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.

SIGNIFY - New UK LFS Study

I am happy to be in a position to confirm that a new UK study will look at active surveillance for Li Fraumeni Syndrome patients. The SIGNIFY study, which is now at the final stage of approval, is being run by the Institute of Cancer Research and will initially be available at two centres, Manchester and the Royal Marsden. The protocol will look at the effectiveness of annual whole body and brain MRI scans in confirmed LFS patients. A secondary part of the study will look at the psychological impact of screening.

Recruitment to this new study hasn't started yet, and there is a possibility that it may change slightly before it gets complete approval. As soon as the trial is confirmed and we have some more concrete information details will be posted here. The people running the study are in touch with the George Pantziarka TP53 Trust and will keep us informed.

Aside from anything else, this is a good example of how the forum on the Trust's web site is turning into a valuable tool. The first mention of the proposed trial surfaced there last week, and now we have official confirmation. Thanks to all those who first raised the alert.

Peripheral Neuropathy and Chemotherapy

Side effects from chemotherapy can often be worse than the symptoms of cancer itself - as many patients know, and as we know from our experiences with our son George. For taxane-based chemotherapy, such as Taxol, Paclitaxel and Docetaxel (which is one of the drugs that George had), one of the worst side effects is called peripheral neuropathy. This involves nerve damage, particularly in the hands and feet. It usually manifests as tingling, numbness, burning or pain, but can also involve blood pressure changes, balance problems, constipation and a range of other problems.

It can be severe, and in our case it got so bad that George ended up having to come off treatment, with disastrous results in the end. Again, this is common, and so-called 'dose limiting toxicities' mean the treatments are scaled back or stopped, even when they are showing some signs of effectiveness. Obviously, finding good ways to stop the side-effects means that patients can continue with treatments, and also their quality of life doesn't descend into misery.

Which makes the results of a recent clinical trial worth noting. This was a randomised placebo-controlled trial - which means some patients got the treatment and some got a dummy pill and then the two groups of patients were compared to see what difference the treatment made. The trial was specifically looking at peripheral neuropathy in cancer patients being treated with Paclitaxel. And the treatment being tested? Omega-3 fish oil capsules three times a day. Yep, good old fashioned fish oils rather than some fancy new drug.

The results? 70% of the fish oil patients didn't get peripheral neuropathy, will in the control group it was only 40% that didn't. Not only that, there was a clear tendency for the symptoms to be less severe in the fish oil group for those patients who did suffer some symptoms.

Given all of the other positive benefits of fish oils, this is certainly a study worth bringing to the attention of your oncologists if you're being treated with Paclitaxel or other taxane-based drug. Let's hope that the trial is replicated soon so that results are confirmed.

Anyone looking for the details should take a look at the (open access) paper reporting the result here: http://www.biomedcentral.com/content/pdf/1471-2407-12-355.pdf

Fighting Cancer?

I've written before about the metaphor of a "war on cancer" - not a phrase I find particularly helpful. One aspect of this "war" is that patients are seen as in a personal battle with the disease. They are in a fight with cancer - the disease is at war with them - and the weapons in that war are toxic treatments like chemotherapy, radiation and radical surgery. I don't think these are useful images and are more likely to inspire horror than hope.

I am reminded of all this by reading a really interesting blog post from a person with Li Fraumeni Syndrome and who currently has a rare form of cancer called Leiomyosarcoma,. The blog is called 'Always Look On The Bright Side...' - and the post on 'Fighting Cancer - A Personal View' is well worth a read.

An Anti-Cancer Polypill

The big health news story of the day is on the report that adoption of the 'polypill' - the proposed pill that combines a statin with three common blood pressure drugs. According to the authors of the study, rolling this polypill out to all over 50s will save tens of thousands of lives (I've seen different numbers in different reports, but they all agree it's a significant fugure). The rationale of the pill is that by taking these relatively cheap and non-toxic drugs lives will be saved by reducing the number of heart attacks and strokes. However, the effect should, in theory, extend to lives saved by preventing cancer. There's pre-clinical evidence that at least two of the drugs - simvastatin and losartan - have cancer prevention properties.

The idea of a polypill is one that I'll be exploring later in the year when it comes to cancer, and specifically for Li Fraumeni Syndrome and other hereditary cancer syndromes. An anti-cancer polypill would take simvastatin and losartan - one half of the current polypill - and add two additional drugs - aspirin and metformin. I believe that such an anti-cancer polypill has huge potential, both for the over 50s and also for people at high risk of cancer, including those who've been treated for the disease and are in remission.

As I said, this is an area that I'll be exploring in more detail in the future, so watch this space...