From immunotherapy to mRNA vaccines – the latest science on melanoma treatment explained
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More than 16,000 Australians will be diagnosed with melanoma each year. Most of these will be caught early, and can be cured by surgery.
However, for patients with advanced or metastatic melanoma, which has spread from the skin to other organs, the outlook was bleak until the advent of targeted therapies (that attack specific cancer traits) and immune therapies (that leverage the immune system). Over the past decade, these treatments have seen a significant climb in the number of advanced melanoma patients surviving for at least five years after diagnosis, from less than 10% in 2011 to around 50% in 2021.
While this is great news, there are still many melanoma patients who cannot be treated effectively with current therapies. Researchers have developed two exciting new therapies that are being evaluated in clinical trials for advanced melanoma patients. Both involve the use of immunotherapy at different times and in different ways.
The first results from these trials are now being shared publicly, offering insight into the future of melanoma treatment.
Immunotherapy before surgery
Immunotherapy works by boosting the power of a patient’s immune system to help kill cancer cells. One type of immunotherapy uses something called “immune checkpoint inhibitors”.
Immune cells carry “immune checkpoint” proteins, which control their activity. Cancer cells can interact with these checkpoints to turn off immune cells and hide from the immune system. Immune checkpoint inhibitors block this interaction and help keep the immune system activated to fight the cancer.
Results from an ongoing phase 3 trial using immune checkpoint inhibitors were recently published in the New England Journal of Medicine.
This trial used two types of immune checkpoint inhibitors: nivolumab, which blocks an immune checkpoint called PD-1, and ipilimumab, which blocks CTLA-4.
Some 423 patients (including many from Australia) were enrolled in the trial, and participants were randomly assigned to one of two groups.
The first group had surgery to remove their melanoma, and were then given immunotherapy (nivolumab) to help kill any remaining cancer cells. Giving a systemic (whole body) therapy such as immunotherapy after surgery is a standard way of treating melanoma. The second group received immunotherapy first (nivolumab plus ipilimumab) and then underwent surgery. This is a new approach to treating these cancers.
Based on previous observations, the researchers had predicted that giving patients immunotherapy while the whole tumour was still present would activate the tumour-fighting abilities of the patient’s immune system much better than giving it once the tumour had been removed.
Sure enough, 12 months after starting therapy, 83.7% of patients who received immunotherapy before surgery remained cancer-free, compared to 57.2% in the control group who received immunotherapy after surgery.
Based on these results, Australian of the year Georgina Long – who co-led the trial with Christian Blank from The Netherlands Cancer Institute – has suggested this method of immunotherapy before surgery should be considered a new standard of treatment for higher risk stage 3 melanoma. She also said a similar strategy should be evaluated for other cancers.
The promising results of this phase 3 trial suggest we might see this combination treatment being used in Australian hospitals within the next few years.
mRNA vaccines
Another emerging form of melanoma therapy is the post-surgery combination of a different checkpoint inhibitor (pembrolizumab, which blocks PD-1), with a messenger RNA vaccine (mRNA-4157).
While checkpoint inhibitors like pembrolizumab have been around for more than a decade, mRNA vaccines like mRNA-4157 are a newer phenomenon. You might be familiar with mRNA vaccines though, as the biotechnology companies Pfizer-BioNTech and Moderna released COVID vaccines based on mRNA technology.
mRNA-4157 works basically the same way – the mRNA is injected into the patient and produces antigens, which are small proteins that train the body’s immune system to attack a disease (in this case, cancer, and for COVID, the virus).
However, mRNA-4157 is unique – literally. It’s a type of personalised medicine, where the mRNA is created specifically to match a patient’s cancer. First, the patient’s tumour is genetically sequenced to figure out what antigens will best help the immune system to recognise their cancer. Then a patient-specific version of mRNA-4157 is created that produces those antigens.
The latest results of a three-year, phase 2 clinical trial which combined pembrolizumab and mRNA-4157 were announced this past week. Overall, 2.5 years after starting the trial, 74.8% of patients treated with immunotherapy combined with mRNA-4157 post-surgery remained cancer-free, compared to 55.6% of those treated with immunotherapy alone. These were patients who were suffering from high-risk, late-stage forms of melanoma, who generally have poor outcomes.
