TIME Cancer

The Cancer Breakthrough With Big Implications

STEVE GSCHMEISSNER—Getty Images/Science Photo Library RM Lung cancer cell

Screening tumors could lead to smarter decisions about which cancer treatments will work best for individual patients

Once you’ve been diagnosed with cancer, you’re sent for a dizzying array of tests — but most of them are focused on you, as the living host of the tumors, and not on the malignant growths themselves.

That may soon change, as researchers report in the journal Science. Some cancer centers already take biopsies of tumors and run them through genetic tests, to get a better sense of what’s driving the cancer. That information can be helpful in deciding which of the growing number of targeted anti-cancer drugs will work best to stop those growths.

MORE: Promising New Cancer Treatment Uses Immune Cells

But the down side of these powerful drugs is that tumors become resistant to them relatively quickly, often within a year or two. So to find better ways of stopping such resistance from developing, Jeffrey Engelman and his co-senior author Cyril Benes from Massachusetts General Hospital took tumor testing one step further. They actually allowed some of those tumor cells — from lung cancers — to grow in a lab dish. That made it possible to throw various anti-cancer drugs at them to see how the cancer cells responded — providing a valuable window into how the tumors inside the body might react.

They found, not surprisingly, that hitting tumors with combinations of targeted drugs could effectively shut down the cancer cells’ ability to resist the treatment. When they transplanted the human tumors into mice, those given the combination of drugs saw their growths shrink, and the drugs remained active nearly twice as long as the single drug in suppressing tumor growth. The findings could help doctors to tailor cancer treatments specifically to individual patients and help them to avoid drug resistance and ultimately improve their chances of surviving their cancer.

MORE: Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

“It’s a substantial step,” says Engelman of the results. “Because before we just had the genetic information but we wouldn’t have the cells alive so that we could test what types of therapies might work.”

He and Benes stress that they haven’t used their screening method yet to guide any patient treatment decisions, but hope that will happen soon. They’re encouraged by the fact that their method identified several mutations that might be driving cancer that hadn’t been known before, thus opening up the number of drugs that target these abnormalities that patients could take.

“Sometimes there are genetic mutations in genes that we can’t target [with a drug]. Sometimes there is ambiguity in genetics — we know the mutations but we don’t know what they mean, or there are multiple mutations together and we don’t know how to treat them. And sometimes we don’t know what mutations are driving the cancer,” says Engelman. But by testing the actual tumor cells against well known drugs or drug combinations, researchers wouldn’t have to know the answers to all of these questions. Instead they could cut straight to the arguable most important outcome — finding the best drugs for treating a particular patient’s cancer. Ultimately, the researchers see such drug screening as going hand in hand with genetic screening – the gene tests would identify the known mutations, and that would inform which drugs to test tumor cells against.

Before that happens, Engleman and Benes admit that more refinements need to be made in their process. Now, it takes two to six months to grow the tumor cells properly in order to be screened by the drugs. That time needs to be shrunk to a weeks or even days if doctors and patients can take advantage of the information. But they’re confident that will happen. “We know ways to cut this shorter,” says Engelman. “What’s exciting is that this technology make you think you have a real shot at getting there. And we’re going to take that shot.”

TIME ebola

Ebola Treatment Trials to Start in December

The international humanitarian aid group Doctors Without Borders will start testing three new Ebola therapies at their sites in Africa in December

The health group Doctors Without Borders said Thursday that it will begin testing three therapies it hopes will prove effective in treating Ebola, as the death toll from the disease’s worst outbreak ever surpassed 5,000 and with and with more than 14,000 still affected in West Africa.

The group, which is leading the on-the-ground care of Ebola patients in Guinea, Liberia and Sierra Leone, is partnering with researchers and clinicians who want to learn more about the most promising treatments for Ebola, so that their doctors can provide patients more than the supportive care they deliver now.

MORE: We’re getting closer to vaccines and drugs for Ebola

“We are on the front line, and when you have a disease that kills 50% to 70% of patients, then we have a certain responsibility to try to do our best to host trials for treatments in our facilities,” says Bertrand Draguez, medical director of Doctors Without Borders.

None of the therapies have been tested in the traditional way of moving through all stages of animal models and then into safety and efficacy trials in people. Instead, they are jumping from animal trials and early human safety studies in healthy people directly into patients. But given the urgency of the escalating epidemic, Draguez says, “the worst case scenario would be to not test anything.”

MORE: How Guinea found the vest way to survive Ebola

One trial, spearheaded by the French National Institute of Health and Medical Research (INSERM) will see how well the antiviral drug favipiravir fares against Ebola in Gueckedou, Guinea. Another, headed by the Wellcome Trust, will test the antiviral drug brincidofovir at one of Doctors Without Borders’ treatment centers in the region that hasn’t been designated yet. Finally, the Antwerp Institute of Tropical Medicine will look at the effects of whole blood and plasma from Ebola survivors at the Ebola treatment center in Conakry, Guinea.

Why these three therapies? Draguez says they rose to the top of the list because of a combination of their promise in controlling the Ebola virus and their availability. Other treatments, such as ZMapp, a combination of antibodies that helped at least two U.S. aid workers survive their infections, are worth studying but won’t be available in enough doses to properly test in West Africa. “We said ‘OK, even if a drug looks promising we have to start with what we have,’” says Draguez. Both brincidofovir and favipiravir also have the added advantage of being oral pills and therefore more easily given to and taken by patients, many of whom are too weak to eat.

MORE: Here’s what scientists know about Ebola in Sierra Leone

Patients at the trial sites will be asked if they want to participate in testing new, experimental therapies for treating Ebola, and will be given detailed information about the drugs and their potential risks. Any patient can refuse to participate, and his care will not be affected by his decision.

The trails will focus on how well they help patients to survive for 14 days after the therapies start—enough time, the researchers hope, to suppress Ebola’s activity and encourage the patients’ own immune systems to fight the infection and begin to clear the virus.

MORE: WHO chief says Ebola response ‘did not match’ scale of the outbreak

The trials represent an important first step in gathering critical information about how best to treat Ebola infection. To date, such data is sparse—most of the information comes from case studies, and those primarily involved supportive care such as hydration and nutrition, which are important for patients in the early stages of infection, but can’t help those who are sicker. The handful of cases involving some of the experimental therapies aren’t enough to guide doctors on proper dosing, nor are they sufficient to give physicians confidence that they aren’t doing more harm than good when they use them.

The World Health Organization (WHO) and the countries’ Ministries of Health are also working with Doctors Without Borders and the study leaders to conduct the trials. WHO also recently announced plans to test two vaccines in West Africa as well.

All of these trials are designed to finally provide some order in the house of Ebola treatments. While the goal is to turn the results around quickly—the first data are expected in February 2015—it’s possible that much of what is learned from these trials may come too late for those currently infected. But they will prove invaluable for the inevitable outbreaks that emerge in the future.

MORE: See How Ebola Drugs Grow In Tobacco Leaves

TIME Diet/Nutrition

Which Fad Diet Is Best for Weight Loss?

Researchers combed through all the available data on these popular diets and compared them head-to-head on weight loss and how well they lowered risk of heart disease

If you’re going to go on a diet, you might as well pick one that meets the most basic criteria of actually working. But proving a diet can deliver weight loss over the long term requires reliable data—and lots of it. That’s what Dr. Mark Eisenberg, professor of medicine at McGill University, and his colleagues went looking for. They scoured existing research about Atkins, South Beach, Weight Watchers and the Zone diets to find out which was most effective and which had the most scientifically rigorous proof to back up its weight-loss claims, especially over the long term. Their results were published Tuesday in the journal Circulation: Cardiovascular Quality and Outcomes.

Each year, north Americans spend more than $66 billion on these and other diets in an effort to shed pounds and keep them off. But when the scientists culled they data on these diets, they could find only 12 studies that met criteria for being scientifically sound and well designed. “What is incredible to me is that dieting is a multibillion-dollar industry, and if we look at the amount of data out there, it’s miniscule in comparison to the market,” he says. “There are very few well-done studies, and most of them look at the short term. And weight loss is obviously a long term issue.”

