected.  :31

Segev says most of us just need to get fully immunized and don’t need an antibody level to demonstrate protection. At Johns Hopkins, I’m Elizabeth Tracey.

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Keeping someone’s immune response damped down is necessary when someone gets an organ transplant, but Dorry Segev, a transplant surgeon at Johns Hopkins, says it may also allow the virus to remain active for prolonged periods of time.

Segev: In somebody with a healthy immune system, if they should happen to get Covid their immune system kicks in, they develop antibodies against that Covid, they develop all sorts of other immune responses, and they get rid of that virus. If you are immunocompromised you may not be able to mount that kind of an immune response in general, and so maybe you’ll get over the severe symptoms of the disease but that disease can linger because you can’t kill it with your immune system.  :30

Segev is working on vaccination strategies for people who are on medicines to keep their immune response under control, and notes that for those who’ve had Covid reducing their medicines to allow them to clear the virus appeared safe. At Johns Hopkins, I’m Elizabeth Tracey.

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Organ transplant recipients are on medicines to keep their immune response in check, and so are many others: people with so called autoimmune disease like lupus, or some people with asthma. Dorry Segev, a transplant surgeon at Johns Hopkins, says these people are not able to respond well to Covid-19 vaccinations.

Segev: We have found the certain immunosuppressive agents are particularly inhibitory, but anybody who is on immunosuppressive drugs is at increased risk for a suboptimal vaccine response. This can extend to people well beyond just the transplant population. People with autoimmune diseases and all sorts of other conditions where they need to suppress the immune system to prevent to prevent flares, to prevent rejection.  :26

Segev says research is underway to determine if a strategy to enable effective vaccination in this very large population of people can be developed. In the meantime he advocates for a very conservative approach for people with these conditions to avoid infection. At Johns Hopkins, I’m Elizabeth Tracey.

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People who receive organ transplants must go on a regimen of drugs to suppress their immune response and allow the organ to survive and function. Yet when that strategy is working it also leaves people without the ability to respond to vaccines. Dorry Segev, a transplant surgeon at Johns Hopkins, says a very fine line must be trod.

Segev: In fact transplant patients take immunosuppression for a very good reason, and that is to keep their organs from rejecting. They are at lifelong risk of organ rejection, which we have to mitigate by suppressing their immune system. But like everything else with transplant patients it is a balance. If we over-immunosuppress we put them at risk of infections, we make vaccines not work. If we under-immunosuppress then we put them at risk of rejection.  :29

Segev is currently studying whether stopping immune suppressing medicines and then vaccinating people who’ve had a transplant will enable the vaccine to work and the transplant to continue functioning. At Johns Hopkins, I’m Elizabeth Tracey.

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People who’ve gotten transplants such as kidneys take drugs to keep their immune system from attacking the organ, called immunosuppression, but also damp down their response to vaccinations, a big issue during the pandemic. Now a new study is examining whether these drugs can be paused safely to allow for effective immunization. Dorry Segev, a transplant surgeon at Johns Hopkins, explains.

Segev: The fact that they take immunosuppression contributes dramatically to the fact that they can’t mount an immune response to the vaccines, so one of the questions is what if we hold their immunosuppression for a certain period of time, let their immune system kind of recover a little bit, give them the vaccine dose, hold it a little bit afterward to let the vaccine work, and then restart the immunosuppression and will that help. We don’t want to stop all of the immunosuppression cold turkey because they take immunosuppression for a reason.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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1.2 million overdose deaths by 2029 in North America. That’s the sobering projection of a recent Lancet study. Eric Strain, a substance use disorders expert at Johns Hopkins, says an all encompassing strategy beginning early in life makes sense to him.

Strain: We pay lip service to the social determinants of health. But when it comes to drug abuse, we really aren’t focusing our resources and energy in that way. That’s a tragedy, even for people who don’t necessarily develop a fentanyl habit but use some cannabis and don’t enter the workforce, and don’t engage in healthy relationships, and have other problems that maybe we consider a lower grade, you know we’re losing a life that way. How do we maximize the opportunity for people to lead meaningful and purposeful lives? :33

Strain hopes that providing opportunities and correcting problems throughout the lifespan will enable people. At Johns Hopkins, I’m Elizabeth Tracey