Blazing a New Trail in Cancer Treatment
Posted On May 03, 2017
When I soldiered through a breast cancer scare a decade ago, back in my early 40s, I had only known one person who had elected to pursue alternative cancer treatment. Diagnosed with a malignant brain tumor, he wound up surviving for 15 years after oncologists told him he had six months to live. Not only did he defy his “death sentence,” he enjoyed a relatively good quality of life until a few months before he finally succumbed. Before I knew that my own diagnosis was a false alarm, I contemplated what course to take. Traditional chemo and surgery? Or an alternative approach—considered unorthodox, something that demanded patients stick to a regimen of supplements and organic foods? I don’t take any prescription medications and favor the natural approach, but like most people, I found the thought of going against the conventional medical community intimidating. Thankfully, I didn’t have to make such a decision, since it was indeed a false alarm.
A chasm exists between conventional oncologists and integrative practices, and people diagnosed with cancer are demanding integrative and alternative therapies as cancer treatment that address more than just the symptoms and the disease itself. They are seeking to extend life while creating a better quality of life. More and more cancer specialists are embracing the integrative approach, and alternative therapies are gaining wider acceptance.
“There are now a number of centers offering an integrative approach,” says Maurie Markman, MD, President of Medicine & Science at Cancer Treatment Centers of America (CTCA), which has integrative hospitals in Atlanta, Chicago, Philadelphia, Tulsa, and Phoenix. “We are learning every day that every aspect of a patient’s care affects the outcome and quality of life.”
Markman recently made multiple presentations at the 10th international conference of the Society for Integrative Oncology, an event that attracted more than 300 attendees from around the world. “We have better testing to understand the abnormalities in tumors and the genes and proteins driving that person’s cancer,” he continues. “Advances are being made on a daily basis, and we owe it to our patients today to partner with them to manage a complex disease. It’s an unbelievably exciting time.”
Carolyn Lammersfeld, MS, RD, CSO, LD, CNSC—a registered dietician who is focused on issues of nutrition and metabolism, and who serves as the Vice President of Integrative Medicine at CTCA—also presented at the integrative oncology conference. According to Lammersfeld, “When individuals try to navigate the integrative approach on their own, they can run into problems if none of their practitioners know what the others are doing. With a center like ours, everything you need to support you during your cancer journey is all under one roof—oncology care, a registered dietician, mind-body resources, occupational therapists, massage therapists, acupuncturists, spiritual support, and chiropractors. You have a team approach after your initial assessment with your oncologist. Each nutritional plan I write, for example, is going to be very different depending on the type of chemotherapy, radiation, and surgery involved.”
Just as “one-size-fits-all” is a disaster in fashion, research proves that approaching cancer with generally prescribed chemotherapy and radiation can be ineffective. “We have not significantly increased the life span for those with solid tumors in the last 50 years using conventional cancer treatment,” notes Mark Rosenberg, MD, Medical Director of the Institute for Healthy Aging, Director of the Integrative Cancer Therapies Fellowship with the American Academy of Anti-Aging Medicine, and founder of the Rosenberg Integrative Cancer Treatment and Research Institute in Boca Raton, Florida. “Conventional treatment doesn’t kill cancer stem cells,” insists Dr. Rosenberg. “What we’ve been doing doesn’t work. It actually accelerates the growth of cancer cells and makes them more aggressive and more resistant to therapies. Every single cancer is different. What I’m most excited about right now is doing chemo sensitivity testing on live tissue from tumors. That allows you to measure what will keep the patient alive a lot longer.”
Dr. Rosenberg conducts both genetic and molecular tumor testing, then tailors lowdose chemotherapy according to what the tests indicate will produce the best results for each individual patient. “While that doesn’t make financial sense to pharmaceutical companies, live tissue testing is what works best for the patient,” Rosenberg says. “You can actually measure cancer cell death using the chemo sensitivity testing.”
By closely examining the genetic and molecular makeup of tumors, Dr. Rosenberg also creates a pH manipulation therapy that utilizes offlabel drugs (those that are approved for use with different maladies). “Many cancers thrive on sugar, and cancer cells produce lactic acid,” Rosenberg says. (Lactic acid is a byproduct of the breakdown of the simple sugar, glucose.) “These cancer cells have to shed that lactic acid. We use a glycolytic drug to inhibit them from doing so, which effectively kills cancer cells. We’ve found that we can use multiple drugs off-label to target multiple pathways to cancer cells. We’re turning what were considered terminal cancers into chronic disease.”
Dr. Rosenberg’s patients work closely with a nutritionist, who designs a diet to help their bodies get nutrients and alter their body chemistry so it supports them in their fight against cancer. “Because of the sugar connection with cancer, many patients are on a no-sugar, low-carb, lowprotein diet that is rich in good fats—but once again, everything is geared to the individual,” says the doctor, who finds that time in a hypobaric chamber (the type of oxygenated room used in the training of astronauts) is helpful to many of his patients.