To qualify as well-done, studies had to involve enough people to produce statistically significant results, have a control group that wasn’t put on a diet but simply educated about good nutrition and the importance of exercise, and follow individuals for more than a year to see if the results held. “In heart-health studies, they involve thousands, and tens of thousands of people. With [diet] studies we’re talking about hundreds at the most,” says Eisenberg.

The 12 strong studies revealed that none of the four diet plans led to dramatic weight loss, and none was significantly better than the others when it came to keeping weight off for a year or more. All were effective in helping dieters to shed about the same number of pounds in the short term: around 5% of their starting body weight. Weight Watchers was more effective than average care in dropping weight, but head-to-head comparisons showed that at one year, Atkins, Weight Watchers and Zone resulted in similar weight loss on average, and that after two years, some of the lost weight was regained by people who followed Atkins or Weight Watchers.

The diets also did not result in differences in heart-disease risk factors, such as high cholesterol, high blood pressure or blood sugar levels. “We couldn’t find big differences between the different diets,” says Eisenberg.

MORE: 14 Fad Diets You Shouldn’t Try

Some of the studies he and his team reviewed included information on how much the dieters were exercising, but others did not. It’s possible that some people who change their eating habits to lose weight may also start exercising, which can contribute to weight loss—suggesting the diet alone may not be responsible for the dropped pounds.

He says that these results shouldn’t discourage dieters who need to lose weight, and suggests that since the diets produce similar results, people should find the one that’s most suited to the way they live and therefore are more likely to stick with. Weight Watchers, for example, involves a more group-based, behavior-modification approach that may be better for people who work well in groups and need some external motivation, while the other three are more centered around individuals and dependent on their own ability to stay with a program over several months. Atkins and South Beach and Zone all focus on lowering carbohydrates and increasing consumption of healthy fats and proteins.

MORE: Americans’ Diets Are Improving (Sort Of)

Given the enormous amount of money spent on diets—and the rates of obesity and type-2 diabetes in the U.S. and Canada—Eisenberg says what’s really needed is more information that can help people to make better choices about which plan is right for them, and to improve their chances of losing weight, not just for a few months but for the long term.

Read next: How to Get in Shape Using Psychology: 6 New Tricks From Research

TIME ebola

Ebola Patient in New York Is Cured and Released From Hospital

Physician who worked in Guinea urged public to refocus attention on West Africa

Craig Spencer, the physician who became the fourth person diagnosed with Ebola in the U.S., was released Tuesday after being deemed free of the virus.

“Today I am healthy and no longer infectious,” he said at a news conference.

Spencer was treated at Bellevue Hospital in New York City for just under three weeks. It’s not clear exactly what therapies Spencer received, although officials said he received “innovative, state of the art treatments” that were learned from other facilities that have successfully treated Ebola patients in the U.S., including Emory University, the University of Nebraska and the National Institutes of Health. Both Spencer and the medical staff at Bellevue, however, did also mention the importance of the supportive care he got, including hydration and nutrition fluids.

“My early detection, reporting and recovery from Ebola infection speak to the effectiveness of the protocols in place for health staffers returning from West Africa,” he said. “I am a living example of how those protocols work. Early detection is critical for both surviving Ebola and ensuring that it is not transmitted to others.”

With his parents in attendance, and surrounded by the doctors, nurses and lab technicians who contributed to his care, Spencer thanked the staff at Bellevue. New York Mayor Bill de Blasio mentioned that staffers had delivered Spencer’s banjo to him as well to help him pass the time.

Spencer, however, was eager to turn the conversation back to West Africa, where he spent five weeks in Guinea, one of the three hardest-hit nations in the outbreak that has killed some 5,000 people. “I cried as I held children who were not strong enough to survive the virus,” he said. Within weeks of his own diagnosis, he received calls on his personal cell phone from many of the patients he had cured who wanted to wish him well and offer any help he might need.

“Please join me in turning the attention back to West Africa, to ensure that medical workers and volunteers do not face stigma upon returning home,” he added. “Volunteers need our support in order to fight the outbreak at its source.”

