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Alternative and Integrative Cancer News & Information
May 2009
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Should I take antioxidants like vitamins C and E with chemotherapy? Can I take some immune boosting herbs like garlic or green tea when I receive radiation therapy? Will it help or hurt me? Questions like these are probably asked hundreds of times every day by cancer patients. Apparently, there are a number of viewpoints on this topic. As we will see from the four articles below, there is not a consensus of opinion. Therefore, when making a treatment decision about this important topic you should always speak with a qualified integrative doctor who has sufficient training and expertise in this area to guide you appropriately.

Disclaimer - Please Read: None of the information in CancerWire is a substitute for professional medical advice, examination, diagnosis or treatment and you should always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to an existing treatment. No information contained in Cancer Monthly or CancerWire including the information below, should be used to diagnose, treat, cure or prevent any disease without the supervision of a medical doctor.

Vitamin C Reduces Effectiveness of Cancer Drugs
 
Heaney


This article is based on a study conducted by Mark L. Heaney and others. Dr. Heaney is a hematologist and oncologist at the Memorial Sloan-Kettering Cancer Center. He specializes in Leukemia, Lymphoproliferative Disorders, and Lymphomas.

Vitamin C is a powerful antioxidant that some research has suggested might help cancer patients, but a new study in the journal Cancer Research finds that taking vitamin C may actually lessen the effectiveness of cancer treatment.

"The use of vitamin C supplements could have the potential to reduce the ability of patients to respond to therapy," Mark L. Heaney, associate attending physician at Memorial Sloan-Kettering Cancer Center said in a statement.

In the 1970s, Nobel-prize winning scientist Linus Pauling suggested that high doses of vitamin C might help cure cancer. The idea has been controversial, however, and some research finds that the antioxidant might actually have the opposite effect.

Dr. Heaney and his colleagues tested the effects of vitamin C on myeloid leukemia and lymphoma cancer cells in a laboratory. When the cells were exposed to vitamin C before being treated with chemotherapy drugs, the drugs became 30 to 70 percent less effective. The more vitamin C that was in the cells, the less effective the chemotherapy became.

Then the researchers injected cancer cells into mice. They found that mice given vitamin C before chemotherapy had tumors about four times larger than mice treated with chemotherapy alone.

The question was - why did vitamin C reduce the chemotherapy drugs' effectiveness? Initially the researchers thought it was due to the antioxidant effects of vitamin C. Some types of chemotherapy drugs produce molecules called reactive oxygen species (ROS), which lead to cancer cell death. Vitamin C combats these molecules, helping the cancer cells remain intact even after chemotherapy treatment.

However, the researchers discovered that the primary mechanism actually lies in the energy-producing structures in cells called mitochondria. Chemotherapy drugs work, in part, by damaging the mitochondria, which triggers cancer cell death. Vitamin C protects mitochondria cells from this damage. "Vitamin C appears to protect the mitochondria from extensive damage, thus saving the cell," according to Dr. Heaney.

Although the researchers say their results need to be confirmed in future studies, they could affect the use of vitamin C in cancer patients receiving chemotherapy. They say their findings are directly applicable to treatment regimens, because the concentration of vitamin C used in the mice was similar to the concentration in patients who take vitamin C supplements.

Dr. Heaney says vitamin C is helpful for protecting healthy cells because it preserves the mitochondria. "But that isn't what you want when you are trying to eliminate cancer cells," he says. He suggests that cancer patients eat a healthy diet rich in vitamin C-rich foods, but he does not recommend taking large doses of vitamin C supplements.

Sources:

Heaney ML, et al. Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs. Cancer Res. 2008;68;8031-8038.

"Vitamin C Supplements may Reduce Benefit from Wide Range of Anticancer Drugs." News release. October 1, 2008.


Herbal Remedies Can Interact with Cancer Drugs
 
Engdal


This article is based on a study performed by Silje Engdal and her colleagues at the Norwegian University of Science and Technology.

