~Cancer Adjuvant Therapy

~Cancer Adjuvant Therapy
Reprinted with permission of Life Extension®.



The good news is that many of the 4 million people being treated for cancer in America will survive the disease and go on to live full and productive lives.

While the numbers that survive are far too low (about 44%), many of the more than 1500 daily cancer deaths occur because patients and their families are unaware of the depth of the resources currently available. Unfortunately, some die avowing they would never resort to natural medicine, while others are interested but lack the expertise to implement the program to their best advantage. Regrettably, some turn to alternative care fairly late in the course of the disease process, weakening the probability of recovery.

Mainstream medicine (relying upon surgery, chemotherapy, and radiation) may initially appear successful, but the indications of the disease process are less often addressed. Conventional cancer treatments are not for those individuals who are frail in body or spirit. For the past 30 years, cancer therapies have experienced tremendous setbacks because of an associated toxic response, resulting in significant numbers of treatment-induced deaths rather than disease-induced fatalities. Awareness regarding historic numbers of unsuccessful outcomes has forced patients to look for alternatives to bolster survival odds. Many who use alternative therapies report doing so without their oncologist's knowledge, fearful of criticism or rejection by a physician (Richardson et al. 2000).

The University of Texas M.D. Anderson Cancer Center (Houston) found that 99.3% of patients had heard of complementary medicine, and 68.7% of patients reported having used at least one unconventional therapy (Richardson et al. 2000). About 75% of the patients surveyed, however, yearned for more information concerning complementary medicine and about one-half of those participating in the survey wanted the information to come from their physician.

Until most recently, major medical schools granted only a few hours to nutritional education out of the hundreds of academic hours required to complete medical school. The exclusion began when Abraham Flexner (commissioned to correct inequities occurring in medical schools) penned the Flexner Report of 1910. His contribution, entitled Medical Education in the United States and Canada, closed smaller medical schools and forced those that survived to adopt a uniform curriculum that excluded nutritional courses. Thus, some physicians emerged from medical schools, scoffing at the concept of nutrition influencing health or overcoming disease.

Sir William Osler (1849-1919), chief physician at Johns Hopkins's School of Medicine, drilled into students that medical research must be validated and replicated to be good medicine. This led to controlled experiments (as randomized, controlled trials) that became the backbone of mainstream medicine. Nutritional protocols often used multiple nutrients, a difficult model to apply in clinical trials. Testing a single nutraceutical denied the patient full support of nutritional pharmacology, an injustice when treating a seriously ill patient. In addition, trials are expensive to conduct and early natural healers (by and large) did not represent an affluent subset of society.

But, ever so slowly, the medical scene is being revolutionized. According to the American College for Advancement in Medicine, physicians (in many cases) are showing eagerness to learn more about natural medicine and how to best implement it into their practice (Corbin-Winslow et al. 2002). Scientists, teaching at nutritional seminars, report attendees are often medical doctors, a vast departure from years past.

PREVENTING AND CONTROLLING CANCER

While some individuals will be reading this protocol looking for help managing a malignancy, others will be focusing upon prevention and recurrence. The alphabetical list that follows provides quick guidelines for structuring a program, highlighting major nutrients in the prevention and treatment of cancer.

These recommendations should not be implemented individually in aggressive cancers without careful consultation of the remainder of the material. Cancer patients (and physicians) should be deliberate about reading the entirety of this protocol in order to avoid missing information that could prove to be lifesaving. Note: It is important that the reader also consult the protocols entitled Cancer Treatment: The Critical Factors and Cancer: Should Patients Take Dietary Supplements?

The dosages required for treating cancer (which are considerably larger than those required for prevention) can change the effects that a nutrient has on the body. The risk is multidirectional. Overdosing or underdosing, as well as a lack of patient awareness regarding the full potential of natural pharmaceuticals, hampers recovery.

THE CRITICAL IMPORTANCE OF SCHEDULED BLOOD TESTS

It is important to measure the successes or losses in regard to treatment-associated tumor response. Evaluating tumor markers in the blood or tumor imagery provides a basis for calculating regression of the disease. In addition, tumor markers provide direction for introducing other therapies if failures are evidenced.