Sophie Delaunay, executive director of Medecins Sas Frontiers (Doctors Without Borders)-USA, the group for which Spencer was working when he was infected in Guinea, echoed that message. “We could not be more proud of Craig,” she said at the news conference. “He and others [who volunteer to work in west Africa] are to be respected and honored. They protect us all. As they tirelessly care for the sick and try to stop this outbreak, it is imperative that our focus remains squarely on west Africa, the source of the Ebola epidemic. Stopping it there protects us here.”

Spencer’s fiancée, one of the four people who had direct contact with him before he was placed in isolation, remains in quarantine out of an abundance of caution as she monitors her temperature for any potential signs of Ebola. Her quarantine is expected to be lifted on Nov. 14.

TIME Brain

New Hope for Replacing Nerves Damaged by Parkinson’s Disease

Stem cells may provide a new way of regrowing the motor neurons affected by the movement disorder

Reporting in the journal Cell Stem Cell, scientists say that stem cells turned into motor nerves function nearly identically to fetal motor nerves: the kind now used to treat some patients with Parkinson’s disease. That could mean that the stem cells may become an important source of new nerves to replace the ones damaged in diseases like Parkinson’s.

In Parkinson’s, motor nerves that normally produce dopamine, which is critical for regulating muscle movements and controlling dexterity, are damaged, and dopamine levels drop dramatically. The researchers, led by Malin Parmar, an associate professor of regenerative neurobiology at Lund University, took human embryonic stem cells extracted from excess IVF embryos and treated them to develop into motor neurons. They transplanted these neurons into the brains of rats bred to develop Parkinson’s and found that the lab-made cells brought dopamine levels in these animals back to normal levels in five months. The nerves sent out long extensions to connect with other nerve cells in the brain—such networks are important to ensuring coordinated and regulated muscle movements, and without them, patients experience uncontrollable tremors. The effects were similar to those seen when fetal nerves are transplanted into Parkinson’s patients, a treatment currently used to help alleviate symptoms in some patients.

While the results are exciting, it’s just the first step in bringing stem cell-based treatments to human patients. The study did not delve into how well the new neurons functioned and whether they could reverse symptoms of Parkinson’s in the animals. And even if they do improve those symptoms, scientists still have to show that humans could get the same effects. In an editorial accompany the article, Roger Barker of Addenbrooke’s Hospital and the University of Cambridge warned that the exciting possibilities of stem-cell based therapies shouldn’t push scientists—or patients—to expect too much too soon. Before the cells can be tested in people, he writes, it’s necessary to have “a knowledge of what the final product should look like and the need to get there in a collaborative way without being tempted to take shortcuts, because a premature clinical trial could impact negatively on the whole field of regenerative medicine.”


It May Be Possible To Prevent HIV Even Without a Vaccine

"We're removing the doorway that HIV uses to get into cells"

Natural immunity is the most reliable way to protect yourself from viruses, bacteria and parasites. And the best way to acquire such immunity, in most cases, is to expose your immune system to the bug in question—either by getting infected or getting immunized.

Until now, such protection was only possible with diseases like chicken pox or polio. But now, scientists at Harvard University say that people might soon arm themselves against HIV in a similar way, but through a different method.

Chad Cowan and Derrick Rossi, both in the department of stem cell and regenerative biology at Harvard University, and their colleagues report in the journal Cell Stem Cell that they have successfully edited the genomes of blood cells to make them impervious to HIV. In order survive, HIV needs to insert its genome into that of a healthy cell, and to infect these cells, HIV latches onto a protein on their surface called CCR5. If CCR5 is mutated, however, it’s as if the locks have been changed and HIV no longer has the right key; it can’t attach itself and the cells are protected from infection. So the scientists tried a new gene editing technique called CRISPR that allows them to precisely snip out parts of a cell’s genome, and they spliced out the CCR5 gene. To their surprise, the technique was relatively efficient, transforming about half of the cells they treated with CRISPR into CCR5-free, or HIV-resistant, cells.

“It was stunning to us how efficient CRISPR was in doing the genome editing,” says Cowan.

