Mar
11
2017

Obesity And Diabetes Can Cause Cancer

Dr. Nalini Chilkov gave a talk about how obesity and diabetes can cause cancer. The original title was “Integrative Cancer Care, Increased Rates of Cancer and Cancer Mortality Associated with Obesity and Insulin Resistance, Nutraceutical and Botanical Interventions”. Her talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

In the following I will present a brief summary of her lecture.

Obesity is a major risk factor for cancer

Obesity causes 14% of all cancer deaths in men and 20% of cancer deaths in women.  This link explains this in more detail. The following 15 cancers were linked to obesity in terms of causation. They are: colon cancer, gastric cancer, gallbladder cancer, ovarian cancer, breast cancer, liver cancer, uterine cancer, endometrial cancer, rectal cancer, pancreatic cancer, cervical cancer, non-Hodgkin’s lymphoma, renal cancer, multiple myeloma and esophageal cancer.

The American Society of Clinical Oncology reported about a meta-analysis involving 82 studies. This involved more than 200,000 women with breast cancer. Premenopausal and postmenopausal women were compared who were obese or normal weight. Premenopausal, obese breast cancer women had a 75% increase in mortality compared to the normal weight breast cancer group. With postmenopausal, obese breast cancer women there was a 34% increase of mortality compared to the normal weight group.

With obese prostate cancer patients there is a similar observation. Obese patients have a more aggressive prostate cancer on the Gleason score and the cancer is in a more advanced stage at the time of diagnosis.

Diabetes increases mortality from cancer

Obesity is a common risk factor for both cancer and diabetes. But diabetes by itself is also increasing mortality of several cancers. In a consensus report details of the relationship between cancer and diabetes have been discussed in detail. The following cancers have been identified to have an increased risk of diabetes: pancreatic, gastric, esophageal, colorectal, liver, gallbladder, breast, ovarian, endometrial, cervical, urinary bladder, renal, multiple myeloma and non-Hodgkin’s lymphoma.

A meta-analysis suggests that cancer patients who are diabetic have a 1.41-fold increased risk of dying compared to those cancer patients who have normal blood sugars. Dr. Chilkov explained in detail what the various mechanism are that account for the faster cancer growth in obese and diabetic patients. High insulin levels is one of the risk factors, so is IGF-1, an insulin-like growth factor. The aromatase enzyme in fatty tissue turns male type hormones into estrogen, which also can stimulate cancer growth.

Carbohydrate restriction diet to prevent obesity

Low carb diets like the Mediterranean diet, the ketogenic diet and the Atkins diet will drop blood insulin and lactate levels. Cancer size and cancer growth are related to insulin and lactate levels. A low carb diet can reduce insulin-mediated uptake of sugar into cancer cells.

Research has shown that cancer metabolism slows down when a 10%-20% carb/high protein diet is consumed by the patient. This reduces the amount of sugar that is taken up by cancer cells. It also reduces insulin, so there is less cancer growth. A ketogenic diet is a more strict way to restrict carbohydrates. Intermittent fasting is also a useful method to reduce carbohydrate intake.

Here is an interesting study that illustrates the power of intermittent fasting. The study involved 2413 patients with early breast cancer who were followed for 7 years. Those breast cancer patients, who consistently did not eat anything between dinner and breakfast for 13 hours or more, had a 36% lower risk of having a cancer recurrence. There was also a 21% lower risk of dying from breast cancer when fasting was done for 13 hours or more overnight.

Supplements to prevent obesity, diabetes and cancer

A low carb diet and in some cases even a ketogenic diet is beneficial as a baseline. A regular exercise program is also useful for general fitness building and cardiovascular strengthening. In addition Dr. Chilkov recommended the following supplements.

