A Big Boost for Antioxidants

Two major scientific papers recently appeared strongly supporting the concurrent use of antioxidants and chemotherapy. One of these is a randomized controlled trial, the other a laboratory experiment. Both conclude that the antioxidant vitamin E (alpha-tocopherol) protects against nerve damage from the common chemotherapy drug cisplatin, without interfering with its effectiveness.

The Clinical Trial

The first study comes from the Neuroscience Department of the Regina Elena National Cancer Institute in Rome, Italy. Its aim was to evaluate the nerve-protective effect of antioxidant supplementation with vitamin E in patients who were being treated with cisplatin chemotherapy. Between April 1999 and October 2000, these patients were randomly assigned to receive either cisplatin alone or cisplatin with vitamin E supplementation. Alpha-tocopherol (300 milligrams per day = approximately 300 International Units) was administered orally before cisplatin chemotherapy and then continued for three months after the suspension of the treatment.

Twenty-seven patients completed six cycles of cisplatin chemotherapy: 13 in the supplementation group and 14 in the chemotherapy-alone group. The incidence of nerve damage was 85.7 percent with cisplatin alone. But this fell to 30.7 percent when this single antioxidant was added. This was a nearly two-thirds reduction and was, of course, highly significant. The severity of the nerve damage was also significantly lower in patients who were supplemented with vitamin E.

Preclinical studies showed that when cisplatin was combined with vitamin E, "no differences were observed in tumor weight inhibition, tumor growth delay, or life span as compared with treatment with cisplatin alone." In other words "supplementation of patients receiving cisplatin chemotherapy with vitamin E decreases the incidence and severity of peripheral neurotoxicity," but does not interfere with the effectiveness of treatment.

The finding is particularly significant because cisplatin is an alkylating agent, the kind of chemotherapy whose potency is said by some oncologists to be diminished by concurrent antioxidant use. That is because such agents are thought to work by generating "free radicals" in cancerous cells. Antioxidants theoretically could interfere with that activity. In reality, however, that does not appear to happen.

The study was published in the Journal of Clinical Oncology, the "Bible" of the cancer world. Hopefully, it will have an impact on oncologists who have been telling their patients never to take antioxidants during chemotherapy, on the unproven premise that this would undermine the effectiveness of toxic drugs.

Animal Experiments

In the second study, the same scientists gave vitamin E (alpha-tocopherol) to mice that had been inoculated with human melanoma cells. The animals were then given cisplatin (also called DDP). This paper also showed that vitamin E supplementation did not interfere with the effectiveness of cisplatin. In fact, vitamin E "was able to increase survival of mice treated with a high dose" of the drug. While the toxicity of high-dose cisplatin caused death in about 70 percent of mice, a combination of vitamin E and cisplatin reduced such treatment-related deaths to about 30 percent.

An analysis of the animals' organs showed that the protective effect of vitamin E was mainly related to its antioxidant activity. Vitamin E also protected mice from severe nerve damage induced by cisplatin. The authors concluded that vitamin E "protects against the systemic toxicity and neurotoxicity induced by DDP [i.e., cisplatin] without interfering with its antitumor activity and suggest that this combination is a promising strategy to improve the therapeutic index of DDP-based chemotherapy."

A 300 mg dose of vitamin E costs under 10¢ per day. As I pointed out in my book, "Antioxidants Against Cancer," alpha-tocopherol is just one member of an extended family of tocopherols and tocotrienols. It would be interesting to know what the results would have been if the authors had used a somewhat higher dose (400 to 800 IU) of vitamin E; a mixed tocopherol and tocotrienol formulation, including alpha-tocopherol succinate (the kind of vitamin E that seems to have the greatest anticancer activity); and a mixture of vitamin E and other dietary micronutrients (such as selenium, vitamin A and vitamin C). It may be possible to reduce the toxicity of cisplatin even further, while possibly increasing its effectiveness as well.

For years, skeptical oncologists have demanded proof, in the form of randomized controlled trials, that antioxidants do not interfere with chemotherapy. So here's proof. I hope that these studies will help to quell their fears and lead to a more intensive and sympathetic investigation of antioxidants' promising role in cancer treatment.