Scientists have previously used CRISPR to make another change in how HIV infects cells; they snipped out the HIV genes that the virus inserted into healthy cells. That process essentially returned HIV infected cells back to healthy ones.

The latest results, however, suggest that the technique may be useful even before HIV gets inside cells. CRISPR could be useful in treating HIV patients if it can replace patients’ own immune cells with the blockaded versions. The cells Cowan and Rossi used were blood stem cells, which give rise to the body’s entire blood and immune system. In order to work as a potential treatment for HIV, patients would provide a sample of blood stem cells from their bone marrow, which would be treated with CRISPR to remove the CCR5 gene, and these cells would be transplanted back to the patient. Since the bone marrow stem cells populate the entire blood and immune system, the patient would eventually have blood cells that were protected, or “immunized,” against HIV. “We’re removing the doorway that HIV uses to get into cells,” says Cowan.

To test this idea, they are already working with another research group to see if the HIV-impervious cells can treat mice infected with HIV.

Because healthy cells would be barricaded from HIV, the process might also lead to a cure for the disease. While the results are currently being tested to treat animals already infected with HIV, it may also be possible to one day transform a person’s immune cell genomes to be protected against the virus. Some people are already fortunate enough to be protected this way—a small percentage of people of European ancestry have natural immunity against HIV because they have two copies of mutated CCR5. They have been well studied and so far, their CCR5 aberrations don’t seem to be linked to any known health issues. “They are totally normal except for the fact that they are resistant to HIV,” says Cowan. “That’s a heartening thing: to have a group of people who are alive today who have been studied and looked at and seem totally fine.”

That’s why clinicians who research the virus and treat HIV patients are excited by the possibilities of CRISPR-aided strategies. If it’s possible to close the door on HIV, then it may be realistic to start thinking about closing the door on the AIDS epidemic in the near future.

Read next: How Meditation May Help People With HIV

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TIME ebola

How Guinea Found the Best Way to Survive Ebola

Seyllou—AFP/Getty Images A medical staff worker of the 'Doctors without Borders' medical aid organization at a center for victims of the Ebola virus in Guekedou, Guinea on April 1, 2014.

As the world waits for new treatments and a vaccine, doctors in Guinea have found the best way to help patients survive Ebola

With the number of cases topping 13,000 and deaths climbing close to 5,000, the current outbreak of Ebola in West Africa is the virus’s worst yet. But from the tragic illness and mortality emerge some important lessons from the region.

The latest, published in the New England Journal of Medicine, details the cases that first appeared in Guinea’s capital city of Conakry between March and April. Unlike in other parts of the region, where the mortality rate from Ebola averages around 60% to 70%, in Conakry it has remained around 43%.

MORE: Here’s What Scientists Know About Ebola in Sierra Leone

Why? As Dr. Robert Fowler, a clinician in pandemic and epidemic diseases with the World Health Organization (WHO) and physician at the University of Toronto, explains, Guinea’s first Ebola treatment center, established in the capital, took a very aggressive approach to handling patients. Working with the humanitarian aid group Medecins Sans Frontieres (MSF) or Doctors Without Borders, the WHO and the country’s Ministry of Health set up a facility where Ebola patients were immediately hooked up to IV fluids and treated for dehydration—often a complication of infection. They were also monitored regularly for changes in their blood chemicals, including the electrolytes that are a marker for whether the body’s cells are getting enough water and nutrients to function. While routine blood work is standard practice at every hospital in developed nations, such testing wasn’t at Conakry health facilities.

“At the beginning of the outbreak, there was no [Ebola] treatment center,” says Fowler. “It evolved from an old cholera treatment facility and the evolution of care went from having no beds to having IVs, IV fluids, antibiotics and antimalarial [drugs]. We were only able to do hand-held point-of-care testing [of blood samples] but that was quite novel for treatment centers anywhere in the outbreak, even though that’s expected and routine almost everywhere else in the world.”

