181 - Viewing cancer through an evolutionary lens: a radically different approach to treatment

Robert (Bob) Gatenby is a radiologist who specializes in exploring theoretical and experimental models of evolutionary dynamics in cancer and cancer drug resistance. He has developed an adaptive therapy approach for treating cancer which has shown promise in improving survival times with less cumulative drug use. In this episode, Bob explains what brought him into medicine, his search for organizing principles from which to understand cancer, and the mathematical modeling of other complex systems that led him to model the dynamics of tumor cell changes in cancer. He discusses his pilot clinical trial treating metastatic prostate cancer, in which he used an evolutionary game theory model to analyze patient-specific tumor dynamics and determine the on/off cycling of treatment. He describes how altering chemotherapy to maximize the fitness ratio between drug-sensitive and drug-resistant cancer cells can increase patient survival and explains how treatment of metastatic cancer may be improved using adaptive therapy and strategic sequencing of different chemotherapy drugs. Sign up to receive Peter's email newsletter: https://bit.ly/4c602k2 We discuss: 00:00:00 - intro 00:00:10 - Bob’s unlikely path to medicine and his disappointment with his medical school experience 00:12:30 - Rethinking the approach to cancer: using first principles and applying mathematical models 00:29:27 - Relating predator prey-models to cancer 00:37:50 - Insights into cancer gathered from ecological models of pests and pesticides 00:47:27 - Bob’s pilot clinical trial: the advantages of adaptive therapy compared to standard prostate cancer treatment 00:55:25 - New avenues of cancer therapy: utilizing drug-sensitive cancer cells to control drug-resistant cancer cells 01:03:29 - The vulnerability of small populations of cancer cells and the problem with a “single strike” treatment approach 01:14:30 - Using a sequence of therapies to make cancer cells more susceptible to targeted treatment 01:25:56 - How immunotherapy fits into the cancer treatment toolkit 01:31:25 - Insights into why cancer spreads, where it metastasizes, and the source-sync trade off of cancer 01:42:45 - Defining Eco- and Evo-indices and how they can be used to make better clinical decisions 01:55:24 - Advantages of early screening for cancer 01:58:36 - Bob’s goals for follow-ups after the success of his prostate cancer trial 02:09:22 - Treatment options for cancer patients who have been told they have “failed therapy” Show notes page: https://peterattiamd.com/robertgatenby/ -------- About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle