Point-counterpoint: using clinical trials for the evaluation of integrative cancer therapies.
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Biomedical subjects
Publications and source records attributed to Andrew Vickers.
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beta-Glucan primes leukocyte CR3 for enhanced cytotoxicity and synergizes with anti-tumor monoclonal antibodies (mAb). We studied readily available (1-->3)-beta- D-glucan using the immune deficient xenograft tumor models, and examined the relationship of its anti-tumor effect and physico-chemical properties. Established subcutaneous (s.c.) human xenografts were treated for 29 days orally with daily beta-glucan by intragastric injection and mAb intravenously (i.v.) twice weekly. Control mice received either mAb alone or beta-glucan alone. Tumor sizes were monitored over time. beta-Glucans were studied by carbohydrate linkage analysis, and high performance size-exclusion chromatography with multiple angle laser scattering detection. Orally administered beta- D-glucan greatly enhanced the anti-tumor effects of mAb against established tumors in mice. We observed this beta-glucan effect irrespective of antigen (GD2, GD3, CD20, epidermal growth factor-receptor, HER-2), human tumor type (neuroblastoma, melanoma, lymphoma, epidermoid carcinoma and breast carcinoma) or tumor sites (s.c. versus systemic). This effect correlated with the molecular size of the (1-->3),(1-->4)-beta- D-glucan. Orally administered (1-->3),(1-->6)-beta- D-glucans also synergized with mAb, although the effect was generally less marked. Given the favorable efficacy and toxicity profile of oral beta- D-glucan treatment, the role of natural products that contain beta-glucan in cancer treatment as an enhancer of the effect of mAb therapy deserves further study.
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There appears to be exceptional and growing public enthusiasm for botanical, or "herbal", medicines, especially amongst cancer patients. This has recently begun to be matched by increasing scientific attention. Whilst it is known that plant extracts are active against cancer, the standard approach has been to isolate, synthesize and administer the single chemical compound thought responsible for this effect. However, different components in a botanical may have synergistic activities. There is also some evidence that the presence of multiple compounds in a botanical extract can buffer the toxic effects of a single constituent. Though many of the botanicals popular among patients are probably not of benefit (e.g. Mistletoe, Pau D'arco), several botanicals have shown promise in Phase III (Sho-saiko-to, PSK) or Phase II (PC-SPES) trial. Quality control of botanicals poses significant challenges: small differences in genetics, soil, temperature, moisture and time of harvesting can lead to significant differences in the concentration of important constituents. Phase I and II methodology is also problematic: botanicals have low toxicity and are unlikely to cause rapid tumor regression. There is currently minimal regulation of botanical medicines.
Oncology has always coexisted with therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as "unproven," suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown. Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good quality clinical trials, and they have been shown to be ineffective. In this article, clinical trial data on a number of alternative cancer cures including Livingston-Wheeler, Di Bella Multitherapy, antineoplastons, vitamin C, hydrazine sulfate, Laetrile, and psychotherapy are reviewed. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven."