ROGER EXPLORES… Natural therapies: Avoid anything promoted as alternative, rely on science instead

by Roger Wilson

I have been asked a few times already why cancer patient support organisations do not promote – in fact, even caution against - non-standard treatments, often described as alternative therapies, ones that their clinicians do not provide. We all know that cancer can be life-limiting and surely, we should all be doing everything we can to ensure that life is preserved for as long as it can be. There are people who tell you that they have a magic cure and if you subscribe to their website, or buy their bottle of pills, you will be cured, so why don’t we promote them and why don’t the doctors use them?

There is one simple line which sums up such circumstances.  If it sounds too good to be true, it probably is.

Why patient advocates do not promote ‘alternative’ therapies

There are very good reasons why patient support organisations with a long-standing reputation do not promote non-standard therapies. That is because there is no evidence that they work.  One person’s good fortune is not evidence, even if it is true. That one case may never be replicated.

A bottle of pills bought from an unregulated website will not be a medicine. If it had the activity of a proper medical compound, it would be regulated like a medical compound.  For it to be sold, it must have shown benefit to patients who received it in clinical studies. It will also be safe, its side effects will be known, it will not present dangers to specific individuals.

Responsible pharmaceutical companies producing cancer treatments do not advertise their drugs. They are regulated and limited to advising doctors through targeted communications and there will also be factual summary descriptions for lay people which are carefully written not to be promotional.

The providers of ‘alternative’ approaches to therapy claim that they cannot afford what it takes to build the evidence that their claims are true. The trouble is that most of these therapies have been examined by pharmaceutical and biotechnology companies at some time or another to see whether there is enough evidence of efficacy which might justify the investment it takes to go through the authorisation process.  The pharma business model is based on being able to patent new medicines.

In the UK, there was a government funded project in the mid-2000s which enabled academic units to look at herbal and alternative medicines for cancer, initially in the laboratory and later in clinical trials. Homeopathic treatments had a formal clinical trial. Only a handful of the compounds investigated showed any potential and the project was quietly closed leaving a couple of surviving compounds in experimental use. Homoeopathy is not available in the UK on the National Health Service because of this work.

https://www.england.nhs.uk/wp-content/uploads/2017/11/sps-homeopathy.pdf

Caution required !

 There are some very popular remedies mostly marketed on the internet which attract patients looking for ‘alternative’ approaches to treating their cancer.   Let’s take a closer look:

• One of them is Rick Simpson Oil (RSO), made from the flower of the cannabis marijuana plant. It is promoted as remedy against cancer because the Canadian engineer Rick Simpson who developed the oil treated a skin cancer with it. There have been tests on various cancers with, so far, no scientifically reported success. The oil is high in the psychoactive component found in cannabis, THC (tetrahydrocannabinol), and this means that regulators and politicians are cautious about authorising it for sale regardless of any effectiveness. This is a therapy which is getting academic research but should be treated with caution and only used in a ‘complementary’ manner, not as an ‘alternative’. https://pmc.ncbi.nlm.nih.gov/articles/PMC8864433/
• Another high-profile internet remedy is fenbendazole, a veterinary treatment for parasitic worms which is cheap and very accessible. It is derived from benzene, a petroleum product. Again, the promotion relies on a powerful story of a single case cancer cure. A clinical trial however treated 1100 patients with no success. Study of the drug continues but while there has been good activity in human cancer cell-lines in the laboratory its ingestion in human use is proving challenging and there are concerns it can cause liver damage. This is certainly a case of extreme caution, even in a ‘complementary’ approach. https://ar.iiarjournals.org/content/44/9/3725
• Some compounds may have a value for patients in general, but there is often a warning. An example of this is with St John’s Wort, a widely available herbal compound with many values in calming anxiety, but which can interfere with the action of chemotherapies and targeted cancer drugs. A patient on cancer treatment should therefore avoid it.

‘Alternative’ is a dangerous word. It implies that the treatment being promoted can take the place of a standard medical therapy. Avoid anything promoted that way! When a description such as ‘complementary’ is used, it indicates that the maker sees the treatment as one which sits alongside standard medical therapy. This is more acceptable, but it can still be challenging because it is important to ensure that nothing in the treatment clashes with treatment that your doctors are prescribing.

Cancer medicine with natural compounds

However, as I have stated above, it is true that there are natural compounds which are being scientifically investigated because there is evidence, usually from academic laboratory research, that they have an active component in them. These compounds are often complex to manufacture, and it needs the expertise and resources of a biotechnology or pharmaceutical company to take them on to prove that they are safe and effective.  The process can be costly as such compounds cannot be patented, which would protect them from competition for up to ten years.  Through this route they will come into clinical trials, to market authorisation and clinical adoption if they show real value. This is the same approach as any manufactured drug, but the cost of this process must be carried by the developer and can have a high level of commercial risk. There are several examples of natural compounds in the range of cancer chemotherapy which have come to clinical use by this route:

• They include paclitaxel and other taxanes (from a yew tree), vinblastine and vincristine (from the Madagascan periwinkle flower), etoposide (from the mayapple or mandrake, a poisonous plant which grows in the eastern USA and Canada) and eribulin (from a marine sponge).
  
• Most relevant for us with sarcoma is probably trabectedin (also known as Yondelis), that is widely used as a second-line chemotherapy in advanced sarcoma. This is a toxin originally extracted from a sea squirt, a single-cell creature that lives in marshy Caribbean coastal regions. The first human patients to take it received the processed extract from actual sea squirts, today’s patients have a synthesized copy, just as potent but saving the lives of millions of squirts.
• The vegetable extract called resveratrol comes from grape skins, ginger and other fruit and vegetables and has been subject of several laboratory studies worldwide, mainly to examine whether it could be a preventative agent in cancer. The latest study is funded by Cancer Research UK and led by Professor Karen Brown, Director of the Leicester Cancer Research Centre and funded by Cancer Research UK. In the COLO-PREVENT trial 1300 patients who have had colorectal polyps, a pre-cancerous condition, are receiving various treatments including resveratrol to see whether they help prevent the condition returning as cancer. In a Phase 1 safety study healthy students took an escalating dose over several months. It was stopped when the participants reported they were having difficulty taking so many tablets at a time. The daily dose of resveratrol they were taking when this research study closed was described to the author by Professor Will Steward, the lead investigator, as “equal to that found in several cases of red wine”. The assessment was that the compound was safe!  But does it work?  There has consistently been evidence from the laboratory that resveratrol helps DNA repair but how it does that remains a mystery. Resveratrol is an anti-oxidant which can be taken as a complementary therapy and is available over the counter. An extensive scientific review is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164842/

Let’s support science

So, my advice about natural medicines is to avoid them if they are suggested as an ‘alternative’ to standard medical care. ‘Complementary’ therapies may be more acceptable, as some may have some evidence of benefit, but it is wise for patients to check with their doctors to ensure that they do not clash with prescribed drugs. Therapies which actually work get authorised by the regulators, there are no secret lists of banned treatments. Authorised therapies are known to our clinicians and will be recommended to patients when it is appropriate.

The search for treatments from a natural source is happening. But while you who read this are part of an audience of advocates who support science, the question is whether we can together persuade those patients with strongly differing views to take this advice.

Credits:  Graphic design by Karl Berger