Table 1: Type of Cancers and the Tumor Marker Used for Assessment
Type of Cancer Tumor Marker Blood Test
Ovarian cancer CA 125, CK-BB
Prostate cancer PSA, PAP, prolactin, testosterone
Breast cancer CA 27.29, CEA, alkaline phosphatase, and prolactin (or CA 15-3 rather than the CA 27.29)
Colon, rectum, liver, stomach, and other organ cancers CEA, CA 19-9, AFP, TPS, and GGTP
Pancreatic cancer CA 19.9, CEA, and GGTP
Leukemia, lymphoma, and Hodgkin's disease LDH, CBC with differential, immune cell differentiation and leukemia profile


It is also important to evaluate the effectiveness of immune-boosting therapies and guard against anemia and therapeutic toxicities. At a minimum, a monthly complete blood chemistry (CBC) test that includes assessment of hematocrit, hemoglobin, and liver and kidney function should be done in all cancer patients undergoing treatment.

An immune cell test should be performed bimonthly, measuring total blood count, CD4 (T-helper), CD4/CD8 (T-helper-to-T-suppressor) ratio, and NK (natural killer) cell activity. Also consider tests measuring cortisol levels (Cortisol am and pm) and HCG (human chorionic gonadotropin), a hormone that may be elevated 10-12 years prior to a diagnosis of cancer. For information regarding test availability call (800) 208-3444.

COMPLEMENTARY THERAPIES

  • Alpha-Lipoic Acid
  • Arginine
  • Carotenoids
  • Cimetidine
  • Clodronate
  • Coenzyme Q10 and Statin Drugs
  • Conjugated Linoleic Acid
  • Cyclooxygenase-2 Inhibitors
  • Berberine Containing Herbs
  • Feverfew
  • Ginger
  • Green Tea
  • Curcumin
  • Dimethyl Sulfoxide
  • Essential Fatty Acids
  • Garlic
  • Glutamine
  • Inositol hexaphosphate
  • Lactoferrin
  • Melatonin
  • Modified Citrus Pectin
  • N-acetyl-cysteine
  • Resveratrol
  • Selenium
  • Silibinin
  • Soy
  • Theanine
  • Thymus Extract
  • Vitamin A
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Vitamin K


When describing the various complementary cancer therapies, it is not possible to endorse one supplement, hormone, or drug over another. We have provided as much evidence as space allows so that patients and their physicians can evaluate what approach may be suited for the individual situation.

A great deal of effort has been made to identify therapies that are substantiated in published scientific literature or that provide a cancer patient with the opportunity to experiment with cutting-edge treatment strategies. The focus of our effort has been to identify potentially lifesaving therapies that have been overlooked by mainstream oncology. We also attempt to discuss both positive and negative studies when applicable.

The Life Extension Foundation can assume no responsibility for outcome, apart from a self-assigned duty to stay abreast of the most promising of therapies and to share the data with members. No warranties (expressed or implied) accompany the material; neither is the information intended to replace medical advice. As always, each reader is urged to consult professional help for medical problems, especially those involving cancer. All supplements, drugs, and hormones are listed alphabetically and not in order of importance.

Alpha-Lipoic Acid--is a powerful antioxidant that regulates gene expression and preserves hearing during cisplatin therapy

Lester Packer, Ph.D. (scientist and professor at the Berkeley Laboratory of the University of California), refers to lipoic acid as the most powerful of all the antioxidants; in fact, Packer says that if he were to invent an ideal antioxidant, it would closely resemble lipoic acid (Packer et al. 1999). Alpha-lipoic acid claims anticarcinogenic credits because it independently scavenges free radicals, including the hydroxyl radical (a free radical involved in all stages of the cancer process and linked to an increase in the likelihood of metastasis).