It’s worth noting these results have not yet been published in peer-reviewed journals. They’re available as company announcements, and were also presented at some cancer conferences in the United States.
Based on the results of this trial, the combination of pembrolizumab and the vaccine progressed to a phase 3 trial in 2023, with the first patients being enrolled in Australia. But the final results of this trial are not expected until 2029.
It is hoped this mRNA-based anti-cancer vaccine will blaze a trail for vaccines targeting other types of cancer, not just melanoma, particularly in combination with checkpoint inhibitors to help stimulate the immune system.
Despite these ongoing advances in melanoma treatment, the best way to fight cancer is still prevention which, in the case of melanoma, means protecting yourself from UV exposure wherever possible.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research) and John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Stop Trying To Lose Weight (And Do This Instead)
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“Lose weight” is a common goal of many people, and it’s especially a common goal handed down from medical authority figures, often as a manner of “kicking the can down the road” with regard to the doctor actually having to do some work. “Lose 20 pounds and then we’ll talk”, etc.
The thing is, it’s often not a very good or helpful goal… Even if it would be healthy for a given person to lose weight. Instead, biochemist Jessie Inchauspé argues, one should set a directly health-giving goal instead, and let any weight loss, if the body agrees it is appropriate, be a by-product of that
She recommends focusing on metabolic health, specifically, her own specialism is blood glucose maintenance. This is something that diabetics deal with (to one degree or another) every day, but it’s something whose importance should not be underestimated for non-diabetics too.
Keep our blood sugar levels healthy, she says, and a lot of the rest of good health will fall into place by itself—precisely because we’re not constantly sabotaging our body (first the pancreas and liver, then the rest of the body like dominoes).
To that end, she offers a multitude of “hacks” that really work.
Her magnum opus, “Glucose Revolution“, explains the science in great detail and does it very well! Not to be mistaken for her shorter, simpler, and entirely pragmatic “do this, then this”-style book, “The Glucose Goddess Method”, which is also great, but doesn’t go into the science more than absolutely necessary; it’s more for the “I’ll trust you; just tell me what I need to know” crowd.
In her own words:
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Prefer text?
We’ve covered Inchauspé’s top 10 recommended hacks here:
10 Ways To Balance Blood Sugars
Enjoy!
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This Book May Save Your Life – by Dr. Karan Rajan
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The title is a bold sell, but the book does include a lot of information about what can go wrong in your body, and how those things can be avoided.
What it’s not: a reiteration of Dr. Michael Greger’s “How Not To Die“. It’s not dense medical information, and it doesn’t cite papers at a rate of ten per page.
What it is: an easy-reading tour guide of the human body and its many quirks and foibles, and how we can leverage those to our benefit. On which note…
Hopefully, your insides will never see the light of day, but this author is a general surgeon and as such, is an experienced and well-qualified tour guide. Here, we learn about everything from the long and interesting journey through our gut, to the unique anatomical features and liabilities of the brain. From the bizarre oddities of the genitals, to things most people don’t know about the process of death.
The style of the book is very casual, with lots of short sections (almost mini chapters-within-chapters, really) making for very light reading—and certainly enjoyable reading too, unless you are inclined to squeamishness.
Bottom line: in honesty, the book is more informative than it is instructional, though it does contain the promised health tips too. With that in mind, it’s a very enjoyable and educational read, and we do recommend it.
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Apple Cider Vinegar vs Apple Cider Vinegar Gummies – Which is Healthier?
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Our Verdict
When comparing apple cider vinegar (bottled) to apple cider vinegar (gummies), we picked the bottled.
Why?
There are several reasons!
The first reason is about dosage. For example, the sample we picked for apple cider vinegar gummies, boasts:
❝2 daily chewable gummies deliver 800 mg of Apple Cider Vinegar a day, equivalent to a teaspoon of liquid apple cider vinegar❞
That sounds good until you note that it’s recommended to take 1–2 tablespoons (not teaspoons) of apple vinegar. So this would need more like 4–8 gummies to make the dose. Suddenly, either that bottle of gummies is running out quickly, or you’re just not taking a meaningful dose and your benefits will likely not exceed placebo.
The other is reason about sugar. Most apple cider vinegar gummies are made with some kind of sugar syrup, often even high-fructose corn syrup, which is one of the least healthy foodstuffs (in the loosest sense of the word “foodstuffs”) known to science.
