SAN DIEGO: Dennis Lyon was a genetic train wreck. Cancer was ravaging his liver, lungs, bones and brain, and tests showed so many tumor mutations that drugs targeting one or two wouldn’t do much good. It seemed like very bad news, yet his doctors were encouraged.
The reason: People with the most messed-up genes often are the ones who do best on treatments that enlist the immune system.
“These are the patients we used to be very depressed about,” thinking they couldn’t be helped, said Dr. Razelle Kurzrock at the University of California, San Diego. “Now when we see those types of patients, we’re really excited,” because there are so many ways for the immune system to recognize the cancer cells as abnormal.
Immunotherapy is the hottest thing in cancer care. Drugs called checkpoint inhibitors can vanquish some advanced cancers by removing a chemical cloak that hides them from the immune system. Former President Jimmy Carter got one at age 91 for skin cancer that spread to his brain, and now is in remission.
But they’re expensive, have side effects, and work for only about one-quarter of patients — as few as 5 percent with colon cancer and as many as half with the skin cancer, melanoma. Sometimes the benefits are brief.
Worst of all: For a small number of unlucky folks, treatment can backfire. Their cancer grows exponentially after getting a checkpoint drug.
“We’re going to have to figure out not only who to treat with immunotherapy but who not to treat,” Kurzrock said.
Gene tests are starting to help sort that out. But for patients, the big question is “Will it work for me?“
PREDICTING WHO BENEFITS
The first step is testing for a protein called PD-L1 that’s often involved in forming that chemical cloak. Some checkpoint drugs target this or a related protein, so people with a lot of it should respond to treatment.
That was the hope when Diane Tippett showed up last October at Georgetown Lombardi Comprehensive Cancer Center with a salivary gland cancer that had spread to her liver and lungs.
“Five years ago, I probably would have thrown up my hands and given her standard chemo,” said the center’s director, Dr. Louis Weiner.
Instead, he ordered tests that showed Tippett had a PD-L1 mutation, meaning her cancer made a lot of it. He started the 49-year-old Leonardtown, Maryland, woman on a checkpoint drug, Opdivo, and told her to come back in a few months.
“Quite honestly, I didn’t know if I’d ever see her again,” he said.
Now, Tippett’s lung tumors are gone. Her liver tumor shrank 50 percent and is stable. She got married in July and says she feels great.
“I don’t feel any different than you do. I’m not tired, I’ve got all my hair,” she said. “I want more people to know about it and to ask their doctors about it,” she said of immunotherapy and the testing that led her to it.
NOT THE WHOLE STORY
That protein isn’t a very reliable predictor, though. Some people with a lot of it don’t benefit from the drugs and the opposite also is true. There are other checkpoints besides that one, too.
Researchers increasingly are focusing on something else Tippett had: a high number of flawed genes. It’s a sign that tumors have been evolving over time and are hard to treat with drugs that target a single gene. It sometimes accompanies two other DNA problems that some checkpoint drugs already are approved to treat.
Lyon, the San Diego man, had nearly two dozen different mutations after his skin cancer spread widely. In October 2015, he started on Opdivo and was in near-complete remission within two months. Recent tests showed no active cancer in his spine and lungs, and doctors think small spots in his brain and liver may be scar tissue, though they can’t know for sure. A test for tumor DNA in his blood found none.
“It would appear my cancer is all dead,” he said, and called it “nothing short of miraculous” that gene tests led to successful treatment after years of trial and error. “I’m so grateful. No one’s lucky that gets cancer but I may be in an era where there’s a way through this tunnel.”
Three-quarters of patients who are helped by checkpoint drugs have long-lasting benefits, as Lyon did, said Dr. Steven O’Day, an immunotherapy expert at Providence Saint John’s Health Center in Santa Monica, California.
“When you respond, it’s a home run in terms of long-term survival,” O’Day said. “But we still have to be better at predicting who those patients are.”
THE DARK SIDE
Others have not been so fortunate. In November, French researchers reported that 12 of 131 patients, or 9 percent, got much worse after checkpoint drugs, which seemed to speed their tumor growth.
Kurzrock checked with colleagues and quickly found more cases — a 73-year-old man with bladder cancer, a 65-year-old woman with endometrial cancer, and a 44-year-old breast cancer patient whose tumors “just exploded” in size within two months of immunotherapy.
In a report on 155 patients, she tied several gene mutations to this risk. Kurzrock has consulted for some gene-medicine makers and co-founded a company using a software program to determine best treatments for patients depending on their tumor genes.
The unfortunate cases are a reality check, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.
“We are not paying close enough attention to those people” and need to know whether they fared badly because of their treatment or for other reasons, he said.
