Naltrexone is a blocker of opioid receptors and is used in patients who have overdosed on narcotics, but at low doses, there is lab-based work, largely conducted by a single group, that suggests that low dose naltrexone can have immunostimulatory properties and even directly kill cancer cells by a process called apoptosis, a self-destruct program built into cells when they become too mutated (cancer cells that are growing and dividing can turn off this signal).  At websites like www.lowdosenaltrexone.org and www.ldninfo.org, there are descriptions of anecdotal reports of patients with various different cancers who have done well, attributed to the LDN.  To the credit of the people running these sites, there are caveats that these are not scientifically conducted trials.  That’s fine, but there are certainly some people writing on patient and caregiver-mediated online communities who are intimating that LDN is a miracle drug and using terms like cure for lung cancer.

I don’t want to be a wet blanket, but I do think it’s important to inject a little caution here.  In my mind, LDN fits in with DCA or noni juice or many other proposed interventions that are viewed by some as a “why not?” intervention and others as a miracle treatment that is not being studied or addressed by the oncology medical community or pharmaceutical industry because of a supposed profit motive keeping those groups from wanting to cure cancer.   I and most people in the “allopathic”/standard medical pathway recognize that there is major interest in complementary and alternative medicine (CAM) approaches in the general population.  What’s not clear to me is whether the majority of people seeking CAM interventions are looking more for a complementary approach and generally accept conventional medicine strategies, or whether there is a significant portion of the people favoring LDN and other less established interventions because they have a fundamental distrust of the medical and pharmaceutical establishments and believe that the people with the power actually want to suppress the ideas that could cure cancer.

As someone who really believes in knowing your source, I recognize that I’m speaking as someone from the medical establishment.  I also recognize that there is some reason for distrust of a lot of large establishments with the collapse of entire industries recently for good reason.  But even if you have that much distrust of the health care and pharmaceutical industries, I can’t understand why someone wouldn’t think that either the pharmaceutical company or physician with an actual cure for cancer wouldn’t be enticed by the fame and fortune that this would offer.   While I think there are several very reasonable arguments in discussing LDN or many other strategies that aren’t widely accepted in conventional medicine, in my opinion saying that the pharmaceutical industry and the medical establishment are withholding the cure for cancer devalues the discussion.

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I’m surprised to find that I’m moving to a topic that may actually be more controversial than a Michael Moore movie, but in fact, I think that’s where I’m headed.

Several months ago, I wrote a post about dichloroacetate, or DCA, which is a chemical used to treat a childhood disease called congenital lactic acidosis, and which has been the study of some more recent study by Dr. Evangelos Michelakis at the University of Alberta in Edmonton, Alberta in Canada. DCA can increase the activity of mitochondria, which produce energe in the cell and can be suppressed in cancer cells; restoring that function can lead the cells to undergo programmed cell death, or apoptosis, that is supposed to occur when a cell recognizes that it has dysfunctional mutations. Recent work by the group in Edmonton (summary here) suggested that DCA was effective in killing tumor cells in test tubes and some animal models, and the authors suggested that DCA should move readily into clinical trials for cancer. One problem is that DCA is a generically available product that no pharmaceutical company stands to profit from, so it does not have a readily available source of funding for the millions of dollars needed to run clinical trials that might lead to a proper demonstration of effectiveness of not. The University of Alberta has established a charitable fund that has thus far raised signficant financial support in order to test DCA in clinical trials despite the absence of a big pharma beneficiary. Trials are reportedly in development.

At the time that this came out, in a real media frenzy, my post covered some of the news and used the occasion to temper some of the extreme enthusiasm about this agent being a likely miracle for the broad treatment of cancer. I described the huge gap between promising preclinical drug that kills cancer cells in test tubes and rodents and the demonstration of clinical benefit in large trials with real patients. The majority of drugs are abandoned along the way for being too toxic or not living up to the early promise of efficacy. We would do well to remember that back in 1998, when emerging work on angiogenesis by Dr. Judah Folkman was hailed as a certain miracle, again based on very promising work in mice. Dr. Folkman was very circumspect and avoided overpromising what his research could accomplish in humans: “if you’re a mouse and you have cancer, we can take good care of you” and, “Going from mice to people is a big jump, with lots of failures” (basically summarizing my first DCA post in one sentence). In contrast, in that same front-page article in the New York Times that featured this reported breakthrough, Dr. James Watson (who along with Francis Crick discovered the molecular structure of DNA and was awarded the 1962 Nobel Prize in Physiology and Medicine) was quoted as saying, “Judah is going to cure cancer in two years”. I cringed when I heard that, fearing that it would feed a media machine and lead to incredible hype, and it did. But nearly ten years later, we have not cured cancer, at least not nearly enough, even though a few antiangiogenic drugs like Avastin (bevacizumab) have recently been shown to improve outcomes for colon, lung, breast, and some other cancers. Read the rest of this entry »

I received a question on the discussion forum, in the setting of a lot of internet discussion, about an an agent called dichloroacetate, or DCA, as a potential anticancer therapy. This excitement is based on a study out of the University of Alberta in Canada, that appeared in the journal Cancer Cell (article here). This is a very novel molecular therapy approach, and one about which I don’t have a lot of insight yet, but it does provide an opportunity to discuss the gap between a promising result in preclinical studies and a proven anticancer therapy.

DCA is an unpatented small molecule that has been used for decades to treat children with rare molecular disorders associated with mitochondrial problems, but it’s not a drug that I have had occasion to use. Mitochondria are a component of every cell that create energy for the cell, and mitochondrial disorders have been known to be seen with cancer but have been believed to be an effect rather than a key contributing cause of the cancer process.

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The idea is basically that cancer cells suppress their mitochondria, making the cells resistant to apoptosis, or the normal process of programmed cell death, a sort of self-destruct program built into all cells of the body for certain normal developmental processes but also as a defense mechanism in case the cells mutate too much to work properly. The work described in the paper demonstrated that multiple types of cancer cells in test tube (in vitro) and animal models could be suppressed and killed after DCA restored the normal ability of mitochondria and led to apoptosis that destroyed cancer cells. This research suggests it would have no effect on normal non-cancer cells, so it is believed that DCA would not be assocaited with significant side effects. Overall, these results were considered very encouraging for a drug that it inexpensive and orally available. Read the rest of this entry »