Lipoic acid increases the efficacy of other antioxidants, regenerating vitamins C and E, coenzyme Q10, and glutathione for continued service. In fact, lipoic acid boosts the levels of glutathione by 30-70%, particularly in the lungs, liver, and kidney cells of laboratory animals injected with the antioxidant. In addition, glutathione tempers the synthesis of damaging cytokines and adhesion molecules by influencing the activity of nuclear factor kappa B (NF-kB), a transcription factor (Exner et al. 2000). Note: A great deal of material relating to NF-kB is presented in the protocol Cancer Treatment: The Critical Factors.

Lipoic acid can down-regulate genes that accelerate cancer without inducing toxicity. So responsive are cancer cells that laboratory-induced cancers literally soak up lipoic acid, a saturation that increased the lifespan of rats with aggressive cancer by 25% (Karpov et al. 1977).

Alpha-lipoic acid was preferentially toxic to leukemia cells lines (Jurkat and CCRF-CEM cells). The selective toxicity of lipoic acid to Jurkat cells was credited (in part) to the antioxidantís ability to induce apoptosis. Lipoic acid activated (by nearly 100%) an enzyme (caspase) that kills leukemia cells (Pack et al. 2002). Other researchers showed that lipoic acid acted as a potentiator, amplifying the anti-leukemic effects of vitamin D. It is speculated that lipoic acid delivers much of its advantage by inhibiting NF-kB and the appearance of damaging cytokines (Sokoloski et al. 1997; Zhang et al. 2001). Finding that lipoic acid can differentiate between normal and leukemic cells charts new courses in treatment strategies to slow or overcome the disease (Packer et al. 1999).

As with all antioxidants, the appropriateness of using lipoic acid with chemotherapy arises. Animal studies indicate that alpha-lipoic acid decreased side effects associated with cyclophosphamide and vincristine (chemotherapeutic agents) but did not hamper drug effectiveness (Berger et al. 1983). More recently, a combination of alpha-lipoic acid and doxorubicin resulted in a marginally significant increase in survival of leukemic mice (Dovinova et al. 1999). Nonetheless, the definitive answer regarding coupling antioxidants with conventional cancer therapy is complex. Factors, such as type of malignancy, as well as the nature of the cytotoxic chemical and even the time of day the agents are administered, appear to influence outcome (please consult the protocol Cancer: Should Patients Take Dietary Supplements to learn more about the advisability of antioxidant therapy during conventional treatments).

To its credit, lipoic acid appears able to counter the hearing loss and deafness that often accompanies cisplatin therapy. Depreciated hearing occurs as free radicals, produced as a result of treatment, plunder the inner ear; lipoic acid preserves glutathione levels and thus prevents deafness in rats (Rybak et al. 1999).

A suggested lipoic acid dosage for healthy individuals is from 150-300 mg a day. Degenerative diseases usually require larger dosages (sometimes as much as 500 mg 3 times a day).

Arginine

Various scientists have attempted to describe the complex role of arginine in cancer biology and treatment. L-arginine is the common substrate for two enzymes, arginase and nitric oxide synthase. Arginase converts L-arginine to L-ornithine, a pathway that can increase cell proliferation. Nitric oxide synthase converts L-arginine to nitric oxide, a conversion process with uncertain effects regarding cancer.

A positive study conducted by a team of German researchers showed that arginine contributed significantly to immune function by increasing levels of white blood cells. Scottish scientists added that dietary supplementation with arginine in breast cancer patients enhanced NK cell activity and lymphokine cytotoxicity (Brittenden et al. 1994). (Lymphokines are chemical factors produced and released by T-lymphocytes that attract macrophages to a site of infection or inflammation in preparation for attack.) Various researchers have shown that increasing arginine increases neutrophils (white blood cells that remove bacteria, cellular debris, and solid particles), significantly upgrading host defense (Muhling et al. 2002).

Apart from enhancing immune function, arginine increases a number of amino acids, creating the possibility of an amino acid imbalance. Oversupplying some amino acids while undersupplying others is thought to destabilize the tumor. All cells, both healthy and diseased, have amino acid requirements; if not met, the cell is significantly disabled (Muhling et al. 2002). Amino acid manipulation has been applied in oncology for decades with varying degrees of success.