SHOULD WE BE DOING ‘IMMUNOGRAMS’?
That’s the question Dr. Eric Topol, director of the Scripps Translational Science Institute, posed a gene medicine conference he organized in March at the suburban San Diego research center. Should there be baseline tests to map what patients’ natural defenses look like? For example, how many immune system soldiers called T cells do they have in the area of the tumor?
Max Krummel is working on a roadmap to do that. The University of California, San Francisco, scientist heads a project with $10 million from three companies that make checkpoint drugs. He is analyzing hundreds of tumor samples to see what immune system features spell success or failure.
“We’re not looking at how the immune system changes,” but for what starting point works best with the drugs, he said. “What we’re seeing is that the kinds of cells you have in a tumor predict who’s going to respond.”
Krummel, who was involved in work that led to Yervoy, the first checkpoint drug, has started a company to try to tune up one part of the immune system he thinks is key to maintaining a healthy balance.
Cancer exists because the immune system isn’t working as it should, he said, so successful immunotherapy may require “treating the immune system, not treating the tumor.”
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Marilynn Marchione can be followed on Twitter: @MMarchioneAP
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This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
The big question: Will cancer immune therapy work for me?
The big question: Will cancer immune therapy work for me?
Where We Are Going Today: ‘Century Burger’ restaurant in Jeddah
- The original CB, my repeat order, is a simple burger packed with flavor, served with pillow-soft buns, a thick beef patty, Swiss cheese, lettuce, tomato and the signature CB sauce
Saudi burger joint Century Burger offers an extensive menu of mouthwatering dishes.
Known for its hearty meals and fresh ingredients, Century Burger began in Jeddah, where it established its first restaurant on Prince Sultan Road.
Today, the chain has 13 stores across the Kingdom and is among the largest Saudi casual dining brands.
I usually like to start with the black beetroot salad, a refreshing mix of arugula, beetroot, red onion, cooked sweet potatoes, feta cheese and a tangy dressing.
The original CB, my repeat order, is a simple burger packed with flavor, served with pillow-soft buns, a thick beef patty, Swiss cheese, lettuce, tomato and the signature CB sauce.
When I crave something savory and spicy, I opt for the fajita burger: A succulent beef patty topped with fresh grilled vegetables, fajita seasoning and melted cheese.
For anyone looking to reduce their carb intake, the keto burger is savory, delicious and very filling.
One of Century Burger’s many creative takes on burgers is black umami, served with black squid ink buns, grilled chicken breast, Swiss cheese, arugula, crispy onion, a house-made umami sauce and pickles.
The restaurant also offers variety of starters and side orders, from flavored chicken wings and chicken strips to various shrimp options.
Where We Are Going Today: Bab Sharqi – Saudi brand sweets
- This artistic touch makes their packaging both elegant and culturally meaningful
Eid is here, bringing joy, gatherings, and the tradition of sharing sweets. Bab Sharqi, a renowned Saudi brand, blends authenticity and luxury to enhance your celebrations.
Specializing in Middle Eastern confections and petit four, Bab Sharqi distributes its creations across the Kingdom.
The name Bab Sharqi, meaning “Eastern Gate,” reflects the rich heritage of the Arab world. Each box showcases stunning illustrations of historical landmarks from Riyadh, Jazan, AlUla, and Diriyah to Petra and Jerash in Jordan and beyond.
This artistic touch makes their packaging both elegant and culturally meaningful.
I tried their chocolate petit four, and it instantly became my favorite with Saudi coffee. Its buttery, melt-in-your-mouth texture and rich chocolate coating make it perfect for guests or personal indulgence.
They also offer milk petit four, assorted options in various sizes, and beautifully packaged baklava trays with cashew, pistachio, pecan, and even chocolate baklava.
For an extra special treat, the Orientals box is perfect for Eid gatherings. It features baklava filled with pecans and salted caramel, almonds, pistachios, and coconut, all coated in fine Belgian chocolate.
Bab Sharqi’s sweets are available for delivery via HungerStation, ToYou, and Keeta or in-store at Kottouf Wa Hala, a boutique for local and regional sweets.
For more details, visit @babsharqisweets on Instagram.
Fitness enthusiasts challenge themselves with pre-iftar hikes in Pakistani capital
- Hikers set out hour before sunset, break fast on trails on Margalla Hills National Park
- Participants say pre-iftar hikes help boost fat burning, maintain weight in Ramadan
ISLAMABAD: Zarnab Tahir struggled to catch her breath as the steep incline of the hiking trail at Islamabad’s picturesque Margalla Hills tested her endurance. Hiking can put people through physical exertion, especially when they do it on an empty stomach.