Many cancer patients who are on chemotherapy also take herbal remedies to ease treatment side effects or improve their quality of life. Yet according to a study in the March 2009 issue of Integrative Cancer Therapies, at least half of these herbal remedies are untested, and many could have potentially harmful interactions with conventional cancer treatment.

Because herbal remedies are considered to be "natural," many patients are under the impression that they are free from side effects, but that isn't necessarily the case. "Herbal remedies are not as innocent as many people believe," explains study author Silje Engdal, PhD, MPharm, an investigator in the Department of Cancer Research and Molecular Medicine at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. Interactions between herbal remedies and chemotherapy drugs could reduce the effectiveness of the treatment drug, or lead to adverse side effects, Dr. Engdal says.

Yet very few studies are available to confirm what, if any, interactions herbal remedies might have with chemotherapy drugs. Those studies that do exist are often poorly standardized. "One garlic product may not contain exactly the same components in the same amount. Therefore it is difficult to draw conclusions from studies based on different brands of the same remedy," Dr. Engdal says.

To determine the prevalence of chemotherapy-herb interactions among cancer patients, the researchers surveyed 112 adult cancer patients. Patients were asked about their cancer treatment, herbal remedy use, and any side effects they'd experienced. Forty-two of the patients said they were using herbal remedies along with chemotherapy, and 29 of them (69 percent) were taking these remedies on a daily basis-an average of two herbal remedies per day. The most common herbs used by study participants were garlic, ginger, green tea, and noni juice (juice from a Tahitian tree in the coffee family).

Only one of the patients who was taking herbal remedies reported any adverse effects. However, this low number of reported problems may be because chemotherapy itself causes side effects, and patients may have mistakenly attributed any side effects they experienced to the chemotherapy drugs. "In addition, patients think herbal remedies are safe without any side effects, thus the patients will not connect the adverse reactions with the herbal remedies," Dr. Engdal says.

It was difficult to confirm whether any of these herbs might have potential interactions with chemotherapy drugs, because research data weren't available for more than half of the herbs used by patients in the study. Only four of the herbal remedies had been studied: green tea, valerian, garlic, and Echinacea.

For green tea and Echinacea, the studies that do exist indicate the potential for significant interactions with chemotherapy drugs. Of particular concern is the possibility that these and other herbal remedies might affect the metabolism or transport of the chemotherapy drugs, altering the concentration of these drugs in the patients' blood. "If the concentration of the drug in the blood is decreased, the drug may be less effective than expected. If the concentration in the blood is increased, the risk of adverse effects is increased," explains Dr. Engdal. Any change in blood concentration - however slight - is of particular importance with chemotherapy drugs, because the amount of the drug that causes no effect on the cancer cells may be only slightly lower than the amount of the drug needed to cause adverse effects.

The potential for interactions between herbal remedies and chemotherapy drugs needs further study, according to the authors. Until then, cancer patients should use these remedies with great caution. "Patients should tell their doctor if they choose to use herbal remedies together with conventional medicine," says Dr. Engdal. "That way, the doctor can take the herbal remedy into account if unexpected adverse reactions occur or the treatment is not as successful as expected."

Sources:

Engdal S, Klepp O, Nilsen OG. Identification and exploration of herb-drug combinations used by cancer patients. Integr Cancer Ther. 2009;8:29-36.

Picture Credit of Silje Engdal by Ivar Xrnes


Antioxidant-and-Chemotherapy Combo Shows Significant Benefits
 
Block


This article was based on a study performed by Dr. Keith Black and his colleagues. Keith I. Block, M.D., is the Director of Integrative Medical Education at the University of Illinois College of Medicine; Medical Director of the Block Center for Integrative Cancer Treatment in Evanston, Illinois; and editor-in-chief of the peer-reviewed journal Integrative Cancer Therapies.

