Kimmel Cancer Center Director William Nelson at Johns Hopkins says if such a test could motivate people to utilize low-dose CT to image their lungs, that would be a good outcome, and he suspects more of this type of test is coming.

I do think there are going to be risk tests, and I think that may well be the game in lung cancer.

There are some blood-based DNA tests that are going to be coming down the pike, some of them being looked at by the FDA right now, that have a high negative predictive value in the group that would otherwise be recommended for low-dose CT scan imaging.

And you can imagine a test like that, if positive, would be highly motivating for someone to go get screened.

William Nelson, director of the Kimbell Cancer Center at Johns Hopkins, explains.

This protein assay in the bloodstream captured 85% of lung cancer

cases.

Now, remember, what this test would do is say, you are the person who should go get low-dose CT scan imaging, which was already underutilized, even for the people who should use it.

Maybe it's a better criterion to motivate people to go get lower-dose CT.

Johns Hopkins Kimmel Cancer Center Director William Nelson explains.

These folks came up with a blood-based assay of proteins in the bloodstream.

They call it the integral model, 21 proteins that they measure.

How well can these predict who might have lung cancer versus not? The problem they were addressing is that if you look at the US Preventive Services Task Force criteria for who should get screened with low-dose CT scan, it's former smokers who are 50 to 80 years old and have at least a 20-pack year smoking history.

that misses a third of lung cancer cases.

Johns Hopkins Kimmel Cancer Center Director William Nelson says both false positive results, where the test shows a cancer is present but it's not, and false negative results are problematic.

Those are the kinds of things that consume resources, particularly false positives.

If you have a suspicion of something and then you have to chase it down, it consumes resources.

If you didn't have a cancer, then you wouldn't have been subjected to that.

If you had a positive test, how sure is it that you actually have a cancer? That's the predictive value.

In a resource-constrained environment, the real premium tests are those that have a high negative predictive value, i.e. you undergo a test that says you don't need to do 10 more things, that you are in fact safe for the time being, and you're sure that you're safe.

William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says such a strategy is also breathtakingly expensive.

This issue of an early test that you give a lot of people that creates a lot of medical effort afterwards is clearly gonna consume more resources.

Overall, if you're gonna deploy a test like this, even if it were to work, you would have to think about what that means, not just on the test itself, and there was an estimate from the paper that $949 test, if United Kingdom deployed this to the people who needed it, would cost them almost $20 billion a year just for the test.

But you also have to think of all the downstream things you would need to do.

Johns Hopkins Kimmel Cancer Center Director William Nelson explains why this might happen.

As you begin to get these tests, you need a workup to evaluate the suspicious tests.

You need CT scans, you need further blood tests, you need biopsies.

You might need referral to a very specific specialist, and the worry is is that as you utilize these resources, the rest of the people in the region may have scarce resources or impeded access.

This issue of an early test that you give a lot of people that creates a lot of medical effort afterwards is clearly gonna consume more resources.

Kimmel Cancer Center Director William Nelson at Johns Hopkins looks at the specific findings.

They looked at those who used the GLP-1 receptor agonist and fulfilled at least two prescriptions to compare against people who were formally recommended to undergo diet and exercise.

What they found was a 41% reduction overall in the risk for cancer, myeloma, pancreatic cancer, endometrial cancer, that's cancer of the uterus, colorectal cancer, and thyroid cancer.

More and more evidence hinting that if you can treat obesity effectively, it may reduce the risk of cancers that seem to be increased.

William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

GLP-1 receptor agonist use is going up and up.

The risks for cancers associated with obesity also seems to be going up and appearing in younger age groups.

There's already a little bit of a hint that when these drugs are taken for obesity, not for diabetes, they may impact the risk of obesity-related cancers.

They tried to find non-diabetic patients that were obese, so BMI greater than 30, that had had no history of cancer between 2014, that's really when these drugs started to be used for obesity, and 2025.

you know so that the more and and yes maybe you know their eyes are spinning or heads are spinning or whatever when you you mentioned vitamin c or mistletoe or whatever it is that you mentioned but i i think after hearing and after seeing the change in response that you know the oncologist you know that the tide is going to change and i think that that is so so important

It is.

It really is, Doc.

You know, and this harkens back to when I first started practicing.

I still remember a cancer patient, a lady with breast cancer, and she was pursuing complementary care with me, and she went into her follow-up on chemotherapy, and the The doctor, the oncologist said, we need to increase your chemo.

And she says, well, why? He goes, well, look at your blood cell.

Your white blood cell count is still good.

So talk to me a little about mistletoe through that view.

Kimmel Cancer Center Director William Nelson at Johns Hopkins says this is one more place where an expansion of CAR-T capabilities is underway.

There are off-the-shelf CAR T-cell preparations that some companies are trying to create.

This one's interesting because it's tethered to the bone marrow transplantation.

This approach by selecting particular T-cells, engineering them in a particular way, putting them in, you didn't need as many.

They hung around and they didn't cause graft-versus-cells disease.

They were pretty deliberately directed against the cancer itself.

I think this is something that would be an adjunct to bone marrow transplantation.

William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says a number of issues were apparent at the onset.

CAR T cells, when they were originally introduced for treating HIV, one of the challenges was that when they were genetically engineered, this is to remove immune cells from the body by a process of phoresis, to genetically engineer them to go after a very specific target and then re-infuse them.

They didn't live very long when you did that.

Current generation of them, they managed to get them to live long enough to have a fair amount of success.

Having said that, they haven't been that helpful at all treating most solid organ cancers.

William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says a number of issues were apparent at the onset.

CAR T cells, when they were originally introduced for treating HIV, one of the challenges was that when they were genetically engineered, this is to remove immune cells from the body by a process of phoresis, to genetically engineer them to go after a very specific target and then re-infuse them.

They didn't live very long when you did that.

Current generation of them, they managed to get them to live long enough to have a fair amount of success.

Having said that, they haven't been that helpful at all treating most solid organ cancers.

William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says while the drug is going through the FDA's approval process, there are ways for people with pancreas cancer to access treatment.

The FDA has approved a program of expanded access.

Usually in the expanded access program, you're still collecting information, particularly around safety.

It does enhance the knowledge base that the FDA will ultimately use.

I think the idea that you can target RAS generally is a great advance.

It's not gonna be the answer, but it is going to be something that will be an incredible tool to use.