An hour before the sun sets and the call to prayer blares out from various mosques located in Pakistan’s capital city, a group of fitness enthusiasts take to the hiking trails in Margalla Hills National Park.
Islamabad Run With Us — IRU — which describes itself as Pakistan’s “pioneering running community,” is behind the pre-iftar hiking initiative.
“When you engage in pre-iftar (physical) activities during Ramadan, it gives you extra energy, an extra boost,” Qasim Naz, who founded IRU in 2016, told Arab News on hiking trail number three.
“And when someone joins in on an activity once or twice, they figure out it’s not that hard and they can sustain it comfortably.”
Naz stresses that staying active during the holy month is essential. The IRU organizes five activities a week, which include two runs and three hikes.
“Either we can maintain our weight, or if our goal is weight loss, we can achieve it by being in a calorie deficit while eating a healthy diet and exercising,” Naz explained.
Tahir, 22, meanwhile, said that she was committed to reaching the top of hiking trail before sunset. This was the second time she was hiking with IRU.
She agreed with Naz that group activities are “much easier” to sustain.
“I think it is important to go at your own pace and it’s so much easier with the group,” Tahir, a content creator, told Arab News.
“If you go alone, it’s kind of more difficult and you are, like, really slow but if you go with the group you can maintain that pace and I think it’s much easier that way.”
Mahwish Ashraf, a journalist associated with a foreign diplomatic mission in Islamabad, shared how she struggled the first time that she went on a pre-iftar hike with IRU.
“The first time I was hiking, I returned from in between, I couldn’t complete it,” she admitted. “So, this is my second time hiking with the IRU, and gladly, I’m at the main point, the meeting point.”
Eraj Khan, a commercial specialist visiting from Australia to spend Ramadan with his family, said pre-iftar hikes give one “lots of energy.”
“For fat burning, it’s a great activity,” Khan said. “Especially because the last two hours of fasting are the hardest, most people feel really hungry. But so far, I’m loving it.”
As the clock continued to tick and evening settled in, the hikers began to pick up their pace. For Tahir, reaching the top of the trail before sunset was a victory in itself.
She had pushed past exhaustion, embraced the challenge and proved to herself that she was capable of more than she thought she could achieve.
And according to her, hiking with the group made all the difference.
“The energy of the group keeps you going,” she said. “Even when you feel like stopping, you see everyone else moving forward, and you push through.”
French fry revolution satisfies Ramadan night cravings in Jeddah
- One of Crusty’s visitors, Sukinah Qattan, told Arab News: “This atmosphere doesn’t just enhance the joy of tasting food; it also enriches Saudi Arabia’s culinary sector, supports local chefs
JEDDAH: During the holy month of Ramadan, Jeddah’s streets come alive with food stalls, drawing crowds to savor local favorites such as the popular “basta” fries pop-up experience.
Stalls, particularly those selling French fries, line the streets, bringing people together in a celebration of local flavors.
Food carts and traditional kiosks set up in alleyways of residential areas and in public squares serve delicious dishes and beverages, evoking nostalgia and reviving the spirit of the past.
The word “basta” comes from the Arabic term for simplicity, “basata,” to represent an experience that is modest, affordable, and rich in flavor.
In these attractive settings, markets bustle with activity as the aroma of kebda (liver), balila (chickpeas), and French fries fills the air, bringing the warmth of social gatherings that define the holy month.
Keeping tradition alive
Abdulrahman Ghazi, owner of the food stall Balilat Ajdadna, spoke to Arab News about the city’s love for its street foods.
“French fries have always been a Ramadan favorite, along with balila and liver. We’ve been serving customers in Al-Safa district for 28 years, and our loyal patrons know us well,” he said.
“We prepare kebda using an old traditional method, but with our own twist. We cook it with natural oil, suet, and lamb fat, without using any additional oils. This technique is highly favored by many,” Ghazi explained.
The authentic way of preparing balila takes more time and requires at least three hours of slow cooking over low heat with plenty of water, he added.
“In the past, balila was soaked for 12 hours before cooking to ensure it was thoroughly cleaned of bicarbonate residue, a crucial step that many overlook today. Unfortunately, some now use bicarbonate with a pressure cooker to speed up the process, which takes away from its true flavor.”
He insisted that the correct way to prepare balila is to let the chickpeas soak overnight, wash it thoroughly, and then cook it slowly.
“That’s why we call it ‘Balila Ajdadna’ — because it is made just like our ancestors used to prepare it in Makkah, where we originally come from,” Ghazi added.
The stall’s balila is priced is SR5 ($1.30) for a small plate and SR10 for a large plate. The small plate of fries costs SR6 and the large goes for SR12, with all the sauces one could wish for.
Although rising costs, particularly for oil, have led to price increases, Ghazi said that they strive to keep prices stable.
