Red Wine, Grape Juice and Breast Cancer

What is the relationship of alcohol to cancer, and especially to breast cancer? The record is mixed, but by and large I think that the moderate use of red wine is good for most people who are trying to prevent cancer. It is conventionally believed that wine is harmful to breast cancer patients. A study from Canada last year showed a slightly higher rate of breast cancer in women who reported drinking wine, but slightly less cancer in those who drank whiskey or beer. The authors themselves cautioned that "the magnitude of the change in risk was small" {Breast Cancer Res Treat 2000;64:201-9}.

New evidence, howver, suggests that red wine may be helpful. As most of you know, the female hormone estrogen promotes the growth of breast cancer cells. There is an important enzyme in the body, called aromatase, that converts "male" hormones (androgens) into "female" hormones (estrogens). Scientists have therefore invented drugs to inhibit the action of aromatase and thereby prevent the "feeding" of breast cancer cells. These drugs include anastrozole (Arimidex) from Zeneca; letrozole (Femara) from Novartis; and vorozole (Rivizor) from Janssen. These are now widely used as therapies for breast cancer, especially for patients who can no longer take the older anti-hormonal drug tamoxifen.

But now, scientists at the City of Hope in Duarte, Calif. have discovered a commonly consumed nutritional item that also has the ability to inhibit aromatase. Wine. Yes, red wine contains natural chemicals that act as "non-hormonal aromatase inhibitors." In an animal experiment earlier this year, it was found that red wine completely inhibited the abnormal growth that was associated with aromatase {Breast Cancer Res Treat 2001;67:133-46}.

I am NOT suggesting that you stop taking Arimidex or Femara for your breast cancer and switch to a glass of Mouton Rothschild (as pleasant as that might be). I do think this study sheds new light on the old controversy of whether or not alcoholic beverages are good or bad for people fighting cancer.

The question is a complicated one. First of all, one needs to specify which kind of alcoholic beverage is under discussion. Beer, whisky and wine have somewhat different effects on the body. Second, oftentimes scientists talk about "wine," but don't specify whether it is red or white, not to mention the many varieties.

Japanese scientists have found that an antioxidant in red wine, resveratrol, could be a "promising anticancer agent" for both hormone-dependent and hormone-independent breast cancers, and may mitigate the growth stimulatory effect of certain harmful substances found in the Western-style diet {J Cancer Res Clin Oncol 2001;127:258-64}.

Overall, I would say that the data supports the moderate use of red wine by people who are trying to prevent cancer. The greatest amount of resveratrol is found in wines from colder climates. These include Burgundy, Bordeaux, champagne, Alsace rieslings, as well as German and Canadian ice wines. I favor organic wines. Fetzer is one company that is very alert to the dangers of pesticide contamination. Their Bonterra line of organic wines are very good.

Grape juice also contains resveratrol (about half as much as red wine) and has many of the other antioxidants that make wine beneficial. (I know of no studies on aromatase inhibitors in grape juice,however.) If possible, seek out an organic grape juice(such as Mountain Sun) that is not contaminated with pesticide residues.

Drug Corruption Revealed

This week, a major pharmaceutical company, TAP Pharmaceutical, of Lake Forest, Ill., agreed to pay $875 million to settle charges that it inflated the price of the prostate cancer drug Lupron and also bribed doctors to prescribe it. A federal indictment charged one doctor and six TAP managers with conspiracy to give doctors free drugs, trips to resorts, and free consulting services in order to obtain their referrals of prescriptions for Lupron to Medicare program beneficiaries. TAP is a 50-50 venture between Abbott Laboratories (news/quote), of Abbott Park, Ill., and Takeda Chemical Industries Ltd. in Japan.(See: NY Times website October 3, 2001).

One can only wonder how widespread such practices are. In the past, the bribing of doctors with trips and kickbacks was openly practiced. Today, it is illegal but obviously still goes on. We need doctors to prescribe drugs based on the likelihood that it will benefit us. Too often, they allow themselves to be manipulated by manufacturers. This creates a climate of uncritical enthusiasm for pharmaceuticals.

Irinotecan Under Scrutiny

Last year there was a lot of hoopla over the drug irinotecan (also known as Camptosar or CPT-11). In March of last year, the FDA approved it as a first-line treatment for colon cancer. But in April investigators halted two large national studies involving this drug after finding an unexpectedly large number of deaths in the patients who were treated with the drug (Journal of Clinical Oncology 2001;19:3801-3807) . Now, a special investigation has concluded that the drug itself played a role in these deaths. The investigation found three times the number of deaths in combinations using irinotecan compared with the chemotherapy regimens that did not include this toxic drug.

There are two particular syndromes of side effects that are associated with irinotecan. The first involves severe dehydration, low white blood cell counts, fever, and abnormalities in various blood tests. The second relates to the cardiovascular system and includes fatal heart attacks, blood clots that travel to the lungs, or strokes. Patients receiving irinotecan should be carefully montiored, says the American Cancer Society's website.

Why was this drug approved at all? In clinical trials, a combination of three drugs, irinotecan + fluorouracil + leucovorin, was compared with just fluorouracil + leucovorin as a first-line treatment for metastatic colon cancer. In one, there was a small advantage to adding irinotecan to fluorouracil + leucovorin. The response rate in "evaluable" patients was 49 percent in the irinotecan group compared to 31 percent in the no-irinotecan group. If, however, one includes all patients who were enrolled in the clinical trial, on a so-called "intent to treat" basis, there was only a 35 percent response rate with the irinotecan-added group.

Overall survival was 17.4 months in the irinotecan-added group compared to 14.1 months in the other group, a gain of 3.3 months. But severe toxic effects were significantly more frequent in the irinotecan-containing protocol than in the two-drug combination{Lancet 2000;355:1041-1047}.

On this basis, however, the FDA approved irinotecan, to be used in combination with fluorouracil + leucovorin, as a first-line therapy for metastatic colorectal cancer. As I wrote in my update to Questioning Chemotherapy last year, "What is lacking is convincing proof that either the two-drug or the three-drug combination is better than placebo or best supportive care for stage IV colon cancer." Now we know that the combination is more likely to lead to treatment deaths as well.

There's got to be a better way to treat colon cancer! We need first of all to focus on increasing overall survival...not just temporary shrinkages of tumors. Second, we need to put the emphasis on non-toxic and significantly less toxic treatments, especially those focused on the immune system. This is the best hope of effective cancer treatments.

Here at the Moss Reports

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Till next week...Best wishes for your safety and good health!

Ralph W. Moss, Ph.D.