<p><a href="https://peterattiamd.com/maxdiehn/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220711-pod-maxdiehn&utm_content=220711-pod-maxdiehn-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220711-pod-maxdiehn&utm_content=220711-pod-maxdiehn-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=2220711-pod-maxdiehn&utm_content=220711-pod-maxdiehn-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Max Diehn is a Professor of Radiation Oncology at Stanford and a clinical radiation oncologist specializing in lung cancer. Max's research focuses on developing novel methods for detecting circulating tumor DNA in the blood of cancer patients and on elucidating the molecular pathways and genes associated with cancer. His interests also include uncovering biomarkers that can predict patient survival, responses to therapy, and disease recurrence. In this packed episode, Max discusses the history of blood-based cancer screening and the importance of understanding the predictive value of tests—sensitivity, specificity, negative predictive value, positive predictive value – and how these metrics play into cancer screening. Max then goes in depth on the topic of liquid biopsies, including the history, current landscape, and possible future of liquid biopsies as a cancer detection tool. He discusses how these non-invasive blood tests can detect DNA/RNA from tumor cells released into the blood as well as the different methods one can use to predict if a cancer is present. He gets granular on the topic of cell-free DNA/RNA signature, methylation patterns, and the importance of knowing mutation information, and he ends with a discussion on the exciting future of liquid biopsies and how we can possibly get to the panacea of cancer screening.</p> <p>We discuss:</p> <ul type="disc"> <li>Max's training that planted the seeds for development of liquid biopsies [4:30];</li> <li>Max's decision to specialize in radiation oncology [11:45];</li> <li>A culture at Stanford that values research and physician scientists [17:00];</li> <li>The motivation to develop liquid biopsies [19:15];</li> <li>History of blood-based cancer screening and understanding the predictive value of tests [25:30];</li> <li>Current state of lung cancer and the need for better screening [32:45];</li> <li>Low-dose CT scans: an important tool for managing lung cancer but with limitations [42:00];</li> <li>Using liquid biopsies to identify circulating tumor cells [47:00];</li> <li>Liquid biopsy research moves from circulating tumor cells to cell-free DNA [1:03:00];</li> <li>Zeroing-in on circulating tumor DNA in cell-free DNA [1:10:48];</li> <li>Cell-free RNA and Max's vision for cancer detection from a blood sample [1:22:00];</li> <li>Methylation patterns and other informative signatures found in DNA [1:24:30];</li> <li>Mutation-based methods of liquid biopsies [1:26:30];</li> <li>Understanding the sensitivity and specificity of a diagnostic test [1:30:30];</li> <li>Existing clinical liquid biopsy tests and their limitations [1:37:30];</li> <li>The future of liquid biopsies [1:44:00];</li> <li>How we get to the panacea of cancer screening [1:52:00];</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Understand Diagnostic Test Interpretation
Learn sensitivity, specificity, prevalence, positive predictive value (PPV), and negative predictive value (NPV) to accurately interpret diagnostic test results, especially for cancer screening. Utilize available calculators or apps to plug in these values and understand how they influence a test’s utility.
2. Prioritize Early Cancer Detection
Recognize that earlier cancer detection, which leads to lower tumor burden and reduced genetic heterogeneity, consistently results in better patient outcomes and increased chances of successful treatment. This fundamental principle underscores the critical importance of catching cancer as early as possible.
3. Demand Rigorous Screening Test Trials
Advocate for and support large, randomized clinical trials that prove new cancer screening tests, such as liquid biopsies, decrease cancer-specific mortality before widespread adoption. This ensures that new technologies genuinely save lives and do not merely add healthcare costs or patient anxiety.
4. Guide Adjuvant Therapy with Liquid Biopsies
If you are an early-stage cancer patient who has completed initial treatment (surgery/radiation), discuss with your doctor the option of using highly sensitive liquid biopsies to detect minimal residual disease (MRD). A positive MRD test may guide the use of adjuvant therapies like immunotherapy, aiming to cure microscopic cancer cells before they become clinically detectable.
5. Avoid Overtreatment via Repeat Testing
Explore the potential for serial liquid biopsy testing in patients at risk of recurrence to guide adjuvant therapy decisions. This approach could help avoid unnecessary treatment and its associated toxicities in patients who are genuinely cured, by only initiating therapy when a positive signal of residual cancer is detected.
6. Evaluate New Screening Tests Critically
When new cancer screening tests are introduced, compare their sensitivity and specificity against existing, proven screening methods. If a new test is not as good as established ones, carefully consider its utility, focusing on practical advantages like increased access or convenience rather than assuming superiority based on novelty.
7. Be Aware of Lung Cancer Risk
Understand that lung cancer is the number one cause of cancer death for both men and women, and 15% of those who die from it have never smoked. This awareness is crucial as anyone with lungs can develop the disease due to various risk factors beyond smoking.
8. Follow Data in Scientific Research
As a scientist, prioritize following the objective data generated by experiments, allowing it to guide your research direction rather than rigidly adhering to a preconceived area of focus. This adaptive approach can lead to unexpected and significant discoveries.
9. Ground Research in Clinical Needs
For physician-scientists, initiate research projects by identifying unmet clinical needs or suboptimal practices in patient care. This ensures that scientific endeavors are directly relevant and potentially impactful for improving diagnostic or treatment outcomes.
10. Leverage Startup Funds for Research
For new faculty members or researchers, strategically use initial startup funds provided by your department or university to pursue high-risk, potentially transformative research projects. This funding can kickstart work that may not yet qualify for traditional grant funding.
11. Recognize Research Reproducibility Challenges
Be aware that scientific findings, particularly in early-stage diagnostic development, may not always be easily reproducible or as effective as initially reported. When evaluating scientific literature, seek corroboration from multiple independent studies using diverse methods to identify robust findings.
12. Deepen Knowledge with Podcast Membership
If you enjoy the podcast and wish to expand your understanding of health and wellness, consider joining the membership program for more in-depth content, comprehensive show notes, and exclusive episodes. Visit peteratiyahmd.com/subscribe for details.
13. Seek Professional Medical Advice
Always seek professional medical advice, diagnosis, or treatment from your healthcare professionals for any medical conditions. Do not disregard or delay obtaining medical advice based on information from this podcast or other general sources.