The specific brand we picked today was the best we can find; it used maltitol syrup.
Maltitol syrup, a corn derivative (and technically a sugar alcohol), has a Glycemic Index of 52, so it does raise blood sugars but not as much as sucrose would. However (and somewhat counterproductive to taking apple cider vinegar for gut health) it can cause digestive problems for many people.
And remember, you’re taking 4–8 gummies, so this is amounting to several tablespoons of the syrup by now.
On the flipside, apple cider vinegar itself has two main drawbacks, but they’re much less troublesome issues:
- many people don’t like the taste
- its acidic nature is not good for teeth
To this the common advice for both is to dilute it with water, thus diluting the taste and the acidity.
(this writer shoots hers from a shot glass, thus not bathing the teeth since it passes them “without touching the sides”; as for the taste, well, I find it invigorating—I do chase it with water, though to be sure of not leaving vinegar in my mouth)
Want to check them out for yourself?
Here they are:
Apple cider vinegar | Apple cider vinegar gummies
Want to know more about apple cider vinegar?
Check out:
- An Apple (Cider Vinegar) A Day…
- 10 Ways To Balance Blood Sugars
- How To Recover Quickly From A Stomach Bug
Take care!
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How Stress Affects Your Body
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Dr. Sharon Bergquist gives us a tour:
Stress, from the inside out
Stress is a natural physical and emotional response to challenges or being overwhelmed. It can be beneficial in short-term situations (e.g. escape from a tiger) but is harmful when prolonged or frequent (e.g. escape the rat-race).
Immediate physiological response: cortisol, adrenaline (epinephrine), and norepinephrine are released by the adrenal glands.
The effects this has (non-exhaustive list; we’re just citing what’s in the video here):
- Cortisol impairs blood vessel function, promoting atherosclerosis.
- Adrenaline increases heart rate and blood pressure, leading to hypertension.
- Stress disrupts the brain-gut connection, causing:
- Digestive issues like irritable bowel syndrome and heartburn.
- Changes in gut bacteria composition, potentially affecting overall health.
- Cortisol increases appetite and cravings for energy-dense “comfort foods”.
- This in turn promotes visceral fat storage, which raises the risk of heart disease and insulin resistance.
- Immune-specific effects:
- Stress hormones initially aid in healing and immune defense.
- Chronic stress weakens immune function (by over-working it constantly), increasing susceptibility to infections and slowing recovery.
- Other systemic effects:
- Chronic stress shortens telomeres, which protect chromosomes. Shortened telomeres accelerate cellular aging.
- Chronic stress can also cause acne, hair loss, sexual dysfunction, headaches, muscle tension, fatigue, irritability, and difficulty concentrating.
So, how to manage this? The video says that viewing stressful situations as controllable challenges, rather than insurmountable threats, leads to better short-term performance and long-term health.
Which would be wonderful, except that usually things are stressful precisely because they are not entirely within the field of our control, and the usual advice is to tend to what we can control, and accept what we can’t.
However… That paradigm still leaves out the very big set of “this might be somewhat within our control or it might not; we really don’t know yet; we can probably impact it but what if we don’t do enough, or take the wrong approach and do the wrong thing? And also we have 17 competing stressors, which ones should we prioritize tending to first, and…” and so on.
To that end, we suggest checking out the “Want to learn more?” link we drop below the video today, as it is about managing stress realistically, in a world that, if we’re honest about it, can sometimes be frankly unmanageable.
Meanwhile, enjoy:
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Want to learn more?
You might also like to read:
Heart Health vs Systemic Stress ← this is good in and of itself, and also links to other stress-related resources of ours
Take care!
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Cottage cheese is back and all over TikTok. Two dietitians explain why social media’s obsessed
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You might remember cottage cheese from your childhood. Back then, it was considered “diet food”. You ate it out of the tub, with celery or spread it on crackers for a low-calorie snack. Then cottage cheese went out of fashion.
But cottage cheese is having a resurgence. In recent months, Google searches for “cottage cheese” have risen to the highest levels since 2004.
Social media influencers have been promoting its benefits on TikTok and Instagram with hashtags such as #cottagecheese, #cottagecheeseforlife, and #cottagecheeserecipe. Sales of cottage cheese around the world have skyrocketed.
Let’s see why cottage cheese is having such a moment.
