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Back to #412 ‒ The evolving science of cancer: emerging approaches to prevention and early detection, and the advances reshaping treatment | Siddhartha Mukherjee, M.D., Ph.D., with Siddhartha Mukherjee.

Do Most Pancreatic Cancers Have a KRAS Mutation?

Siddhartha Mukherjee says most pancreatic cancers have KRAS mutations. Peter Attia asked whether that was so, and whether the mutation makes an antigen a CAR T cell could attack.

Mukherjee says not really. KRAS produces an antigen in some patients, but most of KRAS is hidden inside, so most of KRAS is not a CAR T target. He says KRAS is a target for small molecules that shut off its function, a lock and a key, and that this is not immunotherapy. A second path he describes is a CAR T cell against a unique pancreatic antigen, even if that removed the pancreas. He says that antigen has not been found. He says people can live without an endocrine pancreas, as in type 1 diabetes, and that patients live after a Whipple removes enough of the organ.

Transcript

#412 ‒ The evolving science of cancer: emerging approaches to prevention and early detection, and the advances reshaping treatment | Siddhartha Mukherjee, M.D., Ph.D. ·

The Peter Attia Drive

More from this episode

  1. Why Is There No Cholesterol Test for Cancer?Siddhartha Mukherjee says medicine has no simple screening biomarker for cancer the way blood pressure and cholesterol work for heart disease: hypertension…
  2. Should Everyone Get a Blood Test for Cancer?Siddhartha Mukherjee says blood tests that can find some cancers early are probably not going to work if they are used on everyone, with no selection for…
  3. Does Immune Therapy Help Smokers With Lung Cancer?Siddhartha Mukherjee says immune therapy is now known to extend the lifespan of smokers with lung cancer if it is given to the right population of people.
  4. What Percent of Cancer Mutations Are Random?Peter Attia says about two-thirds of cancer mutations, 66-ish percent, are purely random.
  5. How Much Does BRCA1 Raise Breast Cancer Risk?Siddhartha Mukherjee says a BRCA1 mutation is a shove mutation: it puts a person at a ninefold or tenfold risk, above the normal population, of hereditary…
  6. What Are Cancer Sleeper Cells?Siddhartha Mukherjee calls dormant cells that already carry cancer mutations sleeper cells. A person can have them and still not have cancer.
  7. Does High Insulin Make Cancer Resist Treatment?Siddhartha Mukherjee says chronic insulinemic tone has the capacity to make cancers grow and to leave them resistant to some forms of therapy.
  8. Is Osteoarthritis an Obesity Disease?Siddhartha Mukherjee says he has never believed osteoarthritis is an obesity disease.
  9. Why Can't T Cells Finish Off Cancer?Peter Attia says T cells rarely mount a response strong enough to finish the job on their own, even when they already know a lethal tumor is not self.
  10. Why Do Immune Cells Leave Cancer Alone?Siddhartha Mukherjee says immune cells leave cancer alone because the cancer cells that survive display dozens of surface flags telling T cells and B cells…
  11. What Does the Thymus Have to Do With Cancer?Siddhartha Mukherjee says a talk from someone at Harvard used AI to read CAT scans and found one correlate of disease: whether the thymus was still there.
  12. How Does CAR T Cell Therapy Work?Siddhartha Mukherjee says a CAR T cell is made by taking cells from the body, using a virus to insert a gene, growing those T cells, and putting them back so…
  13. Can a Person Live Without B Cells?Siddhartha Mukherjee says human beings can live with their B cells killed.
  14. Can Surgery Cure Cancer in the Tail of the Pancreas?Siddhartha Mukherjee says surgery can cure some pancreatic cancers that start in the tail.
  15. Why Does a Lower Tumor Burden Improve Cancer Treatment?Siddhartha Mukherjee says a lower tumor burden raises the chance treatment works because fewer cancer cells are left that can resist the therapy.
  16. Why Is Colorectal Cancer Going Up?Siddhartha Mukherjee says he does not know why colorectal cancer is going up.
  17. Will There Be a Drug That Prevents Cancer?Siddhartha Mukherjee says yes, there will be chemoprevention. Asked where the gains that save lives will come from, he says the answer is always prevention.
  18. Do People Over 110 Die of Cancer?Siddhartha Mukherjee says people more than 110 years old do not die of cancer. They die of regenerative failure. Skin stops regenerating and falls off.
  19. What Is Dream Time Before Writing a Book?Siddhartha Mukherjee calls the first part of writing a book dream time.

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