MORE: This Map Will Show You Every Ebola Outbreak in History

The key to helping Ebola patients survive their infection, Fowler and his colleagues saw, was hydrating them with IV fluids, ensuring that their blood work remained stable and addressing any changes in their metabolites as quickly as possible. In the first month of Ebola cases, 37 patients tested positive for the virus, 28 were treated with IV fluids and 16 died. While the death rate remained high, it was lower than that typically seen in other parts of West Africa.

“Our hypothesis has always been that we wanted to establish a culture of very aggressive supportive care for patients who were coming in dehydrated with electrolyte and metabolic abnormalities and try to correct those very early on, so the complications of very severe depletion don’t compound the effects of Ebola virus infection,” Fowler says.

MORE: Why Cuba Is So Good at Fighting Ebola

Fowler is convinced that the key to improving Ebola survival rates is to think about it differently. Instead of thinking of Ebola as an almost-always fatal disease, see it instead as one that is survivable with the right treatments, he says. If people understood that survival is possible—and at higher rates than previously thought—then more people who might be exposed or infected would seek care sooner rather than later, when it’s too late. “I truly do think we can change the way people think about this illness if we evolve the thinking from needing to have isolation facilities…to saying we need rapidly mobilized treatment facilities that can help care for patients with aggressive supportive care as early as possible,” he says.

Even with the dozens of patients he and his team saw at the treatment facility in Conakry, “we just weren’t keeping up with their fluid needs as much as we needed to,” he says. “Collectively as a team, we were thinking we were failing miserably in terms of our goal of delivering optimal care.”

To succeed takes an enormous amount of resources, labor and personnel. Health workers need to routinely draw and measure patients’ blood to track any slight negative changes in their physical state. Fowler acknowledges the need for drug treatments and an effective vaccine, but for now, as thousands of patients struggle to fight off the virus, “we really, really need more health care workers so we can spend enough time with patients and deliver the kind of supportive care that will improve their outcomes,” he says.

MORE: Nurse Explains Why She Fought Ebola Quarantine

Fowler admits the challenges facing recruitment. For starters, working with Ebola patients requires health care personnel to suit up in personal protective equipment that leaves no skin exposed, making them uncomfortable in the equatorial heat of the region. “We are nowhere near hitting the mark that needs to be hit to improve outcomes,” he says. But as data like his starts to build, best practices and the most effective ways to treat Ebola patients are emerging. And hopefully they will start to make a difference.

TIME Developmental Disorders

ADHD Linked to the Air Pregnant Women Breathe

Alan Hicks—Getty Images Heavy traffic can pollute the air with compounds that can contribute to ADHD

Everything an expectant mother does can have an impact on her baby’s development—including the air she breathes

Research has long connected what a mom-to-be eats and drinks to the health of her baby, and recent studies have even linked behavioral experiences such as stress, sleep and mood to the growing fetus’s development.

Now, scientists reporting in the journal PLOS ONE have pinpointed one exposure that could contribute to a baby’s higher risk of developing attention deficit hyperactivity disorders (ADHD), which the latest data from the Centers for Disease Control show affects around 11% of children aged four to 17 years.

MORE: Early Exposure to Air Pollution Tied to Higher Risk of Hyperactivity in Children

Frederica Perera, director of the center for environmental health sciences at the Mailman School of Public Health at Columbia University, and her colleagues focused in on how the pollutants in the air that pregnant women breathe can affect their babies’ cognitive development. Perera previously found a correlation between polycyclic aromatic hydrocarbons (PAHs) emitted by burning fossil fuels (such as in car exhaust and some forms of residential heating) to developmental delays by age three, reduced IQ in kindergartners and attentional problems by age six. So the team looked specifically at symptoms associated with concentration and evaluated how these effects connected to PAHs might be contributing to ADHD.

The scientists measured the level of PAHs in both the cord blood retrieved when the mothers gave birth and the mothers’ blood following delivery. They also collected urine samples from the children at age three or five years and analyzed them for PAH levels. The children born to mothers with higher levels of PAH during pregnancy had five-fold increased odds of showing symptoms of ADHD than those who were born to mothers with lower levels. The effect remained strong even after the researchers adjusted for the babies’ exposure to air pollution and smoking after birth.