What is cottage cheese?
Cottage cheese is a fresh dairy cheese product with a mild flavour and a slightly tangy taste. It is made by curdling cow’s milk, then draining the whey, leaving behind the curds. These curds are usually small and lumpy, and the texture can vary from creamy to dry, depending on the amount of whey left in the cheese.
The term “cottage cheese” is said to have originated because the cheese was generally made in cottage-type houses from leftover milk, after making butter.
Cottage cheese is cheap, costing about A$12 per kilogram in the supermarket, similar to ricotta cheese.
It’s also surprisingly simple to make at home using freely available recipes. All you need is milk, salt and a splash of vinegar.
We’re using cottage cheese in new ways
It’s difficult to know what started the latest cottage cheese trend. But the creativity of social media means people are sharing alternative ways to use cottage cheese, changing people’s views from it being boring and lacking flavour to it being versatile and healthy.
People are spreading cottage cheese on toast and using it to make dishes such as porridge, dips, salads, bread and flatbreads. They’re using it in cakes and scones, and in desserts such as mousse and ice cream.
Is cottage cheese healthy?
Compared with other cheeses, cottage cheese is low in fat and therefore energy (kilojoules or kJ). This makes it a smart choice for people looking to cut down on their daily energy intake.
For example, 100 grams of cottage cheese contains about 556kJ. The same amount of cheddar contains 1,254kJ and parmesan 1,565kJ.
Many cheeses are rich in protein but they often contain higher amounts of kilojoules due to their fat content. But cottage cheese has substantial amounts of protein with fewer kilojoules.
This makes cottage cheese an ideal option for people aiming to maximise their protein intake without eating large amounts of kilojoules.
Some 100g of cottage cheese provides 17g protein. This is about the same found in three eggs, 60g chicken breast or 320 millilitres (about 300g) full-fat yoghurt.
Cottage cheese also contains high levels of vitamin B12 (important for healthy brain function), riboflavin (supports healthy skin and eyes), phosphorus (helps build strong bones and teeth) and folate (essential for cell growth).
However, cottage cheese is lower in calcium compared with other cheeses. It contains just 89 milligrams per 100g. This compares with parmesan (948mg), haloumi (620mg) and ricotta (170mg).
You’ve convinced me. How can I use cottage cheese?
Beyond its excellent nutrition profile, the resurgence of cottage cheese is enabling people to experiment in the kitchen. Its neutral flavour and varied textures – ranging from smooth to chunky – makes it suitable for a range of dishes, from sweet to savoury.
TikTok and Instagram have some great recipes. You could start with an old faithful recipe of celery and cottage cheese, and work your way towards new options such as cottage cheese ice cream.
The healthiest recipes will be those that combine cottage cheese with wholefoods such as fruits, vegetables, nuts and seeds, and lean protein sources.
For instance, you can make a cottage cheese wrap then fill it with vegetables and a lean source of protein (such as chicken or fish).
Other combinations include cottage cheese salad dressings, vegetable dips and egg salads.
Cottage cheese’s rise in popularity is well deserved. Including more cottage cheese in your diet is a smart choice for getting a high dose of protein without adding processed ingredients or too much energy. Embrace the trend and get creative in the kitchen.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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No, beetroot isn’t vegetable Viagra. But here’s what else it can do
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Beetroot has been in the news for all the wrong reasons. Supply issues in recent months have seen a shortage of tinned beetroot on Australian supermarket shelves. At one point, a tin was reportedly selling on eBay for more than A$65.
But as supplies increase, we turn our attention to beetroot’s apparent health benefits.
Is beetroot really vegetable Viagra, as UK TV doctor Michael Mosley suggests? What about beetroot’s other apparent health benefits – from reducing your blood pressure to improving your daily workout? Here’s what the science says.
What’s so special about beetroot?
Beetroot – alongside foods such as berries, nuts and leafy greens – is a “superfood”. It contains above-average levels per gram of certain vitamins and minerals.
Beetroot is particularly rich in vitamin B and C, minerals, fibre and antioxidants.
Most cooking methods don’t significantly alter its antioxidant levels. Pressure cooking does, however, lower levels of carotenoid (a type of antioxidant) compared to raw beetroot.
Processing into capsules, powders, chips or juice may affect beetroot’s ability to act as an antioxidant. However, this can vary between products, including between different brands of beetroot juice.