A leader in understanding genetics and the ways in which tumors respond to different therapies, David Sidransky, MD— Director of the Head and Neck Cancer Research Division at Johns Hopkins University School of Medicine; Professor of Oncology, Otolaryngology, Cellular and Molecular Medicine, Urology, Genetics, and Pathology at Johns Hopkins University and Hospital; and chairman and co-founder of Champions Oncology—is one of the world’s most highly respected oncologists and researchers in the field. “Now that we’ve been able to take pieces of a cancerous tumor and grow tumors in mice, we can test different therapies on an individual’s actual tumor,” he explains. “The sky’s the limit in understanding how different tumors respond to different therapies and how they affect the progression of tumors. Before, we were having to look at genetic markers one at a time and were only able to guess that one drug might be a little better than the next. Being able to use the mouse as a living petri dish lets us test new biologic drugs and new antibodies on individual tumors. That gives us much higher predictability and allows us for the first time to do true individual therapy.”
The cost to the first patient for this new testing was $50,000. But now, the company has the cost down to $1,500 to implant a tumor. “This is personalized oncology,” says Dr. Sidransky, whose company has now worked with more than 300 patients and is doing tumor grafts at a rate of approximately 60 per month. It takes three months to grow the tumors. What’s next, he notes, is the ability to test the new immune therapies, as he’s now found a way to take a patient’s blood and replicate that patient’s immune system in the mouse avatar.
“We’ve only had four or five failures,” he says. “We’ve never seen anything like this in oncology. In the past, a lot of work was theoretical. Pharmaceutical companies couldn’t even test their drugs on live, individual tumors. The next step for us is being able to test tumors in an immune competent model. A tumor needs to grow its own system of capillaries and vessels to get blood. Now we can test antiangiogenic therapies that target and break down a tumor’s blood cell system. That’s revolutionary.”
On the Molecular Level
The breakthrough company Perthera uses the most advanced molecular diagnostic testing to create a detailed analysis of a patient’s unique cancer, and is the only company that combines genomics, proteomics, and phospho-proteomics to create a detailed molecular profile of a patient’s unique cancer. Michael Pishvaian, MD, PhD, Chief Medical Officer at Perthera and an assistant professor of Hematology and Oncology at the Georgetown Lombardi Comprehensive Cancer Center, chairs the expert medical review panel that combines this analysis with a patient’s medical history to recommend the appropriate course of action based on the latest cancer treatment options available. Because every patient’s cancer is unique, Dr. Pishvaian’s company presents healthcare providers and patients with the best possible personalized cancer treatment options available for advanced stages, inoperable cancer that has not yet spread, rare forms of cancer, cancer that has been removed but is at high risk to come back, or cases in which the oncologist has run out of treatment options.
“Nobody is putting all of this information together,” says Dr. Pishvaian, whose company has processed live tumor tissue from about 50 patients so far, primarily from smaller academic and community hospitals. “One of our goals is to vet the diagnostic companies and find the best-in-class, to look at that patient’s cancer and the true drivers of that individual’s cancer cells. We handle the tissue directly to be able to maximize the tissue sample. The companies are looking for gene mutations that may require targeted therapies and for predictive markers for chemo response. Once all the tests are done, we have loads of molecular and genetic data that we put together with the patient’s history in order to give the oncologist our cancer treatment recommendations.”
Right now, 13.7 million people are living with cancer in the United States, and that number is expected to jump to 18 million by 2022, says Joycelyn L. Speight, MD, PhD, DABR, a board certified radiation oncologist and palliative care specialist at University of California, San Francisco. That university is home to one of the few National Cancer Institute (NCI)-designated Comprehensive Cancer Centers, and offered one of the first integrative medicine and symptom management (palliative care) programs. “We are making advances in cancer treatment with personalized medicine— taking cells from an individual patient and using them to rev up the immune system, and by using the concept of integrative medicine to treat the whole person and not just the disease,” says Dr. Speight, who specializes in women’s cancers.
Speight notes that new therapeutic radiation technology, which uses high levels of energy to destroy the DNA of cancer cells so they can neither grow nor multiply, can be given from outside the body. This is much safer and more effective, as it’s far more targeted than the old “shotgun” approach. Intraoperative radiation delivers a high dose of radiation on a focused area while a patient is still in the operating room after having a lump removed. “Especially with early breast cancer, that may be all the surgery a patient needs,” says Dr. Speight, who says the CyberKnife, a stereotactic radiosurgery that focuses a beam of x-ray on a small tumor in a sensitive area such as the spine or the brain, “limits the risk to normal tissue.”
Traditional chemotherapy has been a shot in the dark, asserts Taz Bhatia, MD, founder and medical director of the Atlanta Center for Holistic and Integrative Medicine. Bhatia is also an acupuncturist, certified nutritionist, and prevention and wellness expert. “You end up damaging a lot of systems in the body while trying to get rid of the cancer, notes Dr. Bhatia. “The art in medicine is really connecting with somebody and understanding that person’s individual cancer journey. We help them pick what they might respond well to.”
Should I ever truly have to suit up for battle against cancer, I take comfort in this thought: Doctors today are striving to create a plan that’s tailored just for me.