  1. To reduce inflammation in the body, Dr. Chilkov recommended taking 2000 to 6000 mg of omega-3 fatty acids per day (molecularly distilled fish oil).
  2. Berberine 500 to 1000 mg three times daily. Dr. Chilkov said that Berberine has anti-cancer properties, improves insulin sensitivity and reduces absorption of sugars in the intestinal tract.
  3. Curcumin inhibits cancer cell division, invasion and metastatic spread through interaction with multiple cell signaling proteins. Several researchers showed that curcumin could lower blood sugar levels by stimulating insulin production from beta cells in the pancreas. Triglycerides, leptins and inflammation in fat cells are also lowered by curcumin. Insulin sensitivity increases through the action of curcumin. Dr. Chilkov recommended 300 mg/day of curcumin for 3 months.
  4. Resveratrol, the bioflavonoid from red wine is a powerful anti-inflammatory. This antioxidant has several other effects, which make it challenging to measure each effect by itself. This group of investigators managed to simultaneously measure these effects. They found that resveratrol lowered the C-reactive protein by 26% and tumor necrosis factor-alpha by 19.8%. Resveratrol also decreased fasting blood sugar and insulin; in addition it reduced hemoglobin A1C and insulin resistance. The recommended daily dose of resveratrol is 1000 to 5000 mg.
  5. Green tea catechins (EGCG) help to normalize the glucose and insulin metabolism. The dosage recommended was 1-3 grams per day.
  6. Reishi mushroom (Ganoderma lucidum) contain polysaccharides with antidiabetic and antiobesity effects. They make gut bacteria produce three types of short-chain fatty acids that control body weight and insulin sensitivity.
Obesity And Diabetes Can Cause Cancer

Obesity And Diabetes Can Cause Cancer

Conclusion

Obesity is a risk factor not only for diabetes, but also for cancer. Chronically elevated blood sugars, increased fasting insulin levels and increased IGF1 levels can cause cancer. In addition they can stimulate tumor growth and increase cancer mortality. It is for this reason that the health care provider should screen all diabetics for cancer. In her talk Dr. Nalini Chilkov gave clear guidelines what supplements will be beneficial to reduce the risk of obesity and diabetes as well as cancer. Start with a healthy, balanced diet. Add an exercise program. Then consider some of the above-mentioned supplements to reduce your risk for cancer, diabetes and obesity.

Jan
02
2017

Gut Bacteria Can Protect Your Brain

The neurologist, Dr. David Perlmutter gave a keynote address where he pointed out that gut bacteria can protect your brain. The topic of his actual talk was “Rewrite your brain’s destiny” and the venue was the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. Many of the talks centered around the gut microbiome. In this talk Dr. Perlmutter stressed the fact that the right mix of gut bacteria will protect your brain, while the wrong mix can make you sick. There were many slides, but too much information to mention all of details of the talk here. I will summarize the broad outline of Dr. Perlmutter’s presentation and emphasize the practical implications this has for everyday life to prevent degenerative brain diseases.

A few facts

  1. Did you know that the brain uses 25% of the body’s energy, but has only a 3% of the body’s weight?
  2. The gut flora has trillions of gut bacteria with its own DNA material. 99% of the DNA material in our body comes from the gut bacteria and the bacteria on our skin surface; only 1% of the entire DNA in the body is your own DNA. We are eating for 100 trillion bacteria, but if they are good bacteria they provide us with important vitamins and they produce molecules that stimulate our immune system.
  3. This means we better have bacteria in our guts that are friendly, not the bad bacteria that can cause us problems. An Italian study determined the gut flora of children in central Africa (Burkina Faso) and compared the gut flora to children from developed countries in Europe. There was a significant difference with the African children having a healthy microbiome in the gut and the children from developed Europe having unhealthy gut bacteria. This is important new information. Many other research papers have established that leaky gut syndrome and autoimmune diseases are linked to dysbiosis, which is the name for the unhealthy microbiome in the gut.

Chronic inflammation

Dr. Perlmutter showed several slides where literature was cited showing that chronic inflammation in the civilized world is increasing. He also showed that dysbiosis (unhealthy gut bacteria taking over) is also increasing. On several slides Dr. Perlmutter showed that in civilized countries like Iceland, Denmark, Germany, the US, Japan and others the bacterial diversity of the gut bacteria in people was vastly reduced compared to the diversity of gut bacteria of people in Kenya, Ethiopia, Nigeria or rural India. The same countries that have diminished gut bacterial diversity (dysbiosis) also have the highest prevalence of Alzheimer’s disease. On the other hand the same countries with diverse gut bacteria have a low incidence of Alzheimer’s disease. When infestation with parasites was examined there was also a parallel between increased parasitic stress and low Alzheimer’s disease rates, again in countries like Kenya, Ethiopia, Nigeria or rural India. The same countries where gut dysbiosis was present the parasitic infestation was low.