Is beetroot really vegetable Viagra?
The Romans are said to have used beetroot and its juice as an aphrodisiac.
But there’s limited scientific evidence to say beetroot improves your sex life. This does not mean it doesn’t. Rather, the vast number of scientific studies looking at the effect of beetroot have not measured libido or other aspects of sexual health.
How could it work?
When we eat beetroot, chemical reactions involving bacteria and enzymes transform the nitrate in beetroot into nitrite, then to nitric oxide. Nitric oxide helps dilate (widen) blood vessels, potentially improving circulation.
The richest sources of dietary nitric oxide that have been tested in clinical studies are beetroot, rocket and spinach.
Nitric oxide is also thought to support testosterone in its role in controlling blood flow before and during sex in men.
Beetroot’s ability to improve blood flow can benefit the circulatory system of the heart and blood vessels. This may positively impact sexual function, theoretically in men and women.
Therefore, it is reasonable to suggest there could be a modest link between beetroot and preparedness for sex, but don’t expect it to transform your sex life.
What else could it do?
Beetroot has received increasing attention over recent years due to its antioxidant and anti-tumour effect in humans.
Clinical trials have not verified all beetroot’s active ingredients and their effects. However, beetroot may be a potentially helpful treatment for various health issues related to oxidative stress and inflammation, such as cancer and diabetes. The idea is that you can take beetroot supplements or eat extra beetroot alongside your regular medicines (rather than replace them).
There is evidence beetroot juice can help lower systolic blood pressure (the first number in your blood pressure reading) by 2.73-4.81 mmHg (millimetres of mercury, the standard unit of measuring blood pressure) in people with high blood pressure. Some researchers say this reduction is comparable to the effects seen with certain medications and dietary interventions.
Other research finds even people without high blood pressure (but at risk of it) could benefit.
Beetroot may also improve athletic performance. Some studies show small benefits for endurance athletes (who run, swim or cycle long distances). These studies looked at various forms of the food, such as beetroot juice as well as beetroot-based supplements.
How to get more beetroot in your diet
There is scientific evidence to support positive impacts of consuming beetroot in whole, juice and supplement forms. So even if you can’t get hold of tinned beetroot, there are plenty of other ways you can get more beetroot into your diet. You can try:
- raw beetroot – grate raw beetroot and add it to salads or coleslaw, or slice beetroot to use as a crunchy topping for sandwiches or wraps
- cooked beetroot – roast beetroot with olive oil, salt and pepper for a flavour packed side dish. Alternatively, steam beetroot and serve it as a standalone dish or mixed into other dishes
- beetroot juice – make fresh beetroot juice using a juicer. You can combine it with other fruits and vegetables for added flavour. You can also blend raw or cooked beetroot with water and strain to make a juice
- smoothies – add beetroot to your favourite smoothie. It pairs well with fruits such as berries, apples and oranges
- soups – use beetroot in soups for both flavour and colour. Borscht is a classic beetroot soup, but you can also experiment with other recipes
- pickled beetroot – make pickled beetroot at home, or buy it from the supermarket. This can be a tasty addition to salads or sandwiches
- beetroot hummus – blend cooked beetroot into your homemade hummus for a vibrant and nutritious dip. You can also buy beetroot hummus from the supermarket
- grilled beetroot – slice beetroot and grill it for a smoky flavour
- beetroot chips – slice raw beetroot thinly, toss the slices with olive oil and your favourite seasonings, then bake or dehydrate them to make crispy beetroot chips
- cakes and baked goods – add grated beetroot to muffins, cakes, or brownies for a moist and colourful twist.
Are there any downsides?
Compared to the large number of studies on the beneficial effects of beetroot, there is very little evidence of negative side effects.
If you eat large amounts of beetroot, your urine may turn red or purple (called beeturia). But this is generally harmless.
There have been reports in some countries of beetroot-based dietary supplements contaminated with harmful substances, yet we have not seen this reported in Australia.
What’s the take-home message?
Beetroot may give some modest boost to sex for men and women, likely by helping your circulation. But it’s unlikely to transform your sex life or act as vegetable Viagra. We know there are many contributing factors to sexual wellbeing. Diet is only one.
For individually tailored support talk to your GP or an accredited practising dietitian.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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