Interesting studies have emerged regarding arginine or arginine analogs in cancer treatment. For example, infusions of arginine significantly reduced the incidence of liver and lung metastasis in laboratory mice. Earlier research found that supplemental arginine altered the number of tumor-infiltrating lymphocytes in human colorectal cancer, offering important implications for new strategies in cancer treatment (Heys et al. 1997). Though many factors are involved (including appropriate dosages), Japanese researchers found that arginine induced apoptosis in pancreatic (AR4-2J) cells, inhibiting cell proliferation (Motoo et al. 2000).

The two faces of arginine, however, cloud dosing with confidence. The role of nitric oxide (NO), a molecule synthesized from arginine, remains controversial and poorly understood. While a few reports indicate that the presence of NO in tumor cells or their microenvironment is detrimental to tumor-cell survival, and subsequently their metastatic potential, a large body of data suggests that NO actually promotes tumor progression. Illustrative of its fickleness, NO was recently identified as a downstream regulator of prolactin, an inhibitor of apoptosis. However, arginine stimulated proliferation of prolactin-dependent Nb2 lymphoma cells in laboratory rats (Dodd et al. 2000). In addition, NO production (by murine mammary adenocarcinoma cells) promoted tumorcell invasiveness. Whereas, introducing NO inhibitors resulted in an antitumor, antimetastatic profile (Orucevic et al. 1999).

Ambiguity and nonconformity reduce arginine's role at the present time to adjunctive support with either traditional cancer treatment or fish oil supplementation. A heartening report regarding arginine, fish oil, and doxorubicin therapy appears in this protocol in the section devoted to Essential Fatty Acids (Ogilvie et al. 2000). Nonetheless, the diverse biological properties of L-arginine demand further careful studies, clarifying chemopreventive advantages and endangerments (Szende et al. 2000).

Carotenoids--have antioxidant activity, inhibit cellular proliferation, and offer protection against numerous types of malignancies

Carotenoids, acting as immune enhancers and free-radical scavengers, are important substances in oncology. When using carotenoids for antioxidant and cancer protection, it appears wise to use mixed carotenoids, that is, alpha-carotene, lycopene, zeaxanthin, canthaxanthin, beta-crytoxanthine, and lutein rather than emphasizing only beta-carotene.

The following are illustrative of the worth of mixed carotenoids:

  • Lycopene offers targeted protection against cancers arising in the prostate (Kucuk et al. 2001), pancreas (Burney et al. 1989), digestive tract (De Stefani 2000), and colon (Nair et al. 2001).
  • The American Journal of Clinical Nutrition added that individuals seeking broad-spectrum colon protection should also include lutein-rich foods in their diet (spinach, broccoli, lettuce, tomatoes, oranges, carrots, celery, and greens) (Slattery et al. 2000).
  • Canthaxanthin, a less well-known carotenoid, was shown to induce apoptosis and inhibit cell growth in both WiDR colon adenocarcinoma and SK-MEL-2 melanoma cells (Palozza et al. 1998).
  • Researchers showed that the risk of breast cancer approximately doubled (2.21-fold) among subjects with blood levels of beta-carotene in the lowest quartile, compared with those in the highest quartile. The risk of breast cancer associated with low levels of other carotenoids was similar, that is, a 2.08-fold increased risk if lutein is deficient and a 1.68-fold greater risk if beta-cryptoxanthin is lacking (Toniolo et al. 2001). A Swedish study found that menopausal status has an impact on the protection delivered by carotenoids. Analysis showed that lycopene was associated with decreased breast cancer risk in postmenopausal women, but in premenopausal women, lutein offered greater protection (Hulten et al. 2001).
  • Leukoplakia (an often precancerous condition marked by white thickened patches on the mucous membranes of the cheeks, gums, or tongue) is responsive to spirulina, a source of proteins, carotenoids, and other micronutrients (Sankaranarayanan et al. 1995). An inverse relationship between beta-carotene and thyroid carcinoma was observed in both papillary and follicular carcinomas (D'Avanzo et al. 1997). A high dietary intake of beta-carotene appears a protective (though modest) factor for the development of ovarian cancer (Huncharek et al. 2001).
  • Lastly, Japanese researchers showed that all the carotenoids inhibited hepatic (liver) invasion, probably through antioxidant properties (Kozuki et al. 2000).


