267 ‒ The latest in cancer therapeutics, diagnostics, and early detection | Keith Flaherty, M.D.

Keith Flaherty is the director of clinical research at the Massachusetts General Hospital Cancer Center and a previous guest on The Drive. In this episode, Keith first delves into the statistics on cancer's prevalence as we age, underscoring the significance of finding effective treatments and early detection methodologies. He touches on the history of cancer therapeutics and illuminates the notable enhancements in cancer therapy within the last decade that are setting the stage for a promising future. He goes into detail on the potential of immunotherapy and therapies that can combat cancer’s evasive tactics while explaining some of the existing challenges around specificity, cost, and scalability. Additionally, Keith highlights the significant leap in early detection methodologies, namely liquid biopsies, which have the potential not only to determine if a cancer is present in an early stage, but also identify the possible tissue of origin.

We discuss:
0:00:00 - Intro
0:00:40 - Keith’s interest and expertise in cancer
0:04:55 - Cancer deaths by decade of life, and how cancer compares to other top causes of death
0:10:33 - The relationship between hormones and cancer
0:18:42 - The link between obesity and cancer
0:23:40 - Current state of treatments for metastatic cancer and reasons for the lack of progress over the decades
0:35:19 - The interplay between the immune system and cancer cells
0:44:29 - Different ways cancer can suppress the immune response, and how immunotherapy can combat cancer’s evasive tactics
0:59:30 - Elimination of a substantial portion of cancers through immune cell engineering faces challenges of specificity, cost, and scalability
1:10:15 - Why TIL therapy isn’t always effective, and the necessity for multimodal therapy to address various aspects of the cancer microenvironment
1:31:49 - The challenge of treating metastatic cancer underscores the importance of early detection to improve survivability
1:38:36 - Liquid biopsies for early detection of cancer and determining the possible tissue of origin
1:49:21 - Commercially available cancer screening tests
1:57:21 - How to address the disparity in cancer care, and the exciting pace of progress for cancer detection and treatment

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About:

The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.

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[PeterAttiaMD]

In this episode, we discuss:
0:00:40 - Keith’s interest and expertise in cancer
0:04:55 - Cancer deaths by decade of life, and how cancer compares to other top causes of death
0:10:33 - The relationship between hormones and cancer
0:18:42 - The link between obesity and cancer
0:23:40 - Current state of treatments for metastatic cancer and reasons for the lack of progress over the decades
0:35:19 - The interplay between the immune system and cancer cells
0:44:29 - Different ways cancer can suppress the immune response, and how immunotherapy can combat cancer’s evasive tactics
0:59:30 - Elimination of a substantial portion of cancers through immune cell engineering faces challenges of specificity, cost, and scalability
1:10:15 - Why TIL therapy isn’t always effective, and the necessity for multimodal therapy to address various aspects of the cancer microenvironment
1:31:49 - The challenge of treating metastatic cancer underscores the importance of early detection to improve survivability
1:38:36 - Liquid biopsies for early detection of cancer and determining the possible tissue of origin
1:49:21 - Commercially available cancer screening tests
1:57:21 - How to address the disparity in cancer care, and the exciting pace of progress for cancer detection and treatment

[mugflub]

Peter Attia is a modern-day superhero. His superpower is a combination of intense passion, incredible intelligence, and an unstoppable drive. He is a force of nature in the world of medicine and is doing so much good. I'm reading his book now and it's phenomenal. He really gives me hope for the future of health care. Medicine 3.0 is on the way!

[andynicoll]

On my way to my yearly cystoscopy. Six years clear since bladder cancer treatment! Yea, fingers crossed.

[sadiqzaman]

Speaking as a clinical Hematopathologist practicing at a national laboratory, this was a great interview that highlighted the importance of further developing and focusing on diagnostics at this juncture in the saga of cancer therapeutics. Having incorporated next-generation sequencing (DNA and more recently RNA) into our diagnostic hematopathology reports over the last 5+ years has done a great deal to allow us to not only more specifically diagnose leukemia or myeloid/ lymphoid neoplasms, but also to provide prognostic information in those patients on whom neither leukemia nor a myeloid/ lymphoid neoplasm has arisen yet. I am excited to see how we can further incorporate advancements in this field to even better prognosticate (and accordingly, prescribe guidance on the frequency/ closeness of follow-up) for those patients in whom leukemia/ lymphoma or its precursors have not yet arisen. Great interview.

[yolandaphillips]

Ah! Thank you!! I thoroughly enjoy your podcasts. I find myself going from re-reading a chapter in your book Longevity to rewatching an episode. Absolutely insightful and inspiring ❤

[petercoderch]

"Men have the highest rate of prostate cancer when their testosterone and DHT levels are at their lowest, in old age." - Yeah, but you're not taking into consideration that the old man had decades of his prostate cells being under oncogenic stimulation from those same hormones, while the young man has only a decade or so of that. HUGE difference. I don't understand why it's so difficult for people to understand the concept of damage accumulating over long spans of time, that you cannot establish a cause-and-effect link between things without taking into consideration time elapsed. It's like when people say that telomere shortening is the cause of ageing because young people have long telomeres and old people short telomeres, when they forget that young people have been around for a lot less long time so they have accumulated a loss less DNA damage, a lot less misfolded proteins, and have undergone a lot less epigenetic drift from having to constantly repair DNA damage(and telomerase actually accelerates the methylation clock). Correlation and causality are two different things. This is logic 101, but who even studies the branch of philosophy and mathematics known as logic nowadays?

[lindaandnathan]

Hi Peter I found you on Andrew and Tim’s channel. Absolutely love your knowledge and how you explain things. Thank you for sharing so much valuable information to general people who don’t otherwise have access to these resources

[ursuladre]

Great lecture on the basics of immunotherapy - thanks for having Dr Flaherty on. I find few podcasts which really get into the path/phys of cancer - thank you!

[dianalipton]

Explains why cancer has flourished after the COVID shots - immune suppression.

[lesnick]

Have I heard correctly that immune therapy overall didn't pay the investment and now metabolic paths are in the focus? Even idea of pulse therapy was mentioned?
That sound more what Dr Seyfried is saying for years...

[LayneSadler]

Delfi was the most interesting thing I saw at AACR this year

[uiop]

Thanks docs. Grateful.
Can someone help? Three oncologists denied that the Warburg Effect is happening in my wife’s breast cancer. Is there a new study?

[dialectic]

What about the Differential Stress Resistance Hypothesis and cancer treatment?

[seanthundercock]

What about incurable cancer like mutiple myeloma mantle cell lymphoma .

[trishmarck]

Why is there never mention about prevention. If early screening is so go why are the deaths so high ?? Screening = profits

[WilliamChan]

So basically every time the US Presidential Primaries are starting to come into view, I'll be looking out for another one of these updates. lol Thank you guys for sharing!

[doprisi]

Is there a modern version of the book "The transformed cell" by Rosenberg and Barry?

[danielevans]

Does moderate to heavy alcohol consumption contribute as an independent risk factor in cancer?

[vansicklejacquie]

Are mammograms very effective in early detection? I’ve heard about a better machine for detection.

[alexolbrych]

I'm new here, just wondering, is chemotherapy ever used as a preventative treatment in healthy patients? Would an every 5 year regiment of chemo starting at age 50 help weed out some of these microscopic-metastatic cases that are currently very difficult to detect?

Worst case scenario here would be a patient who would hypothetically never get cancer in their life. Would this hypothetical treatment shorten their life and shorten their life enjoyment? if so by how much? would it be worth it?