Despite lingering beliefs to the contrary, recently examined data strongly indicate that for most cancer patients, using antioxidant supplements during chemotherapy is not only safe, it often enhances its effectiveness.

Researchers from the University of Illinois at Chicago and the Institute for Integrative Cancer Research and Education have published a review that may have you rethinking your opinions about this controversial topic.

"There's a lot of confusion surrounding this issue, and the advice coming out of many medical institutions is based on the belief that antioxidants may interfere with the chemotherapeutic effect on cancer tissue," says lead author Keith I. Block, MD. "The question has been, Do antioxidants protect healthy tissue, or do they protect cancer tissues from effects of chemotherapy?"

After examining the literature from 845 studies of the simultaneous use of antioxidants and chemotherapy, the team found that 19 studies met the study design criteria to include in the review - all randomized controlled clinical trials, which yield the most scientifically sound data. A total of 1,554 patients with a wide variety of cancers (most advanced or relapsed cases) were evaluated.

The studies examined the impact on 17 different chemotherapy drugs when they were used in conjunction with one or more of the following antioxidant supplements:

7 Glutathione
7 Melatonin
7 Vitamin A
7 Antioxidant mixture
7 Vitamin C
7 N-acetylcysteine
7 Vitamin E
7 Ellagic acid

What the team found, Block says, was "solid and consistent data showing that antioxidants did not interfere with chemotherapeutic effects - and in fact mitigated cancer treatment toxicity - in most patients." Here are just a few examples of their findings:

7 Thirty-one percent of patients who used vitamin E supplements experienced neurotoxicity during treatment, compared to 86 percent of the control group. Patients had malignant cancers that included lung, head and neck, ovarian, and testicular.

7 Glutathione use during chemotherapy resulted in significantly reduced neurotoxicity - and significantly improved tumor response and survival rates - among patients suffering from cancers that included ovarian, colorectal, and gastric.

7 A number of studies showed that patients who used melatonin supplements had consistently better chemotherapeutic responses, significantly fewer side effects, and significantly higher survival rates overall compared to patients who did not use melatonin. Cancers included in these data include lung, colorectal, and breast.

7 In one study, metastatic breast cancer patients who used vitamin A supplements had more than double the treatment response rates of patients in the control group - and 38 percent experienced complete tumor shrinkage. In another study, 43-month survival rates among post-menopausal women was 78 percent, compared to 19 percent among women who did not take vitamin A supplements.

Shrinking tumors and lengthening lives is of course what cancer treatment is all about, but don't underestimate the importance of reducing side effects. After all, fewer ill effects mean fewer patients forego their prescribed chemotherapy regimens.

When patients get sick from chemotherapy, their regimens often are interrupted - either on their doctors' orders or because they choose to stop following them. In fact, Block says, side effects lead as many as one-third of cancer patients to abandon treatment altogether.

Both common sense and existing research tell us that by reducing dosing and interrupting or diminishing a patient's chemotherapy schedule, the efficacy of the treatment - and therefore the outcome - is diminished.

"The potential for antioxidants to reduce chemotherapy side effects is the larger issue behind our research," Block says. "Fewer side effects mean more patients will complete their prescribed regimens at the full recommended dosages and on schedule. We believe the research suggests that antioxidants can not only diminish toxicity, they can improve outcomes in terms of tumor response, survival rates, and treatment tolerance."

Confused and concerned chemotherapy patients often believe they're taking the conservative route by avoiding antioxidants, says Block, "but science substantially supports an approach that integrates both. If you want to pursue therapies that are evidence- based, the current body of knowledge clearly suggests that most people are better off using antioxidants in conjunction with chemotherapy than not."

This is not to say that there won't be an occasional interaction or adverse effect from the use of supplements; there will be, he says.

"When it comes to combining natural products with conventional therapies, people should not assume that all natural products work well with all conventional treatments in all patients," says Block. "Integrative medicine needs to be individualized, but the average patient can benefit from a chemotherapy-supplement regimen that's tailored to his or her individual needs, and put together with a clear understanding of how the various drugs and supplements might interact."

