Health Newsfeed – Johns Hopkins Medicine Podcasts

Can your gut bacteria impact on how you respond to cancer treatment? Elizabeth Tracey reports

For people with advanced melanoma who were being treated with a class of targeted therapies known as checkpoint inhibitors, response to therapy was associated with which types of bacteria they had in their intestine, a new study shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: The microbiota, these are the bacteria that are residents of the intestine. That ecosystem, which bacteria are there in certain individuals versus others, makes a difference for people with advanced melanoma who are treated with immune checkpoint inhibitors, like ipilimumab, nivolumab, it makes a difference to how well they respond. When they are looking at 77 or so folks with advanced melanoma, who got a combination of ipilimumab and nivolumab or one of the other immune checkpoint inhibitors, turns out almost half of them had very significant immune related adverse events.  :34

Nelson says many researchers are looking at ways to modify gut bacteria to help. At Johns Hopkins, I’m Elizabeth Tracey.

Do medicines approved by the FDA on their accelerated pathway ever get confirmed? Elizabeth Tracey reports

When the FDA developed its accelerated pathway to drug approval in 1992, it seemed like a good way to get drugs to the market faster and help more people. Now a study in the BMJ shows that of 253 drugs approved this way, 112 have not been confirmed as safe and effective. Caleb Alexander, an internal medicine expert at Johns Hopkins and a member of an FDA committee, comments.

Alexander: Manufacturers are required to complete confirmatory trials for products approved under the accelerated pathway but all too often these trials aren’t completed until years later, if at all. And when they are completed they may still really fail to put the scientific issues to rest. Endpoints that are selected are sometimes the same surrogate endpoints that were used to gain approval. Sometimes it’s another surrogate endpoint, but not the hard clinical outcomes that we all care about.  :33

Alexander says the latest debacle over Aduhelm points to the need to overhaul this regulatory pathway. At Johns Hopkins, I’m Elizabeth Tracey.

When a man is suspected of having prostate cancer he will likely undergo a biopsy, where a needle is inserted into the prostate gland to look for cancer. Now a new study shows that using magnetic resonance imaging or MRI along with ultrasound helps identify suspicious areas and improves the technique. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the study.

Nelson: Three to four biopsy cores were going to be aimed at that suspicious lesion then the men would have the ten to twelve biopsy cores. They found the clinically significant cancer in 21% of the men who got the targeted biopsy, a little bit more than the men in the ten to twelve core biopsies, 18% of them. But the clinically insignificant cancers were somewhat lower in the experimental group. Have the focused biopsy highlighted by MRI, followed by the core biopsy seemed to be better.  :31

At Johns Hopkins, I’m Elizabeth Tracey.

The ketogenic diet, which consists mostly of fat with some protein and very few carbs, has gained visibility as other diets such as the paleo diet have become increasingly popular for weight loss, and it’s used to control epilepsy. Is such a diet a reasonable choice for the condition instead of a medication? Mackenzie Cervenka, an expert in the management of adults with epilepsy at Johns Hopkins, offers her opinion.

Cervenka: There may be other circumstances where patients are very hesitant to consider antiseizure drugs or medications in general where it’s a personal preference sort of situation and in which case I would counsel patients that we really don’t have strong evidence to guide us with regard to effectiveness of the diet versus trying an initial antiseizure drug but if that is their personal preference, that is available as a potential therapy.  :26

Cervenka says that any attempt to control epilepsy with diet alone must be carefully monitored, both for recurrent seizures as well as other health parameters such as cholesterol and weight, so seek an expert. At Johns Hopkins, I’m Elizabeth Tracey.

High fat, some protein, very few carbohydrates. That’s largely what constitutes a ketogenic diet, developed 100 years ago to help control epilepsy in children and adults. Now the diet is first line treatment for certain metabolic disorders and is gaining ground for epilepsy management. Mackenzie Cervenka, who specializes in the management of epilepsy in adults at Johns Hopkins, says there is a right time to try the diet.

Cervenka: In my opinion if you’re an adult with epilepsy and you’ve tried at least two antiseizure drugs that are appropriate for your type of epilepsy and continue to have seizures this is a reasonable time to consider the diet. One consideration in addition to that is that if you’re an adult with epilepsy who has a tumor or a lesion or some structural reason for having seizures and there’s an option for having epilepsy surgery, that would be the most appropriate next step to pursue.  :30

Cervenka says support and monitoring are needed when someone tries the diet, so seek expert advice if you’re interested. At Johns Hopkins, I’m Elizabeth Tracey.