Further research has established that gut dysbiosis leads to an inflammatory condition of the gut where lipopolysaccharides (LPS) from gut bacteria are absorbed causing inflammatory reactions within the body.

At the same time this leaky gut syndrome can cause obesity and leakage in the gut/brain barrier as indicated in this link. The result is neuroinflammation, cognitive impairment and vulnerability to develop Alzheimer’s disease. Our most dreaded brain diseases come from inflammation: Alzheimer’s, Parkinson’s disease, autism, multiple sclerosis etc. These are degenerative brain disorders due to chronic inflammation. If you eat a lot of red meat, sausages and processed foods your gut microbiome will undergo negative changes. If you eat healthy food with lots of vegetables, fruit and you cut out sugar and too many starches, you have a healthy microbiome, which develops a robust immune system. We have to rethink the gut/brain connection and learn how to prevent these chronic illnesses.

Obesity and gut dysbiosis

In the link above it was shown that obesity is associated with inflammation. It was also shown with MRI scans that the part in the brain, called hippocampus was shriveled up (atrophied). This is a typical sign of dementia and Alzheimer’s disease. The investigators also confirmed with mental health functional tests that these patients had cognitive decline.

Another study also noticed that in a group of obese patients the hippocampus part of the brain was shriveled up the more obese people were. Obesity is associated with dysbiosis of the gut flora.

Practical application: the DASH diet and the Mediterranean diet are both healthy, balanced diets, strikingly different from the Standard American diet. In a study the hypothesis was tested whether the DASH diet and the Mediterranean diet would postpone dementia in a group of elderly patients. The answer was: yes, the hypothesis is true.

What does gut dysbiosis do?

It was shown in mice that chronic inflammation of the gut through ingestion of an irritant (dextran sodium sulfate) led to reduced new nerve growth in the hippocampus compared to control animals. It only took 29 days to show a marked difference between experimental and control animals in terms of reduced growth in the nerve cells of the hippocampus, the center of cognitive control.

The negative mediators were inflammatory kinins released from the gut wall and affecting the brain.

Antibiotic treatments and antibiotic residues in milk, milk products, meat, but also in all GMO foods are the irritants of the gut wall in humans. The antibiotics change the gut flora and lead to dysbiosis, which then causes gut wall inflammation and the cascade of events described above. The new finding is that GMO food contains RoundUp (they are “Roundup ready” crops). The herbicide Roundup was originally patented as an antibiotic and still leads to significant dysbiosis. Dr. Perlmutter urged the audience to buy organic food as the only method to reduce our exposure to Roundup. Roundup contributes to causing celiac disease and gluten intolerance in addition to exposure to the modern wheat (Clearfield wheat). The FDA is starting to do testing on foods for Roundup (glyphosate).

If things are sounding bad for Roundup, it only gets worse: Roundup has now been linked to causing cancer. In medicine it usually takes some time before definite action is taken. The agriculture industry is so deeply entrenched in the use of Roundup; I suspect that denial will be the first line of defense. My first line of defense in turn is to stick to organic food.

To sum up: Roundup and the Standard American diet lead to dysbiosis in the gut, which causes leaky gut syndrome. This causes inflammation with the release of cytokines and LPS from the gut wall to the blood. These substances cross the blood/brain barrier and lead to inflammation in the brain. This affects the hippocampus with the classical sign of shrinkage. But Parkinson’s disease, multiple sclerosis, autism in children and Alzheimer’s disease in older people are all caused by chronic inflammation. There are three more brain-related diseases that are related to gut inflammation: stroke, depression and attention deficit hyperactivity disorder (ADHD). Dr. Perlmutter spent some time explaining that antibiotic overuse even leads to an increase of breast cancer as a Danish study has shown. Antibiotic use showed a linear increase of breast cancer as a result of increased antibiotic amounts used. The highest group had a twofold risk compared to a control group with no antibiotic use. Dr. Perlmutter interpreted this to indicate that chronic gut inflammation can even cause a disease like breast cancer.

