Alternative Therapy in Cancer Miracle or Myth?

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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; 344:783792;
3. Piccart-Gebhart MJ, et al. N Engl J Med 2005; 353:16591672;
5. Perez EA, et al. J Clin Oncol 2011; 29:44914497;
2. Marty M, et al. J Clin Oncol 2005; 23:42654274
4. Bang YG, et al. Lancet 2010; 376:687697
6. Gianni L, et al. Lancet 2010; 375: 377384
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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