It costs over a billion dollars and takes more than a decade to bring a new cancer drug to the marketplace. Even then, it may be relevant to only a small patient population and extend life by just a few months – and that’s being optimistic. The hope for a few extra months assumes you can trust the cherry-picked test data the big drug companies use to gain FDA approval.
All the same, doctors tend to push these expensive new entries instead of older, cheaper drugs that work just as well.
Now, I know some readers have a fit if I even mention a drug in a favorable way. But many readers or their loved ones do opt for chemo, for a variety of reasons.
If they’re going to do that, they should at least try to avoid spending themselves into bankruptcy. A good place to start is to be skeptical of the latest cancer wonder drug.
Instead, consider drugs whose patents have expired, and drugs already prescribed for other health conditions but not licensed for the treatment of cancer. Many of these “off-label” medicines have great potential in cancer therapy.
Organization devoted to cheap but effective drugs
The Repurposing Drugs in Oncology (ReDo) Project is a US and European collaboration between two not-for-profit organizations that include doctors and scientists. They look for effective therapies that aren't being explored because Big Pharma can't profit from them.
ReDo has identified over 250 drugs prescribed for a wide range of conditions that have anti-cancer activity, yet are not used by conventional oncologists.
The most interesting ones have been in widespread use for many years, are low in toxicity, have an anti-cancer mechanism that makes sense, and strong evidence to support them.
In London's famous Harley Street, the private Care Oncology Clinic (COC) is pioneering the use of four of these drugs. They are prescribed in addition to conventional treatments, which their patients usually receive under the National Health Service (NHS). Oncologists working within the NHS usually have no objections and are willing to share patients' clinical records with COC.
Four off-label drugs of choice
The cost of the drugs is just £400 ($520) a year. The four drugs are metformin (diabetes control), atorvastatin (cholesterol lowering), doxycycline (antibiotic) and mebendazole (Vermox) (anti-parasitic).
Established in 2014, COC has now treated over 1,500 patients with a wide range of cancers from stage 1 to stage 4. Audited data on 95 of these cases has recently been analyzed. All were suffering with the most common and aggressive type of brain tumor (glioblastoma).
The results are very encouraging, with a substantial improvement in expected survival times. Under usual protocols – “standard of care” – people live an average of 14.8 months, but this almost doubled to 27.1 months in those taking the four drugs. The two-year survival rate rose from 28.7% to 55.8%. These results are far better than the new, much hyped, hugely expensive immunotherapy drugs.
It pays to target metabolism
COC focuses on the metabolic approach to treating cancer.
Tumors have unique metabolic characteristics that can be targeted while doing little or no harm to healthy cells. One factor unique to cancer cells is an increased uptake of nutrients such as glucose (blood sugar) and glutamine. As we’ve said many times, for many years, cancer cells are gluttons for sugar.
Healthy cells take up glucose too, of course, but cancer cells take up more and they use it in a different way. They convert glucose into energy using biochemical pathways that don't require oxygen (The Warburg Effect).
Other aspects of metabolism are also altered in cancer cells because, besides their hunger for sugar, they need greatly increased amounts of protein, nucleic acids and lipids to support their high rate of growth.
Justin Stebbing, professor of cancer medicine and oncology at St George's Hospital, London, is one of several top cancer specialists associated with COC.
He believes targeting metabolism can make a "big difference" to cancer treatments, saying, "it will be increasingly relevant as we think outside the box and understand cancer in different ways."
The “right” theory of cancer is finally winning
COC focuses on the metabolic approach to treating cancer.
Cancer Defeated has been a longtime advocate of the metabolic theory of cancer, and we’re delighted to see more and more mainstream doctors jump on the bandwagon.
Dr. Padman Vamadevan, scientist and oncology consultant at COC, said, "When we started, not many oncologists were familiar with treating the metabolic features of cancer, so they were skeptical, but now patients report that their doctors are genuinely interested in this research as they see the apparent benefits."
Pan Pantziarka, Program Director for Drug Repurposing and coordinator of the ReDo Project, explained that modern cancer drugs are aimed at very specific targets in cancer cells.
"But these older medicines are known as 'dirty drugs' because they have multiple targets, interfering with more than one protein or signaling pathway at a time. Used in combination they could be very effective.
"If these medicines were coming out today, some would be blockbuster cancer drugs."
The four-drug cocktail
Metformin: Potentially this old diabetes drug has multiple metabolic mechanisms for inhibiting cancer development and growth. For instance, it reduces the release of sugar from the liver to lower blood sugar, and lowers circulating insulin levels to decrease insulin signaling in cancer cells. It activates an enzyme (AMPK) which decreases glucose uptake, protein synthesis, cell proliferation and cell cycle progression.
The relationship between diabetes and cancer has been recognized for over 100 years. A review of studies found that among diabetics taking metformin compared to non-users, incidence of total cancers was down by a third, colorectal cancer was lowered by 32%, there was a 33% reduced risk for lung cancer and the risk of death from all cancers was lowered by more than a third -- 34%.
In September, researchers from Vanderbilt University, Nashville, found patients taking metformin had a substantially reduced rate of liver cancer compared to patients taking an alternative anti-diabetes drug.
Dr. Jonathan Stegall, who specializes in integrative oncology and heads The Center for Advanced Medicine in Atlanta, uses metformin in almost all his patients. He describes it as very safe, well tolerated and "one of the best tools in our toolbox."
He explains that metformin disrupts a particular pathway called mechanistic target of rapamycin (mTOR) which cancer cells use to grow. Even better, it destroys the cancer cells that help kick off cancer development, growth, spread and recurrence- - cancer stem cells. Dr. Stegall describes this as "a huge deal."