P.S. I thank an alert reader for sending me a reference to these experiments. I don't think that these important findings generated a single major news article anywhere in the world! (A search of the Internet comes up almost entirely blank.) Yet if someone had shown that vitamin E interfered with cisplatin you can bet that it would have generated scare headlines all over the world. "Bad news" about the alleged danger of supplements is always good for a juicy story. Favorable news about a two-thirds reduction in serious side effects apparently is not.

Successful Meeting in Washington

I just returned from the Fifth Annual Comprehensive Cancer Care meeting at the Washington, DC, Hilton Hotel. As in the past, the meeting was co-sponsored by the Center for Mind-Body Medicine (CMBM) and the University of Texas Medical School at Houston. It included the participation of the National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine (NCCAM). The meeting took place over a period of five days (April 9-13) and attracted over 750 participants.

Part of CCC Audience

The speakers' roster was, as usual, outstanding. Senator Tom Harkin (D-IA) and James Gordon, MD, founding director of CMBM and head of the President's CAM Commission, introduced the meeting. There were many excellent presenters, too many to mention. Donald Yance, a celebrated herbalist from Oregon, spoke about botanical treatments for cancer. Mitchell Gaynor, MD, an integrative oncologist, who heads the Weill Cornell Medical College's Center for Complementary and Integrative Medicine, spoke about his work, including the use of healing sounds. Obstetrician Joel Evans, MD, discussed the use of nutritional support for cancer patients. Jeffrey White, MD, of the Office of Cancer Complementary and Alternative Medicine, explained the National Cancer Institute's Best Case Series initiative…and that just scratches the surface.

One outstanding feature of this meeting is that it brings together prominent figures from academic medicine and frontline doctors and researchers who are doing controversial work on the cutting edge. Thus, Nicholas Gonzalez, MD, presented a best case series of patients with advanced cancers other than those of the pancreas (the subject of his NIH-funded clinical trial). Stanislaw Burzynski, MD, PhD, talked about the state of antineoplaston research. And Merrill Garnett, DDS, explained cancer as a disorder of the human energy system and the use of his therapeutic substance, poly-MVA.

Since its inception in the mid-1990s, I have been an advisor to this meeting. This year, I was honored to give Saturday's Keynote Address, an overview of the progress in the field of CAM and cancer since the meeting was first held in 1998. I also was kept busy as the official commentator on three panels. I commented on the presentations of E. Dieter Hager, MD, PhD, director of the BioMed clinics of Germany, and Mark Neveu, PhD, president of the National Foundation for Alternative Medicine. I also commented on the presentation of Keith I. Block, MD, who spoke on the integrative approach to oncology. Dr. Block is the director of the Block Center for Integrative Cancer Care in Evanston, Illinois, an adjunct professor at the University of Illinois, and editor of the PubMed-listed medical journal, Integrative Cancer Therapies. I was impressed with the high level of all of these presentations.

Prasad-Labriola Presentation

I also attended the session on the interaction of antioxidants with chemotherapy and radiation, featuring the presentations of Kedar Prasad, PhD, an eminent researcher at the University of Colorado Health Science Center, and Dan Labriola, ND, a naturopath from the Northwest Natural Health Specialty Care Clinic. In 1997, Dr. Prasad called on oncologists to give their patients who were undergoing chemotherapy and radiation a broad spectrum of dietary antioxidants. In 1999, Dr. Labriola created a sensation when, in an article in the journal Oncology, he and an oncologist colleague came down firmly against the use of antioxidants in many of the same situations.

Dr. Prasad mentioned that many oncologists today are warning their patients not to consume fruits, vegetables and tea while taking chemotherapy. He gave a fact-filled presentation on his own and others' work showing synergy between the two types of treatment, and challenged Dr. Labriola (and anyone else) to produce a single clinical paper showing harm when one combines dietary antioxidants with cytotoxic treatments.

There was a rather heated discussion period. Joseph Brenner, MD, an integrative oncologist from Tel Aviv, Israel, pointed out that Dr. Labriola's 1999 paper has been used all over the world to discredit the concurrent use of antioxidants and chemotherapy. Dr. Labriola replied that he was being misunderstood. I myself asked Dr. Labriola to comment on the latest clinical findings from Italy (see above), which found a dramatic reduction in nerve damage from cisplatin when patients received alpha-tocopherol (vitamin E).

