A Medical Outrage

Imagine that you are suffering from a rare and aggressive form of cancer, and after the failure of all your treatments you find yourself days away from death. Unwilling to just give up and die you seek out a different treatment and, miraculously, things stop getting worse and start to turn around. This isn't a miracle cure - the cancer is still there - but you start to gain strength, you become more mobile, you have stepped away from the brink. Now imagine that if the only doctor who could prescribe this treatment was suddenly stopped from giving it to you. Your life line has just been snatched away.

That's a pretty horrible picture I've just painted, but this is exactly the position that Gary Bowden, suffering from a rare bone cancer called chondrosarcoma, finds himself in. The treatment that has pulled him off the Liverpool Care Pathway is Coley's Toxins, prescribed by Dr Henry Mannings at Star Throwers in Wymondham, Norfolk. Dr Mannings is the only person in the UK licensed by the MHRA to give Coley's to his patients. Yet because of a completely unrelated complaint Dr Mannings has been banned by the GMC from prescribing drugs at Star Throwers. Effectively this is the end of treatment for Gary Bowden and the other patients receiving Coley's.

The whole thing stinks. It's an outrage that patients with no other treatment options are being denied a treatment that is working for them. Not one patient has ever complained about Dr Mannings and his treatments - not one.

I am proud to be a trustee at Star Throwers, and I've seen the statement that Gary Bowden wrote to the GMC prior to the hearing against Dr Mannings. It's a catlogue of misdiagnoses, poor treatments and worsening disease. The failure to diagnose his disease for two years doesn't have any spin-offs, but Henry Mannings prescribing at Star Throwers does. It's an outrage.

You can read more about Gary Bowden here: http://www.bbc.co.uk/news/uk-england-norfolk-20579518

Dr Henry Mannings and the GMC

There have been a number of reports in the press and on TV about Dr Henry Mannings and Star Throwers. I have written about Dr Mannings and his use of Coley's Toxins before. In my opinion he is above reproach and the case against him without foundation. The following is a statement that has been issued by Star Throwers, the cancer charity that Dr Mannings founded, and where I am glad to serve as a trustee.

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Star Throwers would like to make it fully clear from the outset that we understand the purpose of the GMC Interim Orders Panel is to ensure patient safety, which we are in full agreement with.

Dr Mannings attended a GMC Interim Orders Panel hearing on Tue 27th November 2012, after which the GMC have concluded that there are no grounds for suspension. They have, however, decided to restrict Dr Mannings' prescribing of medication to within NHS premises only.

Star Throwers charity will remain open as usual, with Dr Mannings continuing to offer advice and support to cancer patients and their families.

The restriction is based on the allegations of one oncology consultant at one hospital, and is despite the fact that the two patients mentioned in the allegations had significantly benefitted from the therapy they had received from Dr Mannings. At no time have there been complaints from any of Dr Mannings’ patients or their families.

The loss of prescribing ability at Star Throwers is a loss to many of the patients who have been given up on by their own oncologist.

It is important to note that the IOP's decision is based "on the interest of patient safety" and has no bearing regarding any findings of fact or the veracity of the allegations.

Although we are not allowed to discuss the details of the Interim Orders Panel's decision report, we find the decision made by the panel difficult to understand considering the overwhelming evidence produced in favour of Dr Mannings, particularly by experienced senior oncologists, a professor of oncology, nurses and pharmacists.

We hope that there will be a full public GMC hearing, whose purpose is to decide the veracity of the allegations, within the next 18 months so that the true facts of this case will become evident.

Dr Mannings would like to express how touched he is by the hundreds of letters written and phone calls in support of Dr Mannings and all the staff at Star Throwers.

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In the PINC - stopping the reverse Warburg Effect

There was an interesting report recently on some work in the US looking at the use of a common anti-malarial drug and breast cancer. The drug in question is chloroquine, which is both cheap and widely used throughout the world. Aside from its action against the parasite that causes malaria, the drug is also known as an inhibitor of autophagy, which is a cellular state in which the cell digests parts of itself, normally as a survival mechanism in the face of lack of nutrients or damage to cell components. 

The study in question is called the PINC trial (Preventing Invasive Neoplasia with Chloroquine), which is specifically looking at women with ductal carcinoma in situ (DCIS), which is a pre-cancerous condition that is often picked up through breast screening. DCIS has the potential to progress to fully blown breast cancer. Part of the problem of the over-diagnosis of cancer associated with breast screening is that currently there is no way to be sure which DCIS lumps are going to become life-threatening cancer and which will remain harmless. The PINC trial is about treating women with DCIS who are waiting for surgery with chloroquine for four weeks and then to assess the effect this has on the DCIS lump. More details on the trial are available here: http://clinicaltrials.gov/ct2/show/NCT01023477


While the trial has yet to report it’s findings, the initial signs are looking positive. If chloroquine can stop DCIS lesions from developing into invasive cancers that would be a major step forward for women. Stopping cancer before it develops is a much better strategy than simply turning every woman with a DCIS lesion into a cancer patient because you don’t know how the lesion is going to develop.