I agree with Dr. Stegall, in spades. Killing cancer stem cells is the holy grail of cancer treatment.
Statins: have anti-inflammatory properties, benefit the immune system, and block the enzyme HMG CoA Reductase in the liver to reduce cholesterol, which cancer cells use for energy. A recent study covering 197,048 women with breast cancer found statins cut the risk of death by 27%. I’m not a big fan of statins for cholesterol, but I’ll keep an open mind on their uses for cancer. It does seem they are an effective anti-inflammatory.
Doxycycline: obstructs mitochondrial function. A trial published in October found breast cancer patients taking this antibiotic had a sizable reduction in cancer stem cells, making cancer recurrence much less likely.
One of the study authors, professor Michael Lisanti from the University of Salford, England, said, "...to find a drug that is effective, readily-available and costs just 10 pence (13 cents) per patient per day is highly significant, particularly as around two-thirds of cancer deaths occur due to recurrence after initial treatment."
His colleague, professor Federica Sotgia, explained how the drug works: "What we infer here is that the stem cells selectively over-express key mitochondrial-related proteins, which means that if we can inhibit mitochondrial function we can disrupt the stem cells."
Mebendazole: helps to block glucose uptake and targets a protein that disrupts the energy supply to cancer cells. It also impedes microtubules which have important roles in cell division and intracellular transport. It's also been shown to slow angiogenesis - the formation of blood vessels cancer cells need in order to spread.
Culture studies show mebendazole slowed lung cancer cell growth five-fold compared to controls and also inhibited breast, ovary, colon and bone cancers. Arrest of tumor growth and spread has also been demonstrated in mice. Last year a research team from New York suggested mebendazole should be used routinely to treat brain tumors.
Other drugs of interest
The antacid cimetidine (Tagamet), the anti-fungal itraconazole, the acne drug isotretinoin (Accutane), and the antidepressant clomipramine (Anafranil) all look promising candidates for drug repurposing. I’m not a fan of any of these for their original purposes (except maybe the anti-fungal), but cancer is a four alarm fire. If we can confirm these drugs will help, they may be worth a try.
Dr. Stegall also uses aspirin and propranolol.
He prescribes aspirin for his cancer patients because research showed a baby aspirin taken every day for five years reduced the risk of colon cancer by almost a quarter. Those already suffering cancer had a 20% reduced risk of death, and the cancer was less likely to spread.
Pretty good for a drug introduced in 1899 and costing mere pennies. And I bet even your hidebound conventional cancer doctor will let you take it.
Aspirin also hinders the hijacking of blood platelets that cancer cells need in order to grow; lowers the possibility of blood clots, which is at increased risk in cancer patients; and may also inhibit cancer through its anti-inflammatory effects.
As for propranolol, it’s a beta blocker prescribed for high blood pressure, but it also works on a receptor that lowers stress. Dr. Stegall says that because cancer patients are under a lot of stress "they really feel like a weight has been lifted off their shoulders once they're on this medication."
A COC success story
When 19-year-old Henry Searle was diagnosed with an inoperable brain tumor in 2015, he was given 14 months to live. After chemo and radiation, his mother Vicki asked the consultants whether natural therapies would help.
She describes their response:
"I was shocked and surprised at how negative the consultants were whenever I asked if diets or supplements could help his immune system...they just said there was no evidence for any of them and that he was getting the gold-standard treatment."
Ignoring their advice, she put her son on an organic sugar-free diet and added supplements including zinc and selenium. Following this, blood tests showed his low functioning immune system improving week by week.
She then ignored objections from Henry's oncologist and visited COC, where the doctors are receptive not only to unconventional uses of drugs but to natural therapies, too.
The COC treatment showed evidence it was working after only a month, with the tumor shrinking. Two years later Henry’s NHS consultant wrote to say there was "no evidence of active disease."
The latest update, in March, 2018, finds him still taking COC's drug cocktail and his condition remains stable.
Professor Justin Stebbing had this to say:
"As a profession, we can be cruel to cancer patients, giving them treatments that are horribly toxic, with minimal benefits. I find it very frustrating when my colleagues are dismissive of patients who want to try other things that are non-toxic and may extend their lives."
Oncologists reluctant to prescribe
Although doctors are entitled to prescribe drugs "off label" if they believe they could be beneficial, in practice oncologists are reluctant to consider this option for several reasons.
Researchers have not conducted final stage cancer trials on them, and probably won’t because their patents have expired and no billion-dollar payday is likely. The drugs may also interfere with conventional treatment or have unforeseen side effects. There may also be consequences for the doctor personally or professionally, as Angus Dalgleish, another professor of oncology at St George's, found out.
He prescribes repurposed drugs for his patients and liaises with their family doctors.
"I’ve had a lot of hassle for that,” he says. “There’s no room for freedom to do the best thing for your patients, just because someone hasn’t put up millions of pounds to do a big drugs trial.
“I call it creative compassion because it’s not in the rule book, but it’s what I would want for myself if I were in the same position. I wouldn’t want to just be told to go and see the palliative care person [essentially hospice].”
Best regards,
Lee Euler,
Publisher
References:
- http://www.redo-project.org/
- http://careoncologyclinic.com/
- https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033411
- https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1749-6632.2011.06285.x
- http://news.vumc.org/2018/09/14/diabetes-drug-may-prevent-cancer/
- https://www.ncbi.nlm.nih.gov/pubmed/28432513
- https://medicalxpress.com/news/2018-10-antibiotic-effective-breast-cancer-clinical.html
- https://www.ncbi.nlm.nih.gov/pubmed/28386621
