By Jerome Burne
I’m not given to melodrama but I think I have just spotted that the cancer establishment is getting ready to perform a massive, unthinkable, screeching U-turn. Impossibly expensive new drugs are out and diet, exercise and supplement (yes you read it right) are in.
My evidence comes from two jaw-dropping articles in a glossy cancer magazine aimed at the general reader that carries drug company ads and conference announcements. The articles are well-informed, accessible and non-technical. Cancer coverage in the lay press is nearly always upbeat describing new drugs that improve survival and are well tolerated with promises of even greater improvements around the corner.
So I was amazed to read this heading to the first feature:
‘Almost four in ten serious adverse drug reactions now listed on the labels of 12 targeted cancer therapies were not mentioned in the studies that lead to their approval. Half of the serious reactions that were missed are potentially fatal.’
This was the conclusion of a team at the Princess Margaret Hospital in Toronto who have been investigating just how reliable is the evidence reported in cancer drug trials. You certainly need it to be when you are trying to weigh up the risks and benefits of treatment. The clear answer is that you need to take it with a large pinch of salt,
Cancer trial: marathon runners only need apply
Drugs such as Avastin and Erbitux, for instance, have been unjustifiably pushed as being very effective with ‘no differences in toxicities’ in the control and placebo groups when that’s simply untrue. Also cancer drugs in clinical trials are routinely tested on patients who are fitter and younger (47) than the age of the majority of those who would be prescribed them in the real world (around 65). You can only get into one of these trials, one wit has suggested, if you are a marathon runner who happens to have cancer.
The distorting effects of this dangerously misleading and over-enthusiastic marketing won’t come as a surprise to any reasonably sophisticated patients but there is an added significance in the case of cancer. Official cancer treatments – drugs, surgery and radiotherapy – are the only permitted ones on the grounds that they are backed up by rigorous trials and so occupy the scientific high ground.
But if they are this unreliable, on what grounds are patients being protected from the ‘false hope’ of the likes of intravenous vitamin C when their oncologist may well be dispensing possibly lethal false hope by giving them a drug with toxicities that have been cynically concealed from clinicians and patients alike?
Of course it is still logically possible to argue that just because the evidence for the inevitable side-effects that come with life-saving drugs (lets ignore the fact that no treatment saves lives, they just prolong them) have been massaged away, that doesn’t automatically mean that vitamin C and the like is safe and effective.
Time to stop spending billions on drug driven trench warfare
This is where the second article comes in. It also appeared in the January/February issue of Cancer World – freely available on-line – and was even more surprising.
It began by making the familiar argument that it is just not feasible to continue spending billions on trench war against cancer. The latest treatments are ‘hugely complex, have limited efficacy and come at a cost that renders them unsustainable,’ it stated. It might have suggested all sorts of fudges and fixes on the grounds that one more push could lead to the breakthrough, but it didn’t.
Instead it bit the bullet and proposed that we need to change tack entirely and start putting far more resources into prevention. And how might we do this? The answer is even more surprising than the admission of fraudulent marketing.
‘A more holistic, systemic understanding of the nature of cancer is emerging where the focus is less on the mutated cancer cell itself and more on the role played by the body’s own physiological processes in turning normal cells into cancer cells and enabling them to thrive and spread.’
Benefits of cleaning up cancer’s neighbourhood
If you are a patient with cancer and you are exploring all options, that is probably a familiar line that makes a lot of sense, but coming from the mainstream? In fact it is a pretty good summary of the approach taken by a pioneering American researcher Professor Mina Bissell whose work was covered on HIUK in early 2015.
She’s been investigating this cancer-creating ‘physiological process’ for thirty years, often in the face of considerable hostility. She has shown that the ‘extra-cellular matrix’, as she terms it – the cells surrounding one that is turning cancerous – can be modified to make the development of cancer more or less likely.
The Cancer World article suggests that rather than devoting all their attention to gene changes, researchers should also be looking at other systems that can affect the environment a cancer is growing in. These include our gut bacteria, the immune system and hormones. ‘Evidence is growing for the ability of diet, exercise and reducing obesity,’ it goes on ‘to prevent, suppress, or reverse the carcinogenic process.’ How many patients have suggested something similar to their oncologists only to be dismissed with a comment about a lack of evidence? Still, better late than never, eh?
Certainly some experts believe prevention along these lines is worth investigating, such as delegates at last year’s World Oncology Forum where the ability of nutritional interventions to reverse cancer was discussed, among them ‘vitamin and mineral supplements’.
And the discussion had got beyond suggesting eating more fish and fibre and exercising. The idea that insulin can stimulate cancer growth was on the agenda, although curiously the obvious implication that a very low carbohydrate diet would make sense wasn’t flagged up. This is also a topic that’s been covered here on HIUK.
Will the Cinderella of research go to the ball?
Top names at centres such as the Ludwig Cancer Research Centre at Johns Hopkins in Baltimore have signed up to an appeal to policy makers and opinion leaders: ‘to promote the development of new evidence-based strategies aimed at cancer prevention and early intervention.’
Wouldn’t it be great if there was a serious push for the likes of mineral and vitamin supplements along with insulin lowering diets and strategies to be run through unbiased trials with a view to including them in what was on offer in regular oncology clinics? They are starting from a low base however. Prevention’s Cinderella status means that it runs at about 3% of the budget.
The most obvious challenge will be wresting funds away from the high profile high tech centres doing genetics to diet, exercise and metabolism. The other issue even more serious challenge will be to find oncologists who have any knowledge at all of nutrition and the intricacies of metabolism let alone hormones and the microbiome.
One place they could start, at least to get an overview of some of the areas that have proved promising so far, would be a new handbook for non-drug approaches called The Cancer Revolution. It describes what very knowledgeable clinicians are already doing already to shift the “extracellular matrix” in an anti-cancer direction. It’s been put out by the charity Yes to Life – conflict of interests statement – I am a trustee.
Scientists researching ways to implement the new initiative will find plenty of plausible and sophisticated approaches to investigate. I’ll be writing about the book very soon.