Irreversible Electroporation

The three main arms of cancer treatments remain surgery, chemotherapy and radiotherapy - these still form the core treatments for most cancers. Arguably the set of treatments called ablative therapies should be added to that list. These include photodynamic therapy, cryoablation, and radio-frequency or microwave ablation. While these treatments work in different ways, they have some common features, they all:

• physically attack tumours (with heat, cold, laser light etc.)
• can be re-applied (i.e. resistance to treatments doesn't set in)
• side-effects are local and easily controlled
• are little used compared to surgery, chemo and radiotherapy

The last point is an important one, as these treatments have excellent safety profiles and can be targeted to achieve good rates of local control of tumours. The downside is that these treatments have to be applied to individual tumours rather than being able to systemically control widely spread disease. However, when used with other treatments these ablative treatments can make a huge difference to outcomes. As a bonus, for those with mutated tumour suppressor genes like TP53 (i.e. patients with Li Fraumeni Syndrome), there are no unwanted long term risks of other cancers due to DNA damage in surrounding tissues.

Mebendazole - Tumours and Tapeworms

There’s a big push by some in the cancer research community to look at old drugs to see if they’ve got some anti-cancer activities. It makes a huge amount of sense to do this as it short circuits all of the phase I trials to test a drug’s toxicity, often these drugs are cheap generics and there’s many years of data on pharmacokinetics and side effects and so on. It means that in a best case scenario you can cut out years of preliminary work. Some of the drugs, like the anti-diabetic drug Metformin or plain old Aspirin also have evidence of anti-cancer effects in the population rather than just from test-tube experiments or computer simulations. And the good news is that the list of such drugs is growing longer by the day, and the evidence continues to mount up that some of the best candidates will enter use soon either as support to existing treatments or, in some cases, as part of new protocols to prevent recurrence of disease after treatment.

One of the more surprising drugs in Mebendazole, an old drug that has been around for a long time as a treatment for parasites like tape-worms. Mebendazole, which is available over the counter in any case, has got a surprising amount of evidence in its favour as an anti-tumour drug. This evidence comes from modelling the molecular profile of the drug to see how it fits with particular cancer pathways, from experiments in test tubes and in animal testing using human tumours. As pre-clinical evidence goes, that’s pretty much the works.

Fund-raising In George's Memory

Once your child is diagnosed with cancer your world changes forever. Aside from the immediate shock, you find yourself and your child immersed in a nightmarish environment of hospitals, treatments, stress and worry. Even the nature of time changes once you enter into treatment - days blur into each other in hospital, respites at home seem to fly by, and there's the endless waiting - for appointments, for drugs, for scans and for results (which is the worst of the waiting). After a while you learn to navigate through the ins and outs of the medical system, working out what you can and can't do, what services exist and where you can find them and so on.

Like a lot of families in that situation we found that there was one organisation that helped us found our way and that was the children's cancer charity CLIC Sargent. The help they offered was purely practical - finding out what we could do about schooling will George was having chemo, helping to sort out the endless paperwork that comes with the territory (and believe me, some of the forms we had to deal with would have been horrendous at the best of times, let alone when dealing with cancer), offering a shoulder to cry or helping us find the best person to deal with specific questions.

Maureen and the rest of the CLIC Sargent team at the Royal Marsden is Sutton were just fantastic. So when asked to nominate a charity for some fund-raising in George's name they were the first name to come to mind. If we had been further along in organising the George Pantziarka TP53 Trust the fund-raising by my colleagues at work would have been for that. But given where we are, there's no doubt that CLIC Sargent deserve your support.

So, please take a look at the ISG Clarendon Relay Marathon Team Challenge here: http://www.justgiving.com/Clarendon-for-George-Pantziarka and help raise some funds for a very worthy cause.

Chemo, Radiotherapy and Fasting

A while back I wrote about some work by Valter Longo and his colleagues looking at the effects of short-term fasting on cancer progression (here: http://www.anticancer.org.uk/2012/02/fasting-and-chemotherapy.html). They showed that short term fasting can slow tumour progression in a range of different cancer types and can sensitise tumours to standard chemotherapy drugs. While this work was performed in mice, it was solid research that is already being followed up in a number of clinical trials.

In the latest update to their work, Dr Longo and his team report that short term fasting also helps to sensitise cells to radiotherapy. This time the work looked at gliomas - aggressive brain cancers - again in mice. This time they looked at how the standard treatments for gliomas, including glioblastoma multiforme, were improved by the adoption of short term fasting. Both chemotherapy (Temozolomide) and radiotherapy had improved responses in those mice subject to complete withdrawal of food for short periods (48 hours) compared to control groups.

These results are in mice, but again there is no reason why they should not apply to people. Though whether there is the same degree of response is an open question which can only be answered through clinical trials.

For the moment this is yet another small step forward and confirms once again that cancer is more than a disease of delinquent cells, and that disordered metabolism is a key feature with clinical significance.

For those wanting the full details of this new research, it has been published in the open access journal PLOS One: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044603

The final word has to be this. If you're a cancer patient and want to try this out for yourself, make sure you talk to your oncology team to ensure you get the support you need.