What can we do to diversify our gut bacteria?

  1. Exercise: A recent study has shown that regular exercise is associated with a diversified gut flora. The reason seems to be the production of butyrate with exercise, which leads to a diversified gut flora. There are reduced LPS levels (lipopolysaccharides from gut bacteria) in people with a higher fitness score.
  2. Eat a DASH diet or the Mediterranean diet as indicated above.
  3. Avoid GMO foods because of the presence of Roundup, which functions like an antibiotic and leads to gut bacteria dysbiosis.
  4. Remember “Antibiotics are weapons of mass microbial destruction”. If you need to take them be careful that you rebuild your gut flora with probiotics. Use of antibiotics increases the risk of type-2 diabetes by 1.53-fold. It also causes a quadrupling of Alzheimer’s disease.
  5. A woman should consider natural childbirth whenever possible, as with a vaginal birth the child is “anointed with gut bacteria”. Vaginally delivered children remain healthier than children delivered by Cesarean section for several years.
  6. Acid-suppressing medications and NSAIDs (anti-inflammatory medication for arthritis) can also lead to dysbiosis. Proton pump inhibitors increase the risk of Alzheimer’s disease by 44%.
  7. Prebiotic fiber can prevent Alzheimer’s. Probiotics do the same.
  8. Avoid sugar: even the Oompa Loompa knew that “If you eat sugar, you get fat” as this YouTube video shows. And obesity is associated with gut dysbiosis with the associated higher risk of degenerative brain diseases.
  9. Take magnesium supplements (250 mg twice per day) and DHA from fish oil capsules. It stabilizes your brain metabolism.
  10. In severe, persistent cases of gut dysbiosis a fecal transplant can be considered by your gastroenterologist. This procedure is done in more than 500 hospitals in the US.
Gut Bacteria Can Protect Your Brain

Gut Bacteria Can Protect Your Brain

Conclusion

The diversity of gut bacteria is immensely important. As discussed, in rural areas of the world there is gut bacteria diversity. In civilized parts of the world dysbiosis of the gut flora frequently occurs. This can lead to gut inflammation and the inflammation eventually gets internalized and can even reach the brain. These are the points to remember: exercise; avoid GMO foods, use prebiotics and probiotics. Avoid antibiotics; also avoid meat from animals that were fed antibiotics for faster growth. Don’t eat processed foods and avoid sugar. A healthy gut creates a healthy body, and this includes a healthy brain as well.

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Dec
11
2016

Cancer Rates Increased In Women

A recent review of cancer rates worldwide shows that cancer rates increased in women. This by itself is alarming, but based on that data the rates likely will go up by 60% in the year 2030. The main reason is the smoking discrepancy among women and men. Men as a group have been smoking more than women. But women as a group are more and more embracing smoking. All of the negative health consequences of the last 3 decades for men are just starting to show now for women as well.

The World Health Organization explains it this way: in high-income countries like Australia, Canada, the US and Western Europe women smoke at nearly the same rate as men.

But in low and middle income countries women do not smoke as much as men do. For instance in China 61% of men are smokers, but only 4.2% of women are smoking. In Argentina 34% of men are currently smokers, which compares to 23% of women who smoke in this country.

When this gap will close, likely by the year 2030 women will have a whole host of diverse cancers, heart attacks and strokes caused by the smoking habit.

Some statistics and facts

High-income countries like Australia, Brazil, Canada, Israel and many northern and western European countries have a 5-year survival rate for breast cancer of 85%. In contrast the 5-year survival rates are 60% or less in low- and middle-income countries like South Africa, Mongolia, Algeria and India.

Cancer prevention measures can make a big difference later in life. Examples are hepatitis B vaccination, which will prevent liver cancer; vaccinating boys and girls against HPV, which will prevent cervical cancer in women; also having regular mammograms will detect breast cancer earlier and improve breast cancer survival rates.