“This is a new finding, and if the PAHs are identified as a contributor to ADHD, that opens up new avenues for preventing ADHD,” says Perera.

MORE: Study Links Exposure to Pollution with Lower IQ

PAHs, says Perera, circulate in the body for a long time, so even brief exposures could contribute to changes in the body. And each person processes the chemicals differently. Some may be more prone to breaking down the compounds into their potentially toxic elements, while others are less affected by the exposure.

While mothers may not be able to control some exposures, such as those from traffic and heating sources, there are some ways that expectant women can reduce their risk. Pushing local legislators to adopt clean air laws is one way to improve air quality, and on a more personal level, families can make sure that cooking areas have proper ventilation, avoid burning candles and incense and other sources of PAHs, and most importantly, ensure that they aren’t exposed to tobacco smoke. “Air quality is a policy problem, but individuals can be empowered to take steps,” Perera says.

MORE: Mom’s Exposure to Air Pollution Can Increase Kids’ Behavior Problems

Women who are pregnant can also eat more antioxidants from sources like fresh fruits and vegetables, since these can counteract some of the oxidative damage that PAHs wreak on fetal cells.

Perera stresses that limiting exposure to PAHs isn’t the only answer to reducing the increasing rate of ADHD in the country. Genetic and other environmental factors all contribute to the disorder, but identifying as many potential factors as possible could start to reduce the effect that the chemicals have not just on mothers, but on their developing babies as well.

TIME Cancer

Promising New Cancer Treatment Uses Immune Cells

A one-two punch is more effective than using two cancer-fighting drugs that boost the immune system against tumors

Cancer researchers are pumping out study after study trying to figure out how best to use the body’s own immune system to fight cancer tumors.

Reporting in the Journal of the American Medical Association, scientists led by Dr. F. Stephen Hodi at Dana Farber Cancer Institute show for the first time that combining two drugs that target the immune system in different ways could help melanoma patients survive longer.

From 2010 to 2011, 245 patients with advanced skin cancer who had not responded to at least one previous treatment were randomly assigned to get a newly approved drug, ipilimumab, designed to help the immune system better target tumors, either alone or in combination with another drug. Ipilimumab (marketed as Yervoy), was among the first anti-cancer medications that allows immune cells to “see” tumors better; since tumors grow from originally normal cells, the immune system often gives them a pass and doesn’t attack them as foreign. But drugs like ipilimumab, called checkpoint blockade inhibitors, help immune cells to look past cancer’s disguise and target abnormally growing tumors.

MORE: A Shot at Cancer

In the study, those who received the combination of ipilimumab and sargramostim, another drug that gives the immune system a laser-like focus on the proteins found on tumors, survived an average of 17.5 months after the study began, compared to 12.7 months for those who took ipilimumab alone. At the end of a year, nearly 70% of those receiving the combination were alive, while 53% of those in the ipilimumab alone group were.

“We show that the combination improves survival, and at the same time decreases side effects,” says Hodi. The patients receiving the two drugs reported fewer gut and respiratory complications, two of the organ systems most affected by checkpoint inhibitor drugs like ipilimumab.

MORE: Why Cancer Drugs May Work Better While You Sleep

The combination, he says, may be more effective since one drug works to suss out tumor cells, like shining a molecular spotlight on them, while the other builds up the body’s defenses against them, allowing immune cells to better target and eliminate cancers.

The time that both groups of patients enjoyed before their melanoma recurred, however, was similar. But Hodi and his team note that the inflammation caused as a side effect of the drugs could be interpreted as early tumor sites, leading researchers to record the presence of tumors that may not be there.

Teasing apart that issue and determining the safe and optimal doses of the combination will require more studies, says Hodi. The dose of ipilimumab he used, for example, was higher than the one approved by the FDA in 2011, since this study was begun before the agency approved the drug. But the idea that a combination of powerful immune-based drugs could help cancer patients fight their disease and survive longer is encouraging. “This world of [new cancer treatments] is moving fast, and there are a slew of possible combinations that others are studying now,” he says. “It’s where the future of cancer therapy will be.”

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