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Alternative Therapy in Cancer Miracle or Myth?
Alternative Therapy in Cancer Miracle or Myth? 1 Mastura Md Yusof Clinical Oncology Department, UMMC, UMSC What is cancer? ‘ Disease that results from unregulated cell growth’ Cells divide and grow uncontrollably. Invade nearby structure(s). Spread to distant organs via the lymphatic system or bloodstream. Conventional Cancer Treatment: Comprehensive, Personalised and evidence- based Chemo Others EFFICACY Surgery Radiotherapy Targeted therapy Palliative care Biological and hormone therapy SIDEEFFECTS Conventional Cancer Treatment Aim of Therapy Radical/curative potentially curative therapy, given with the intent of long term control or cure for the patient i.e. early stage cancers, highly curable cancers Palliative aim is NOT for cure to prolong life and alleviate suffering to improve the quality of life for a patient with no implied impact upon their survival i.e. advanced cancers “Extraordinary claims require extraordinary evidence….” Conventional Treatment • Originates from a long process of rigorous lab research and well – designed clinical trials • Conducted according to good clinical practice • Enable comparison to the existing standard • Prove that a prospective cancer treatment is efficacious and safe. Example : HER 2 Positive Breast Cancer From gene identification to drug development Anti-HER2 monoclonal mouse antibody developed5 HER2 gene is cloned2 HER2 protein found to be overexpressed in breast tumours3 1984 HER2/neu gene identified1 1985 1987 HER2 overexpression associated with more aggressive phenotype4 1989 Trastuzumab clinical trials begin 1992 1993−1995 Anti-HER2 monoclonal mouse antibody humanised: trastuzumab6 1. Ullrich A, et al. Nature 1984; 309:418−4253; 3. Sainsbury JR, et al. Lancet 1985; 1:364−366; 5. Huzdiak RM, et al. Mol Cell Biol 1989; 9:1165–1172; 2. Ishii S, et al. Proc Natl Acad Sci USA 1985; 82:4920–4924 4. Di Fiore PP, et al. Science 1987; 237:178–182 6. Carter P, et al. Proc Natl Acad Sci USA 1992; 89:4285–4289 Example : HER 2 Positive Breast Cancer From drug development to clinical trials to clinical practice US approval: HER2-positive MBC1 1998 EMA approval: Concurrent trastuzumab + chemotherapy in EBC5 EU/US approval: HER2-positive EBC3 2000 EU approval: HER2-positive MBC2 2006 2010 EU/US approval: HER2-positive MGC4 2011 HERA 2 year results expected 2012 EMA approval: Neoadjuvant-adjuvant therapy with trastuzumab6 1. Slamon DJ, et al. N Engl J Med 2001; 344:783792; 3. Piccart-Gebhart MJ, et al. N Engl J Med 2005; 353:16591672; 5. Perez EA, et al. J Clin Oncol 2011; 29:44914497; 2. Marty M, et al. J Clin Oncol 2005; 23:42654274 4. Bang YG, et al. Lancet 2010; 376:687697 6. Gianni L, et al. Lancet 2010; 375: 377384 Survival of Patients with Metastatic Breast Cancer 1974 – 2000 against number of drugs developed Number of drugs used in breast cancer 1.0 30 No. Drugs Available .8 1995-2000 1990-1994 1985-1989 .4 1980-1984 .2 1974-1979 12 24 36 Months Giordano SH, et al, Cancer 100:44-52, 2004 15 10 5 0 0.0 0 20 48 60 19 50 s 19 60 s 19 70 s 19 80 s 19 90 s .6 25 . Why is an oncologist talking about alternative therapy? •Cancer remains a serious illness in Malaysia •2nd leading cause of death after MVA Why is an oncologist talking about alternative therapy? While we don’t use it in our practice, we do believe it is wrong to ignore them. Metaanalysis on CAM use in various countries: on average, over half of all cancer patients use CAM therapies1 Our aim is to try to provide the evidence (or the lack of it) as well as to prevent potential harm in our patients when it involves hazardous substance Natural remedies were commonly used during the 1500s as treatment of breast cancer Natural remedies included: milk goat dung frogs lead plates By the early 1500s surgery was the main treatment for breast cancer Performing a mastectomy without anaesthetic Surgery 3000 BC 1500s Rayter Z & Mansi J (eds). Medical Therapy of Breast Cancer. Cambridge University Press: Cambridge; 2003. Complementary and Alternative Medicine A group of diverse medical and healthcare systems, Alternative medicine is practices and products that used in place of are not normally conventional medicine. considered to be conventional medicine’. They often fall outside the boundaries of conventional Some conventional cancer therapy because they medical practitioners are have not been scientifically also practitioners of CAM proven to be safe and effective. When used together with conventional medicine, it is called Complementary Medicine. Some complementary medicine measures that MAY help people with cancer ( Integrative oncology) Symptoms Measures Anxiety Hypnosis, massage, meditation, relaxation techniques Fatigue Exercise, massage, relaxation techniques, yoga Nausea and vomiting Acupuncture, aromatherapy, hypnosis, music therapy Pain Acupuncture, aromatherapy, biofeedback, hypnosis, massage, music therapy Sleep problems Exercise, relaxation techniques, yoga Stress Aromatherapy, exercise, hypnosis, massage, meditation, tai chi, yoga What are the hallmarks of alternative therapy? Lack of peer-reviewed articles on laboratory and clinical aspects published in reputable medical journals Not science-based Mode of action not proven Lack of clinical trials Dosage often arbitrary No toxicity data from humans Too good to be true Often expensive Myth ( mythology) sacred narrative of traditional origin ‘ Myths may arise as either truthful descriptions or over elaborated accounts of historical events or personification of natural phenomena, or as an explanation of rituals. (Alan Dundes) ‘ideology in narrative form’ ( Bruce Lincoln) widely held but false belief or idea ( Google translator) EXAMPLES of additional ‘therapies’ that have no evidence but are not harmful to cancer patients Dates, raisins Habbatusauda Olive herbs Quranic verses homeopathy Alternative therapies not scientifically proven to prevent or treat cancers The therapies with animal names Keladi tikus (typhonium Flagelliforme) Sabah snake grass Kulat susu harimau hutan Misai kucing Porcupine date Cat whiskers Malaysia The therapies with ‘scientific’ names Transfer factor B17/ amygdalyn/laetrile (apricot seed) Prebiotics Ozone therapy Chelation therapy Stem cell Alkaline diet Magnetic bracelet Malaysia The ‘miraculous’ anti cancer foods ; the antioxidant theory avocados, Garlic Tomatoes beetroot Soursop mangosteen Gerson therapy The alkaline diet Beware of Alternative Therapies Safety Concern Herbs, supplements have the potential of powerful effects on natural biologic processes of the body Especially when processed into concentrated powders, liquids and pills/capsules Pathways linked to negative clinical outcomes: Metabolic interactions Treatment interactions Direct organ toxicity Direct biological effects on cancer Unregulated manufacturing of substance Dose Combining potent compounds Thank You 25 APOC 2013 Bangkok
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