Dr. Nestor Esnaola, surgical oncologist at Fox Chase Cancer Center at Temple University Hospital, Philadelphia, PA said that the cancer prevention methods just mentioned might not be available in developing countries. Instead of mammographies repeat breast self-examinations are more important there. Campaigns against smoking can be utilized in order to prevent cancer of the lungs, the throat and neck. And if colonoscopies are not available, stool samples can be tested for blood and hemoglobin to check for colon cancer.

Different cancer rates increased in women in different countries

There are different cancer types that make the top chart for different countries. For instance in 2012 breast cancer was on top of most countries worldwide as the number 2 killer behind heart attacks and strokes. But other cancers ranked fairly high as well as causes of death: colorectal, lung and cervical cancers.

Despite this trend there were other countries like China and North Korea that had a higher incidence of lung cancer rather than breast cancer. The cancer researchers stated that the reason for this is that the smoking rates are higher in these countries. As already pointed out in China more than ½ of the men smoke, but only a small minority of the women smoke. But women in China are exposed to high amounts of secondhand smoke in addition to environmental pollution, which still causes a lot of lung cancer in women who live in this environment.

In many African countries cervical cancer is very common. Women, who are HIV positive, have a 5-times higher rate of cervical cancer. Southern and eastern Africa where there are higher rates of HIV, have higher rates of cervical cancer.

More data about women’s cancer rates

The American Cancer Society has produced a report entitled “Global Burden of Cancer in women, current status, trends, and interventions”, which points out some interesting statistics.

The greatest numbers of cancer cases and deaths occur among women in Eastern Asia. The estimate for 2012 worldwide was for 1.7 million cancer cases and 1 million deaths in women. China dominated its region with 75% of all female cancer cases and deaths in the region. In North America cancer cases and deaths within the US comprise 90% of the region. The cancer cases and deaths in India make up about 65% of the region of South-Central Asia.

The top mortality rates are found in low to medium income countries, namely in Zimbabwe, Malawi, Kenya, Mongolia and Papua New Guinea.

The most frequently diagnosed cancers in women are breast, lung, and colorectal cancers in economically more developed countries. However, the statistics are different for less developed countries where the top three most diagnosed cancers are breast, cervix, and lung. Similarly the leading causes of cancer deaths for women in developed countries are lung, breast, and colorectal cancers. In developing countries the leading causes of cancer deaths for women is cancer of the breast, lung, and cervix.

Cancer frequencies for women in different countries

The American Cancer Society reports that breast cancer is the most common diagnosed cancer among women in 140 countries. Cervical cancer is most common in 39 countries, all of which are low to medium income countries. There are some countries where other cancer types are more common. For instance in China and North Korea lung cancer is more common among women, in Mongolia and Laos liver cancer, and in South Korea it is thyroid cancer.

The most common cause of death from cancer in women is breast cancer in 103 countries, cancer of the cervix in 43 countries and lung cancer in 27 countries. Other most common cancer deaths in women are in the following countries:

  • Stomach cancer: in Bhutan, Peru, El Salvador, Guatemala, and Tajikistan
  • Liver cancer: in Laos, Mongolia and The Gambia
  • Colorectal cancer: in Japan and Slovakia
  • Esophagus cancer: in Turkmenistan.

Prevention and early detection

Changing the risk factors could modify 20% of breast cancer mortality worldwide. Avoiding excess body weight, physical inactivity and reducing alcohol consumption could all significantly reduce breast cancer mortality. For instance, women with a body mass index of greater than 35.0 have a 1.6-fold higher risk of breast cancer and a 2.1-fold higher mortality rate from breast cancer than women with a body mass index of less than 25.0.

Regular breast cancer screening with mammography is another tool that will reduce breast cancer mortality as the cancer is diagnosed earlier and treated at an early stage where it can often be cured. The WHO recommends for those countries where mammography programs are established that screening should be done only every two years and only between the ages of 50-69 to avoid X-ray over exposure.

Early detection, like for any cancer is the key for successfully treating breast cancer. When the cancer is found early, surgical removal in healthy tissue (lumpectomy) often cures breast cancer. Unfortunately in low to medium income countries the cancer is often found too late, requires more invasive mastectomies and radiotherapy and has a lower survival rate than in developed countries.