In the midst of rising overdose deaths, Spain and a few other countries implemented supervised injection sites so overdoses could be reversed right away, and sure enough, deaths fell. Now the state of Rhode Island has become the first state to approve such a measure. Eric Strain, a substance use disorders expert at Johns Hopkins, comments.

Strain: I fear that our next pivot will be to ‘well, because methadone, buprenorphine and naltrexone aren’t working, we need to offer people safe injection facilities with heroin. And I’m not convinced that that’s the solution. It’s hard for me to see them as making much of an impact. I’m not convinced that they will really help people to move into having purpose and meaning in their lives.   :29

Strain says substance use disorders require an array of interventions to enable people to overcome addiction, and he’s concerned that the supervised injection sites are a stop gap measure. At Johns Hopkins, I’m Elizabeth Tracey.

Opioid overdose deaths reached their highest rate ever in the US in the last 12 months, with a new study showing that expanding prescribing medications like naloxone, doesn’t help. What can stem this tide? Eric Strain, a substance use disorders expert at Johns Hopkins, says those who want to leave their addictions behind must look for the right treatment.

Strain: For the individual who is looking for treatment and wants to move forward I think that the critical thing is to not just say well I’ll take whatever I can find, but to really find some treatment provider or program that will do something more than simply prescribe a medication.  That goes back to the difficulties in finding quality treatment, because we’re not paying for quality treatment.  :28

Strain says until government steps in to mandate what constitutes quality treatment things are not likely to improve. He says it is known what helps keep people in treatment once they start, so implementing that first may be one step in the right direction. At Johns Hopkins, I’m Elizabeth Tracey.

Deaths from drug overdoses topped 92,000 over the previous twelve months, the CDC has reported. Eric Strain, a substance use disorders expert at Johns Hopkins, says the vast majority of those deaths were due to opioids.

Strain: That’s a dramatic increase over 2019 when it was about 51,000. It’s an 18,000 increase in opiate overdoses. Methamphetamine overdoses are increasing. There’s a lot of thought that those seem to be combinations of opioids and stimulants like methamphetamine and cocaine. We can’t fully attribute this to opioids. We need to keep in mind that there’s poly drug use going on and there’s a lot of poly drug use. It’s probably more poly drug use that just a single drug abuse.  :33

Strain says poly drug use can complicate efforts resuscitation efforts because rescuers may not know which agent or combination of agents to use. At Johns Hopkins, I’m Elizabeth Tracey.

Even as Covid deaths begin to climb again nationally, the most recent data on drug overdose deaths shows a dramatic increase in the last year. Eric Strain, a substance use disorders expert at Johns Hopkins, reviews the data.

Strain: The CDC does a rolling number of overdose deaths. They sent out information through December 2020, and there’s a little over 92,000 overdose deaths in the previous 12 months. That’s a 29% increase to the prior year. I think the other thing to be cognizant of is that the overwhelming majority of these are opiate overdoses. Of that 92,000, 69,000, almost 70,000 of them are opioid related. :30

Strain says any number of factors must be considered in understanding this rise, including pandemic related isolation and mental illness, and lack of access to healthcare services including substance use disorder treatment, even while prescribing of medications to help has expanded. At Johns Hopkins, I’m Elizabeth Tracey.

The ketogenic diet is a very high fat and very low carbohydrate diet that helps both children and adults with epilepsy control their seizures, and the diet is now celebrating its one-hundredth anniversary. Eric Kossoff, a neurologist and pediatric ketogenic diet expert at Johns Hopkins, says even then, it was known that such a strategy could help.

Kossoff: The diet was created in 1921 so 100 years ago with the idea being that it was going to mimic periods of starvation and fasting. They knew for decades, you might almost argue for millenia, before 1921, that fasting seemed to help this condition. So when the diet was created that was the intention, was that you would be potentially, okay, that was the idea, mimicking a starvation state. What we know now is that it’s much more complicated than that.  :30

Kossoff says why a high fat diet helps may vary between individuals, and notes that up to 20% of those with epilepsy who try it many not need medication at all. At Johns Hopkins, I’m Elizabeth Tracey.