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Tuesday, March 28, 2023

Hello Health Rounds readers! Surgeons often remove cancer patients' lymph nodes to see if the disease has spread beyond the tumor, but modern cancer drugs that work by boosting immune responses might work even better if lymph nodes are left in place, new research shows. We also highlight a study that suggests claims of cognitive benefits from exercise might have been exaggerated; and a U.S. study that found widely used drugs to prevent heart attacks and strokes are least likely to be prescribed to Black and Hispanic patients.

In breaking news, see these stories from our Reuters journalists: Novartis drug Kisqali cuts risk of recurrence in women with early-stage breast cancer; experimental obesity drug from Viking Therapeutics Inc shows promise in early study; and BioNTech plans to spend US$1 bln on research in 2023.

Regular exercise has plenty of benefits, but sharper thinking skills might not be one of them, a new analysis found. REUTERS/ Heo Ran.

The effectiveness of cancer immunotherapy drugs might be improved if administered before a patient's lymph nodes are removed, new research suggests.

Lymph nodes near a tumor are typically removed during surgery to determine whether cancer cells have spread to them, but the nodes contain tumor-fighting cells that could be activated by immunotherapy drugs, according to a report published in Cell.

The most commonly used cancer immunotherapy drugs, known as immune checkpoint inhibitors, work by defeating defenses cancer uses to evade the immune response, allowing the drugs to reinvigorate "exhausted" responses of immune cells called T cells that recognize and kill cancer cells.

The drugs - such as Merck & Co's Keytruda, Opdivo and Yervoy from Bristol Meyers Squibb and Roche's Tecentriq - were thought to primarily impact T cells inside the tumor. But new research in mice and a small trial in humans shows the treatments also boost effectiveness of T cells stored in lymph nodes near the site of the cancer.

A preoperative course of immunotherapy drugs "could allow the responsive immune cells to become activated and enter the bloodstream before the lymph nodes are removed," said study leader Matthew Spitzer of the Gladstone-UCSF Institute for Genomic Immunology in San Francisco.

"Removing lymph nodes with metastatic cancer cells is probably still important, but taking them out before immunotherapy treatment may be throwing the baby out with the bathwater," he said.

Spitzer said the new findings may help explain studies that showed patients have a higher likelihood of benefiting from immunotherapy if given before surgery.

"This study focused on patients with head and neck cancer, but we hypothesize that the findings will also be consistent in other kinds of cancer, which is something we are currently evaluating," he added.

Funders of the research include Roche's U.S. biotech unit Genentech and the U.S. National Institutes of Health.

Read more about cancer immunotherapies on Reuters.com

• AstraZeneca's Imfinzi improves survival in late-stage lung cancer

• Incyte Corp's Zynyz approved for rare, aggressive skin cancer

• Merck's Keytruda fails against prostate cancer

Regular physical exercise has many health benefits, but sharper thinking skills probably isn't one of them, researchers reported on Monday in Nature Human Behavior.

Previously reported effects of exercise on cognitive function may have been exaggerated, they said.

The researchers re-analyzed data from 24 earlier studies that had in turn pooled data from more than 100 randomized controlled trials involving a total of more than 11,000 participants.

After accounting for differences between those assigned to exercise programs or to control groups, they found that what appeared to be small beneficial effects of exercise on cognition were no longer statistically significant.

The findings do not rule out the possibility that exercise may have benefits for cognition in healthy people, but there is limited evidence to suggest that it does, the researchers said.

Still, they added, the well-documented physical and social benefits of regular exercise are more than enough to justify public-health policies promoting it in daily life.

Use of statins for preventing a first stroke or heart problem due to clogged blood vessels is low across the board among at-risk U.S. adults but lowest in Blacks and Hispanics, survey results show.

In a nationally representative sample of people with risk factors such as smoking, high blood pressure and obesity, statin use was reported by 29.9% of whites, 15.4% of Hispanics and 20.0% of Blacks, researchers found.

In the highest-risk participants - those with a 20% or higher risk of a cardiovascular event during the next 10 years - statins were being used by 37.6% of whites, 23.9% of Hispanics, and 23.8% of Blacks, according to a report in JAMA Cardiology.

Use of statins by people of Asian descent was similar to that of whites, the authors said.

The researchers reviewed data collected between 2013 and 2020 from 3,417 participants in the National Health and Nutrition Examination Survey.

Statins taken for high cholesterol, such as Lipitor and Crestor and generics, are among the world's most widely prescribed drugs.

Reasons for the disparities likely include structural and interpersonal racism impacting healthcare system biases, neighborhood deprivation and pharmacy access, and insurance access and drug costs, said study leader Joshua Jacobs of the University of Utah School of Medicine in Salt Lake City.

"Also, trust (of healthcare and pharmaceuticals) may be playing a large role given the historical atrocities in medical research experienced by people of color," Jacobs added.

"Patients at high risk for cardiovascular disease - especially Black and Hispanic adults – should talk to their health care providers about the potential for statin use," Jacobs said.

Read more about health disparities on Reuters.com

• "Good" cholesterol a less reliable risk marker in Black patients
• Wanted: an oxygen monitor reliable for all races
• Kidney dialysis-related infection rates higher in U.S. minorities

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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