Pleas advise me! Thank you very much - 1245034


My name is Tracey Hoang. I am currently living in Australia. I would like to have some advice for my father who has Lung cancer.

My father has Lung Adenocarcinoma, Stage IV. He was admitted to hospital early May this year when his heart rate was very high around 130/m. He was found that there was a large left pleural effusion with underlying atelectasis of the left lung. He had ICC insertion to drain the the fluid in the lung. From his samples and fluid, the doctor found out that he got lung cancer. My father has gone through all blood tests, and CT scan here in Australia. Luckily, a base substitution(mutation) was identified in EGFR exon 21 in his sample. The oncologist prescribed Iressa for him. My father has been on Iressa for 1 month now. His heart rate now is around 75/m and he feels better after one month on Iressa though he has some side effects of the medication.

I have read some articles about researches on paw paw extract and I am very interested in this natural medication. I have bought Papaya 35(from mature green paw paw,fruit, seeds extract, paw paw leaf extract, pomegranate extract, green tea extract) and Paw Paw Leaf extract from ROCHWAY company. These are the 2 products which are recommended by the company.

Could you please advise us about this matter.
1.Is there any conflicts of the paw paw extract to Iressa? Can he take Paw Paw extracts while he is on Iressa? We have been consulted with our Oncologist on this matter, but he did not advise anything about this. We really believed in Paw Paw anti-cancer effects.

2.And which is the best products of Paw paw for his lung cancer. Paw Paw Cell Reg which contain standardized paw paw twig extract is something else?

3. If my father has gefitinib resisstance, what is the next step of treatment for him? Is there any new generation of Gefitinib yet? Where can my father have clinic trials as my father permanantly live in Vietnam? Is Singapore the nearest place to have?
Thank you very much.



Hello Mickey, I'm so sorry that your dad is going through all this. Please understand our faculty can not provide advice for your father but will provide information known on the subject.

Dr. West has written 2 blog/post in the past month on the subject of resistance to EGFR inhibitors.

Here are the latest links on the subject of tarceva and gefitinib resistance.…

Have you seen our thread on treatments for side effects of gefitinib and tarceva? The first thing seems to be be proactive. Encourage your father to keep his skin moisturized, right out of the shower.

Here is a link to gefitinib and tarcava side effects care.

Your question regarding paw paw has been assigned to one of our GRACE Faculty. You will receive a response as soon as possible. Some answers may also require additional research time, but you can usually expect a response within 1-3 days.
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forum moderator

Posts: 2753

Hello Mickey,

While waiting for the faculty to respond, you might want to look at this previous forum discussion of paw paw: In that discussion, I quoted GRACE contributor Dr. Bufi on his thoughts on paw paw:

"Dr. Bufi has posted his thoughts here on paw paw (graviola - annona muricata): The bottom line: "I would not take or recommend a graviola product or any graviola extract as a dietary supplement. We do not have any convincing proof of efficacy, dosage, concentration, purity, nor basic safety data on the graviola plant."

Forum Moderator

Dr West
Posts: 4735

Thanks to Jim's great summary, I have little to add. The question of what to do in the setting of acquired resistance to an EGFR inhibitor is a very current one, and it doesn't have a clear best answer. I favor either switching to a standard chemo doublet, as you'd do if you were starting someone on first line therapy if they didn't have an EGFR mutation, and I sometimes have patients continue the EGFR inhibitor (if they're demonstrating relatively modest progression and some of the disease appears to still be controlled by the targeted therapy), or just switch to the chemo and discontinue to the EGFR inhibitor, with a thought of re-trying it later, after an interval off of it (where you can occasionally see a response again, and many patients at least demonstrate stable disease again for several months).

I don't recommend paw paw personally, as I know of no truly meaningful, compelling evidence that it improves cancer outcomes in real (human) patients. I cannot speak to potential interactions, but the potential for negative interactions would only make me more wary about including an unproven treatment in the regimen I would otherwise recommend.

Good luck.

-Dr. West

dr walko
Posts: 102

In terms of drug interactions, the papaya or "paw paw" itself appears to not interact with gefitinib, however the lack of information available may very well be due to lack of investigations so I cannot definitively say it would be safe. Ultimately, I agree completely with Dr. West's comment and the US recommendation to avoid it until more is known about efficacy, safety, and dosing.

I will say that green tea is known to block the common enzyme (CYP3A4) that breaks down gefitinib and so use of green tea can increase the amount of gefinitib in the body and lead to more side effects. A logical question is "how much" green tea and this is something that is not well known since different green tea extracts contain differing amounts of the substances that can block enzymes.

Since I feel like I'm always saying "very little data available" to inquiries like this, I will shed a bit of positive light on the topic and say that more attention is being given to characterizing herbal product drug interactions (especially at my institution) so hopefully we will be filling in some of these knowledge holes.

Best wishes,
Dr. Walko

Posts: 2

Thank you very much for your information and great advice.

My father has been on gefitinib for 1 month now. He has some skin rash, dry mouth and tongue, diarrea sometimes. However, he is fellIng better. He is walkingeveryday. I have been reading a lot about nutrition, food for cancer patients to help him better as well as the alternative and complementary therapy(beside paw paw leaf extract- like reishi mushroom, soursop fruit...). Do you have any research about it?

Please advise me more about the good nutrition for my dad and look forward to hearing more from you about the alternative and complementary therapy for cancer patients.

Thank you again for your time and look forward to hearing from you soon.
Tracey Hoang

Dr West
Posts: 4735

It's encouraging to know he's more active. I'm hoping you'll see a favorable report at his next scan that is consistent with his clinical improvement.

Here is a post from a cancer center nutritionist on goals and guidelines of people with cancer:…

If you search the site for "Kelay Trentham", the person who presented this work, you'll find some related posts here. Unfortunately, there isn't really much strong research in the field that provides clear recommendations.

Good luck.

-Dr. West