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Fri, 18 Apr 2003 20:18:28 -0400 (EDT)

 

THE MOSS REPORTS Newsletter (04/18/03)

 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #80 04/18/03

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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.

 

 

To view a picture of part of the CCC audience go to:

http://www.cancerdecisions.com/images/CCC2003.jpg

 

 

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

 

 

 

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.

 

 

To view a picture of Dr. Robert Atkins go to:

http://www.cancerdecisions.com/images/atkins1.jpg

 

 

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

for details.

 

17 Category 1 CME Credits

 

 

--Ralph W. Moss, PhD

 

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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

 

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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.

 

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