Latest Perspectives on Cancer, Heart Health, Alzheimer's Risk and More
Revisiting the Potential of Cancer Immunotherapies
Over the past couple of years, optimism around cancer immunotherapies has grown substantially. One revelation is that a remarkable 80% of cancer patients have neoantigens on their tumors that are recognized by their own immune systems. The challenge lies in effectively harnessing the power of the immune system to eradicate these cancer cells.
Historically, only a very small subset of patients – often less than 20% with certain cancers like melanoma – have responded to immunotherapies like interleukin-2 or checkpoint inhibitors. But with the ability to now identify tumor-specific T cells in a majority of patients, the door has opened to engineered cell therapies that could stimulate a patient’s own immune system to attack their cancer.
Though still early, if ongoing trials continue to show promise, individually designed immunotherapies utilizing techniques like TIL therapy or CAR T cells could become the standard of care within the next decade. Cost and reimbursement issues remain barriers to widespread adoption, but a shift in perspective to evaluate quality-adjusted life years rather than just short-term cost savings will be important.
Aggressive Screening for GI Cancers
Alongside immunotherapy optimism, perspectives have also changed substantially around gastrointestinal cancer screening. Colon cancer stands out as one of few cancer types with a clear visible progression track from benign polyps to malignant disease.
This has led to a belief that through very frequent screening colonoscopies – perhaps even every 1-2 years – deaths due to colon cancer could effectively be eliminated. Though costs and side effects of such frequent testing remain barriers, strong evidence indicates far more aggressive GI cancer screening practices are warranted.
For middle-aged adults especially, pushback against outdated “standard of care” screening recommendations may often be necessary to reduce risks.
APOB as Key Target to Minimize Lifelong Heart Disease Risk
Recommendations continue getting more aggressive regarding lifelong reduction of ASCVD risk. A critical component is very early and deep lowering of APOB – a marker of all atherogenic lipoproteins.
New perspectives point toward beginning medications like statins and PCSK9 inhibitors in one’s 30s or 40s if lifestyle measures fail to reach ideal APOB levels below 60 mg/dL. Though always balancing relative risks and benefits, the safety record of reaching very low levels gives confidence.
Over a lifetime, pursuing pediatric levels of “bad cholesterol” transports could potentially reduce lifetime heart disease risk to near zero. Most side effects arise from short-term acute changes rather than lifelong maintenance at low levels.
Looking Beyond ApoE4 for Alzheimer’s Risk
The APOE gene long dominated discussions around Alzheimer’s disease genetic risk. But newer studies have uncovered additional gene variants that powerfully modify this disease risk, including some that may negate APOE4 risk.
Unfortunately, testing these newer gene markers remains technically difficult and prohibitively expensive for most patients. But down the road, incorporating multilocus genetic data could better tailor disease prevention recommendations for patients rather than relying solely on APOE status.
As one-day genetics and biomarker testing become more clinically actionable, such data may allow for very early, even pre-symptomatic interventions to potentially alter Alzheimer’s disease trajectories.
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