Dr. Labriola replied that it was too soon to draw conclusions, and that the harmful effects of this combination might only emerge years from now, in the form of decreased survival. I replied that chemotherapy drugs are approved all the time based on short- or medium-term results, without any consideration of long-term effects. I mentioned the recent FDA approvals of Gleevec, Herceptin and Gemzar. Drugs are routinely approved, I said, after a few clinical trials show benefit. So why shouldn't vitamin E (which is not a drug, but a normal constituent of food) be endorsed as an adjunctive treatment, since there is no evidence (beyond theoretical considerations) that it is harmful? I didn't receive a satisfactory answer to my question, although Dr. Labriola and I agreed to continue the dialog at a further date.

Overall, I found this CCC conference a very stimulating and congenial meeting. I would strongly urge readers to make a mental note to attend the CCC meeting next year. I will remind you of this as the time approaches.

Dr. Atkins Passes Away

Dr. Robert Atkins

I am saddened to report that this Thursday morning (April 17) Dr. Robert Atkins died as a result of a terrible accident he sustained last week. He hit his head after falling on the ice, went into a coma, and died nine days later. The day before the accident, there had been an unusual spring snowstorm in New York followed by a cold snap. Dr. Atkins was trying to negotiate the snow and ice outside his Manhattan office, but took a hard fall, with these tragic consequences.

For over 30 years Bob Atkins fought for the high-protein, low-carbohydrate diet that bears his name. In the process, he became one of the best-selling authors of all time, as millions of people adopted the Atkins Diet and endorsed the effectiveness of this approach. Last week, "Dr. Atkins New Diet Revolution" topped the New York Times "How-To" best-seller list, where it has resided for an incredible 305 weeks! At the same time, his latest book, "Atkins for Life", topped the hardcover list. In all, he has sold over 15 million books.

Few people in medicine are as famous as Dr. Atkins, although for years scientific respectability eluded him. He was lambasted by the AMA. Then, suddenly, in one of the most remarkable developments in recent medical history, leading scientists (included some at Harvard and other prestigious institutions) took up the Atkins banner. He was lauded in a front-page story in the New York Times Magazine. At the end of last year, he was featured as one of the "People Who Mattered in 2002" by Time magazine. How startling it was to see his full-page portrait, along with other major world celebrities, in that medically conservative periodical. I'm sure that he thoroughly enjoyed this vindication, which few medical pioneers ever get to see.

I first met Bob Atkins at a New Year's Party at health advocate Gary Null's apartment in 1977. Like most people at the time, I thought of him simply as a diet doctor. This was the first time I learned of his intense interest in alternative medicine, especially as it relates to cancer. To me, he was always a stalwart friend and "older brother". After he took over the "Design for Living" radio show in 1988, he invited me to be on the program many times. In fact, he helped launch most of my subsequent books and often generously mentioned my newsletter. These late-night visits to the WOR studios in midtown Manhattan were always exciting events. After my book "Questioning Chemotherapy" came out, it was Bob Atkins who first suggested that that I write a sequel on radiation therapy. This is in fact my current book project. It saddens me to think that he will never get to read it.

My condolences go to his wife, Veronica, for her loss and for this terrible ordeal. Bob Atkins was a person who used his many innate gifts for the betterment of humanity. He will be greatly missed.

Another Important Meeting

The American College for Advancement in Medicine (ACAM) is holding its semi-annual conference in Washington D.C., May 16-18, 2003. The topic is Cancer: Complementary and Conventional Approaches to Prevention and Treatment. The ACAM conference will present and review recent advances in both conventional and complementary medicine to help assist physicians in their clinical management of cancer. I will be speaking on Friday, May 17. For more information contact ACAM at 1-800-532-3688 or email workshops@acam.org for details.

17 Category 1 CME Credits

--Ralph W. Moss, Ph.D.

References:

Pace A, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol. 2003 Mar 1;21(5):927-31.

Leonetti C, et al. Alpha-tocopherol protects against cisplatin-induced toxicity without interfering with antitumor efficacy. Int J Cancer. 2003 Mar 20;104(2):243-50.

IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.

CancerDecisions® PO Box 1076, Lemont, PA 16851 Phone Toll Free: 800-980-1234 | Fax: 814-238-5865 Copyright © 1996-2004 All Rights Reserved