"There are a lot of variables that we can do something about - and those include our lifestyles and diets, as well as the individualized use of antioxidant supplements," he says. "By precisely combining conventional and complementary therapies like antioxidant supplementation, and tailoring that regimen to the needs of each patient, we can have a substantial effect on mitigating toxicity and patient outcomes."

Source:

Block KI et al., Impact of Antioxidant Supplementation on Chemotherapeutic Efficacy: A Systematic Review of the Evidence from Randomized Controlled Trials, Cancer Treatment Reviews (March 14, 2007)


Antioxidants Can Reduce Side Effects and Prolong Survival
 
Simone


This article is based on a study written by Dr. Charles Simone and his colleagues. Dr. Simone is a Medical Doctor, Medical Oncologist, Immunologist, and Radiation Oncologist. He's the author of numerous books on cancer and is the founder of The Simone Protective Cancer Institute.

If you are a cancer patient who has undergone radiation or chemotherapy therapy, there's a pretty good chance you have been advised by a doctor to avoid antioxidant supplements and other nutrients during your treatment. The reason you've likely been given is that these compounds reduce the effectiveness of these therapies and therefore, shorten life spans.

This is not only inaccurate, the opposite is actually true in most cases, says Charles B. Simone, MD, of the Simone Protective Cancer Institute in Lawrenceville, NJ.

Although data dispelling these misconception have been published in the U.S. since the 1970s, "most doctors completely ignore it," says Simone, who led a recently published review* of 50 human studies conducted between 1965 and 2003. The studies were comprised of a total of 8,521 demographically diverse cancer patients.

The review addresses several prevailing assumptions about the use of supplemental antioxidants and other nutrients during chemotherapy and radiation treatment.

The first is that doing these things in tandem shortens patients' lives. However, two-thirds of the 8,521 cancer patients his team studied had increased life spans, Simone says. In one study, patients who could or would not undergo conventional therapies were offered spots in government-sponsored diet studies. These patients lived the same amount of time or longer than those who opted for conventional therapies.

The second misconception is that supplement usage interferes with the physiological workings of chemotherapy and radiation treatments. Again, there has been no evidence that this is the case, says Simone. Instead, antioxidants and nutrients fuel the body for its fight, increasing the number of tumor cells killed by these therapies.

Third, many people believe that patients who take supplemental antioxidants and other nutrients during these traditional therapies suffer from more side effects. But, Simone says, patients consistently have reported experiencing fewer side effects overall.

Simone largely traces the bad press about combining antioxidants with chemo to a 1997 New York Times article in which two physicians from a prominent cancer center "told cancer patients not to take antioxidants and other vitamins while receiving chemotherapy and radiation therapy," he says. "The entire oncology community took the same position without ever reviewing the evidence" - and passed the misinformation along to their patients.

(Simone's practice conducted an unpublished study of 650 consecutive patients within a year's time. 85 percent said they had been told not to take vitamins during treatment. Perhaps more interesting, the majority said they would listen to their doctors before they would believe the scientific evidence.)

"If your doctor tells you not to take antioxidant supplements or nutrients during your treatment, ask him or her to show you the rationale for this decision from a peer-reviewed journal," Simone says. "It cannot be produced because there isn't any."

The bottom line, he says, is that "our study shows that millions of cancer patients who receive chemotherapy and/or radiation therapy should take antioxidants and other nutrients because there is no interference, there is greater cancer destruction, there are fewer side effects, and about two-thirds of the patients live longer."

Source:

Simone CB 2nd et al., Antioxidants and Other Nutrients Do Not Interfere with Chemotherapy or Radiation Therapy and Can Increase Kill and Increase Survival, Part 1. Altern Ther Health Med. 2007 Jan- Feb;13(1):22-8.


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