Health Newsfeed – Johns Hopkins Medicine Podcasts

People who are newly diagnosed with melanoma that has already spread throughout their bodies or can’t be removed surgically have a new treatment option, a recent study finds. The treatment uses two so-called ‘immune checkpoint inhibitors’ explains William Nelson, director of the Kimmel Cancer Center at Johns Hopkins.

Nelson: The combination of relatlimab and nivolumab had about 18% or so significant toxicities. They typically are ‘itisis,’ colitis, pneumonitis. In the nivolumab and ipilimumab one it’s about 59%, that’s a pretty toxic regimen to give. So if that proves to be true that you can get the same improvement in outcome with less in the way of side effects or complications it’ll definitely be a hit.  :31

Nelson notes that about 10% of people with melanoma will present with disease at this advanced stage and may benefit. At Johns Hopkins, I’m Elizabeth Tracey.

Are Covid-19 vaccines still effective in people who’ve undergone treatment for so-called solid organ cancers, such as breast or prostate? The answer seems to be yes, based on a recent study looking at antibody levels to the virus’s spike protein after vaccination in those so treated. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: About 15% already had, before they got their second vaccine, anti-spike antibodies. 65% had after the second vaccine and for the ones who went ahead and got a booster 75% got after the three doses. That immune response declined over time, particularly over about three months. This is not dramatically different than what you see in the general population. What it does tell you is that you should vaccinate these people.  :27

Nelson notes that for folks with other types of cancer the immune response may not be so robust so other treatment strategies may be employed, such as monoclonal antibodies. At Johns Hopkins, I’m Elizabeth Tracey.

The combination of a drug called abiraterone with others routinely used in prostate cancer helps men with one stage of the disease remain disease free longer, two new studies find. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: What they found was that both the abiraterone containing arms in each of the trials that were done were superior to androgen deprivation therapy and at six years 82% of folks were free of any evidence of metastatic prostate cancer when they got abiraterone versus 69% when they didn’t. Enzalutamide didn’t add much. I think it is an advance. The idea is you come in with high risk prostate cancer, you’re likely to get radiation therapy. At this point you’ll probably get androgen deprivation therapy along with abiraterone.  :28

Nelson says the good news is oncologists are learning more about managing many kinds of cancer, including prostate cancer, at different stages, to maximize the benefits of different treatments. At Johns Hopkins, I’m Elizabeth Tracey.

Simply analyzing a blood test to screen for cancer is becoming closer to reality as many more assays come online, with a new one improving lung cancer detection by about 9% when used with CT scanning. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says their underlying strategy is simple.

Nelson: Many of them are from the turnover of cancer cells in the body, DNA, RNA, protein and things in them, they swim around for some period of time and give you a chance to build detection strategies that scientists will call assays. The ideal test will have a high positive predictive value, that’s when the test is positive you have a high chance of having the condition, and also have a high negative predictive value, so if they say it doesn’t seem to be a problem you really can sleep easier as opposed to maybe they missed something.  :30

Nelson says current screening methods often identify possible cancers that turn out to be benign and miss a certain number, and blood testing may improve that. At Johns Hopkins, I’m Elizabeth Tracey.

CT scanning is used to screen for many lung cancers, with a new study finding that adding a simple blood test to the scan helps both find lung cancers and reduce the number of tests needing follow up. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: What they did was identify four different things they could measure in the blood circulation. They would aid in predicting who might be at risk to get lung cancer. They did this panel, they called it 4MP, four marker protein panel, in almost 1300 blood specimens, preceding a lung cancer diagnosis. What they argued in the end is that if you combine this blood test along with the CT scanning, the blood test made for more sensitivity, more likely to detect a cancer if it was present.  :32

About 9% more lung cancers were found using this method while 13% fewer false positives were seen. At Johns Hopkins, I’m Elizabeth Tracey.

Variants of Covid are springing up all the time, perhaps in people who have compromised immune systems and experience prolonged infection or in animal hosts. Stuart Ray, an infectious disease expert at Johns Hopkins, says right now with Delta and Omicron variants circulating, vaccination is more crucial than ever.

Ray: The people who are really unvaccinated and not immune may be particularly susceptible to Delta. And some of the severity we’re seeing may be in that population, so there’s still the situation where you don’t want to be the last person who has no armor. Getting vaccinated is a smart thing to do if you’re not at all vaccinated yet, and following the current recommendations is the safest  way to get immune, but we may see variants that surprise us, because the fitness landscape is shifting, and the rules are changing  for the virus as well as the rest of us.  :28

Ray agrees with many in the field that modified Covid vaccines, many already in development and testing, may be necessary as new variants continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

Both vaccine developers and the FDA have agreed that as new Covid variants emerge and updated vaccines are required, the pathway for providing them should involve testing in far fewer people and over a shorter period of time. Jonathan Zenilman, an infectious disease expert at Johns Hopkins, applauds the effort.

Zenilman: With different variants the FDA has agreed that that would be a reasonable pathway. The challenge is timing. Think about if we were going to develop and field an Omicron  vaccine the simple logistics of production and distribution would take three months at a minimum, so we wouldn’t have  it out until April, and think that Omicron has only been with us for less than three months so I think part of this becomes a predicting game very similar to what we do with the flu and I think that’s what we’re going to see moving forward.  :30

Flu vaccines are updated yearly based on which strains of the flu are circulating in Asia and surrounding countries. The promise of mRNA vaccines should extend to them also to make better matches each year. At Johns Hopkins, I’m Elizabeth Tracey.

Why aren’t Covid vaccines, especially mRNA vaccines, being produced against variants such as Omicron as they emerge? Anna Durbin, an infectious disease expert at Johns Hopkins, says this is what the technology promises.

Durbin: I do think we have to be more forward thinking and also working with regulators because if we could get very fast approval of second, third generation, which we should be able to based on the way we get approval for influenza vaccines and the way this technology works. It’s not a difference in manufacturing it’s just a difference in the genetic sequence of the vaccine. I think that would be very helpful but I think eventually we’re going to have to move to a different sequence of vaccine particularly if we’re seeing more divergence even beyond Omicron.  :32

Durbin and other vaccine experts agree that modification of vaccines is very likely to be ongoing as new variants are also likely to continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

If you’ve had three doses of an mRNA vaccine against Covid you are much less likely to require hospitalization, require ICU level care, or die from Covid-19, even with the now dominant Omicron variant, than if you aren’t vaccinated at all. Anna Durbin, an infectious disease expert at Johns Hopkins, explains.

Durbin: With Omicron the mutations make it more of an escape. The antibodies prevent infection and its incredibly difficult for any vaccine to prevent a respiratory infection, so it’s not surprising that we’re seeing far less efficacy against infection with Omicron and that we’re seeing more disease and I think what’s really important to note is that we still see some good protection against severe disease even in those who have not been boosted yet.  :31

Durbin notes that those who are eligible for their third dose should get it as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Children younger than five comprise the last group in whom a vaccine against Covid is currently being tested. Jonathan Zenilman, an infectious disease expert at Johns Hopkins, says late spring may be when enough data will be in for an emergency use authorization.

Zenilman: It turns out probably because of Omicron cause this is now going on in the middle of a surge, they may have enough cases to show efficacy as well. Under the optimistic progressions we may have data for a small kids vaccine, 6 months to 4 years, by mid-April, early May but that’s going to be a three dose series. And I think all of us who are in this recognize that the primary series even for the adult vaccine is probably a three dose series anyway, which is why they decided to go that way.  :32

Zenilman notes that data from other age groups seems to show that three doses with appropriate spacing are necessary for the best response. At Johns Hopkins, I’m Elizabeth Tracey.