Men who consume 10 or more servings of tomato products per week reduce their risk of prostate cancer by about 35%. The American Chemical Society in August 2001 reported that 32 (largely African-American) patients diagnosed with prostate cancer and awaiting radical prostatectomy were placed on diets that included tomato sauce, providing 30 mg a day of lycopene. After 3 weeks, mean serum prostate specific antigen (PSA) concentrations fell by 17.5%, oxidative burden by 21.3%, DNA damage by 40%, while programmed cell death increased threefold in cancer cells (Holzman 2002). Part of lycopene's protection involves the ability of carotenoids to counteract the proliferation of cancer cells induced by insulin-like growth factors (Agarwal et al. 2000a).

Beta-carotene exhibited a radio-protective effect among 709 children exposed to radiation inflicted by the Chernobyl nuclear accident. For example, the Chernobyl accident showed that irradiation increases the susceptibility of lipids to oxidative damage and that natural beta-carotene may act as an in vivo lipophilic antioxidant or radio-protective agent (Ben-Amotz et al. 1998). Therefore, using beta-carotene following radiotherapy may reduce the tissue damage caused during treatment.

Beta-carotene, perhaps the most controversial of the family of carotenoids, has come under attack several times in the past few years. For example, smokers who received synthetic beta-carotene (as a prophylactic) in the CARET study had a higher rate of lung cancer and death than smokers not supplemented. In fact, the study was terminated by the National Cancer Institute (NCI) because of the widespread discrepancy between the two groups. The CARET study is not new, but because it still concerns beta-carotene users, we will attempt to explain the unexpected results of the study.

Dr. Packer described the subjects as "walking time bombs." Many were victims of asbestos exposure or heavy smoking. The form of beta-carotene selected for the study (synthetic versus natural) was also cited as another possible explanation for the negative outcome.

Dr. Leo Galland, M.D. (practitioner and director of the Foundation of Integrated Medicine, New York City), also explains that high-dose beta-carotene (25,000 IU a day) administered to smokers results in a particular pattern of metabolism (Galland 2000). The process is orchestrated as cytochrome p450 enzymes (Phase I detoxification system) are summoned into action by tars in cigarette smoke. As beta-carotene is acted on by cytochrome p450, oxidized end products are formed, as well as toxic derivatives.

Simultaneously, vitamins C and A, as well as glutathione, are depleted, severing antioxidant protection. This sequence can damage DNA and increase the likelihood of lung cancer, particularly in an environment with initially high oxidative stress, a profile common to smokers. Without full spectrum antioxidant support, the single dose of beta-carotene produces an oxidative environment rather than one of protection. (Comment: As one free radical is neutralized by an antioxidant, another oxidant may be formed. It is well established that vitamin C can serve as a pro-oxidant through the formation of ascorbyl radicals. It is also known that this radical is quenched by vitamin E to yield a tocopheryl radical, which in turn is reduced by the conversion of glutathione to glutathione disulfide. Thus, the full spectrum of antioxidants is preferable, rather than emphasizing single antioxidants.)

Beta-carotene is largely considered nontoxic even at high doses; for example, some nonconventional cancer therapies recommend large amounts of carrot juice. One large glass of carrot juice can contain 100,000-200,000 IU of provitamin A or carotene. The problem with carrot juice is that it is loaded with fructose (sugar). Cancer cells feed on sugar, and drinking carrot juice may induce an insulin spike that could potentially fuel cancer cell propagation.

Cancer patients should consider natural beta-carotene supplements in lieu of carrot juice. Suggested phytonutrient dosages are from 9-20 mg of sulphoraphane, 10-30 mg a day of lycopene, and 15-40 mg of lutein, along with a mixed carotenoid blend that includes alpha- and beta-carotene. A product called PhytoFood Powder provides potent amounts of sulphoraphane, while carotenoid extracts are available in a variety of encapsulated preparations. Note: What Should the Cancer Patient Eat, appearing later in this protocol, contains a discussion regarding the value of sulphoraphanes in the diet.

Continued . . .


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