“Our prices remain the same throughout the year, even during Ramadan. We do not impose additional taxes, and we have always absorbed the costs ourselves.”
French fries take a new turn
While some vendors have remained loyal to tradition, serving fries with classic Saudi sauces such as garlic and homar (tamarind), others have introduced elements from various cuisines, elevating the dish beyond its conventional form.
In an interview with Arab News, Saudi content creator Abdoush, who has over half a million followers on social media, shared his inspiration for launching his fries stall — one that locals call “The Rich Man’s Stall” because its fries sell for SR60.
After years of perfecting his steak-cooking skills, Abdoush decided to elevate the French fries game by adding premium steak cubes, topped with his signature sauce.
“For me, it’s all about taking something familiar and turning it into an unforgettable experience,” he said.
His steak fries stall Crusty is located on Ali Abou Al-Ola street, operating from the backyard of a neighborhood home and serving lines of eager customers.
With innovative ingredients, such as wok-tossed steak cubes finished with a torch, Abdoush’s stall has attracted thousands of visitors during Ramadan.
The stall is a bustling business, with four counters dedicated to fries. Around 20 workers manage the operation, going through over 100 kg of steak per day and an unmeasured amount of potatoes.
According to Aboush, Crusty serves an average of 500 customers on weekdays, while on weekends the number soars to over 700.
“We do this out of love and passion. Food is truly amazing, it’s a blessing,” he said.
But what makes Abdoush’s fries expensive?
“It’s all about the process of making the fries. We don’t just fry them in regular oil — we add tallow and beef fat from the steaks. The steak we use is Russian striploin, a high-grade cut known for its marbling and rich fat content. We add about half a steak on top of the fries,” he explained.
“We also make a special sauce that we drizzle over the steak fries, but I highly recommend adding some homar (tamarind). It gives the dish a unique touch.”
Abdoush’s inspiration behind the steak fries is connected to Jeddah’s culture, especially the rise of French fry pop-ups. “Personally, I love making steaks, and with five years of experience, this was the perfect concept to bring to life.”
Crusty started last year and its popularity this year has been on a whole new level.
After Ramadan, Abdoush plans to launch his first Crusty restaurant specializing in steaks. “We won’t just serve French fries and steaks, we’ll also be adding burgers to the menu,” he said.
Residents and visitors flock to these stalls, where they not only indulge in delicious food but also experience live cooking demonstrations.
One of Crusty’s visitors, Sukinah Qattan, told Arab News: “This atmosphere doesn’t just enhance the joy of tasting food; it also enriches Saudi Arabia’s culinary sector, supports local chefs, and reinforces the presence of traditional dishes in the modern cultural scene.”
Other fries stalls offer more affordable fries. For example, Adani Bar Cafe and Ma’loom restaurant serve fries for no more than SR15.
However, their innovation lies in cutting the potatoes into cubes, instead of the traditional fries shape, and topping them with a cilantro, garlic, and lemon sauce, which visitors love.
Anas Abbas, a fries enthusiast from Jeddah, told Arab News: “Every Ramadan, I make sure to visit Adani Bar. I love their fries. They’ve truly become a Ramadan tradition. I always bring some home for my mother after her Taraweeh prayers because she also appreciates this delicious treat.”
Where We Are Going Today: ‘Salad Flavors’ cafe in Riyadh
Have you ever craved a salad for lunch or dinner but were worried it wouldn’t fill you up? At Salad Flavors, that’s unlikely to be a problem.
Located in Al-Malqa, Riyadh, the cafe offers four different kinds of salads, each with a large selection of fresh toppings and its own special dressing. And while the menu may not be very big, the flavors are.
The bestselling dish comes with grilled chicken and the signature sauce. You will love the crispy eggplant.
A less creamy option would be a great alternative to have for lighter days.
The rich salad is a vegetarian alternative similar to the signature dish but with different toppings and an orange dressing. The sweet potato and okra set it apart.
Another vegetarian choice is the quinoa salad, which has apple and a more balsamic-based dressing to give it extra tang and freshness.
For seafood lovers, the crab salad is a good option. The mango, cucumber, sesame and panko toppings give it the feel of a poke bowl (without the raw fish) and the flavors work great together. I would also prefer a lighter dressing to accompany the salad.
Salad Flavors also offers individual and gathering-sized boxes of grape leaves fatteh and cabbage fatteh. The grape leaves option is zesty, tangy and very tasty, while the cabbage is more unusual but well worth a try.
The only thing missing from the menu is the option for visitors to customize a dish with their favorite toppings and sauce.
But if you’re looking for a new fresh tasting salad place in Riyadh for lunch or dinner, Salad Flavors is among the top options available.