Cervical cancer

Cervical cancer accounts for the 4th most frequently diagnosed cancer in the world. In 2012 there were 527,600 cases diagnosed worldwide and 265,700 deaths from cervical cancer occurred in the same year. 90% of cervical cancers occur in developing countries with India accounting for 25% of the total cases. The key in detecting cervical cancer is a regular screening program. In developed countries where this has been in place cervical cancer incidence has decreased by 80% in 4 decades. At the other end of the spectrum are countries like Uganda, Zimbabwe, and some countries of Central and Eastern Europe where cervical cancer rates have been climbing. The reason for the spread is that the human papillomavirus (HPV) is now more common and screening methods for cervical cancer are not in place. HPV 16 and 18 are the most common carcinogenic subtypes of the human papilloma viruses; they are responsible for 70% of cervical cancers worldwide. By vaccinating teenagers before they engage in sex is a powerful tool to interrupt the infectious spread of an important risk factor for cervical cancer.

Instead of the traditional Pap test from the past the new test that is used now is an HPV-DNA test, a cervical swab that will detect DNA from HPV directly. It is more sensitive than the traditional Pap test. If the HPV-DNA test is positive, the patient is sent to a gynecologist who will perform a colposcopy test, which is a microscopic exam of the cervix. The gynecologist can use several effective treatment methods like a loop electrosurgical excision procedure, laser ablation therapy, cryotherapy or conization for deeper cervical cancer lesions.

As with any cancer early detection and treatment is paramount with cervical cancer. In developed countries the 5-year survival rate is 60 to 70%. In India the 5-year survival rate is 46%.

Cancer of the lung

In 2012 there were 583,100 cases of lung cancer in women worldwide and 491,200 died from it. Lung cancer is the second leading cause of cancer death in women and the third most common cancer. The statistics of lung cancer reflect the tobacco epidemic. It takes about 20 to 30 years after widespread smoking begins in a country before the deadly statistics set in. The peak of the cancer epidemic and the heart attack rates occurs about 30 to 40 years following the peak of smoking in that population.

Lung cancer rates in women have lagged behind men, because women as a group have started smoking later. In places like Hong Kong, the United Kingdom,

Australia, and the United States women started smoking earlier, and they are in the process of declining their smoking habit or quitting. This is reflected in the new lung cancer cases and also in the lung cancer mortality rates. Sadly, in many countries of Europe and Latin America women started smoking much later and they are still increasing their lung cancer statistics and mortality rates. Lung cancer killed 1.1 million men and 0.5 million women worldwide in 2012. In addition it is estimated that there are 21,400 lung cancer deaths annually from second-hand smoke in non-smokers worldwide.

Beside smoking there are other risks causing lung cancer. The estimated risk for women to die in millions is: exposure to household air pollution, 1.6; outdoor air pollution, 1.4; second-hand smoke, 0.35; occupational risk factors, 0.10; and residential radon, 0.03.

Cancer Rates Increased In Women

Cancer Rates Increased In Women

Conclusion

Women are still in the midst of a global increase of cigarette smoking, which starts often with female teenagers. As long as the smoking rate goes up there will be more breast cancer, lung cancer and cervical cancer. The American Cancer Society provided a detailed review of various cancers and how they are still increasing worldwide, because nobody pays attention to preventative measures. A simple step to prevent cancer is to quit smoking. Another step is to engage in regular physical activity. Finally keeping your body mass index under 25.0 is a third step that can be done by adopting a Mediterranean diet.

There are several pockets within the developed countries where cancer rates are coming down, which is encouraging. The initial overview and the three examples given here, breast cancer, cervical cancer and lung cancer were thought to illustrate this complex topic.

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Nov
19
2016

New Breast Cancer Cure?

According to the popular press there is a new breast cancer cure. But we have to be careful with general statements like this. First of all, only 20% of breast cancers are HER2 positive. When the surgeon biopsies breast cancer, the sample is sent to the pathologist. Out of 100 samples, 20 come back with the finding that it is HER2 positive breast cancer.

Herceptin ® (trastuzumab), the first step of breast cancer cure

Trastuzumab is a monoclonal antibody that interferes with the HER2 receptor. Its main use is to treat HER2 positive breast cancers. But trastuzumab (brand name Herceptin ®) has serious side effects. In early HER2 positive breast cancer it can cause heart failure in 5.7–35.4% of patients, while it can cure breast cancer with a 35% cure rate of Her2-positive patients. It is significant to note that many of the studies used trastuzumab in combination with the chemotherapeutic agent anthracycline concomitantly. Anthracycline by itself has some cardio-toxic effect. Most of the studies that investigated heart toxicity of trastuzumab used this monoclonal antibody for 52 weeks. Newer studies show that as little as 9 weeks can be as effective in tumor cures, which reduces the risk of toxic effects on the heart to 2.2–2.3%.

Here is a link that shows visually what the effect of Herceptin ® may be on the HER2 surface marker in a woman with this type of breast cancer.

Lapatinib (Tykerb ® or Tyverb ®), the second step of breast cancer cure

Absorption of aging cancer cells, called apoptosis, is inhibited by overexpression of oncogenic receptor tyrosine kinases. These are proteins that normally function to remove dying cells at the end of their life span. In HER2 breast cancer these kinases are particularly common and are responsible for the cancer cell survival. Lapatinib is a dual tyrosine kinase inhibitor, which interrupts the HER2 and epidermal growth factor receptor (EGFR) pathways. Expressed in simpler terms, it removes dying cancer cells, so they cannot get reactivated or continue to survive.

A phase 3 clinical trial was done with Lapatinib and a chemotherapeutic agent, capecitabine (brand name Xeloda ®).  When the two drugs were combined there was a 51% reduction in the risk of the disease progression.

Herceptin ® and Lapatinib combined as new breast cancer cure

At the 10th European Breast Cancer Conference in Amsterdam professor Nigel Bundred reported about a trial involving 257 women with newly diagnosed, operable, HER2 positive disease. They were recruited between November 2010 and September 2015. Their biopsies were taken and the surgery was scheduled for 2 weeks later.

The trial was in two parts: The first 130 women were treated with trastuzumab (Herceptin ®) only, or lapatinib (Tyverb ®) only, for 11 days after diagnosis and before surgery. From other trials evidence became known that the combination of trastuzumab and lapatinib had better survival rates. The investigators decided to include a second part into their trial starting August 2013 with 127 women. Part of this trial was a combination treatment of trastuzumab and lapatinib.

Samples of tissue were taken from the original breast biopsies and then again two weeks later from the material of the breast surgery.

The pathologist examined the breast cells for a drop in the Ki67 protein, an indicator of cell proliferation. They also looked for an increase of apoptosis of 30% or more from the first date of the first biopsy. A “pathological complete response” was the term they used for a cure. When there was a partial cure, this was termed “minimal residual disease“. This meant that the tumor was less than 5 mm in diameter at the time of surgery. Women who had received the combination treatment had 11% pathological complete response (11% cure rate). 17% of the combination therapy group had minimal residual disease. There was no cure for those randomized to only trastuzumab and only 3% of that group had minimal residual disease.

New Breast Cancer Cure?

New Breast Cancer Cure?

Conclusion

Essentially this new research shows that two inhibitor drugs together are better than one or one in combination with conventional chemotherapy.

But we have to keep in mind that HER2 breast cancer includes only 20% of all types of breast cancer. When you hear that 11% of HER2 breast cancer was cured with the combination therapy in 11 days, it translates into only 2.2% of all types of breast cancer cured and only 3.4% of all breast cancer cases had minimal residual disease (tumor size less than 5 mm in diameter). This could be easily removed by surgery.

What everybody is excited about are the cures of 2.2% of all types of breast cancer (or 11% of HER2 breast cancer). This is a good start. But much more research needs to be done to increase this number of cures. While we are seeing some progress for one group of breast cancer patients, it is not nearly sufficient to advertise this treatment as a “cure”.

For all breast cancers a more promising option is available. A study from Wayne State University, Detroit, Michigan has shown that cryoablation therapy for breast cancer without excision can give a much higher cure rate of 100% over a period of 1 ½ years. In this procedure the tumor is left in place, but killed by cryotherapy (extreme local cold temperatures). It gives a cosmetically superior result. This is an accepted alternative, but is not yet widely practiced.