COMMENTARY

A Novel, Effective Way to Treat Stage IV Breast Cancer

Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

If one works a lot with cancer as I have, mostly as a pathologist, for many decades, one comes to expect surprises from time to time, such as "exceptional responders"[1] or even spontaneous regression.[2]

But if one reads and writes a lot of articles in and for medical journals, as I have done for a living for about 40 years, one does not expect many surprises. Most articles portray small changes in extant knowledge, if any at all.

With that backdrop, I was blown away by a cancer treatment article[3] from Istanbul, Turkey, published in 2017 in the exclusively online medical journal called Cureus. (Disclosure: I am an executive adviser to and hold options in Cureus.)

A 29-year-old overweight (body mass index [BMI] 28.1) woman was diagnosed in December 2015 with a visible and palpable, 7 cm in diameter, primary invasive ductal carcinoma of the left breast. It was found to be histologic grade 2, stage IV triple negative; by MRI, category V, with multiple axillary lymph node metastases. In October 2016, whole body positron emission tomography-CT (PET-CT) confirmed the primary, plus multiple involved axillary lymph nodes, left pectoral invasion, multiple widespread liver masses, and a nodular upper left abdominal lesion.

With a fully informed consent, therapy was begun at the ChemoThermia Oncology Center in Istanbul with a protocol of metabolically supported multidrug chemotherapy in 21-day cycles for 4 months, insulin to achieve low blood glucose, hyperthermia, and hyperbaric oxygen therapy, all concurrent with chemotherapy sessions. The patient was encouraged to consume a ketogenic diet throughout her treatment.

Whole-body PET-CT in February 2017 showed no evidence of residual cancer. Therapy was continued and in April 2017 (6 months total therapy), a mastectomy and lymphadenectomy were performed. No live tumor cells were found in either—only necrotic tumor and hyalinized fibrous tissue. The physicians chose to continue rounds of therapy for 1 full year, with follow-up scans every 3 months.

Their treatment rationale: Toxic chemotherapy can kill breast cancer cells. Cancer cell metabolism depends upon glucose; indeed, cancer cells love glucose. So they gave insulin and a ketogenic diet to lower blood glucose. Hyperthermia aids in uptake of drugs leading to cell death by inhibiting DNA repair. Hyperbaric oxygen therapy increases oxidative stress in tumor cells. And ketone bodies protect normal cells from this stress.

The cancer cells died and the patient was reported to tolerate this whole treatment cascade well without noteworthy adverse events, and even less than usual for this kind of chemotherapy. Her BMI at the end of therapy was 21.8.

I knew very little about this regimen; I'll bet it was the same with you. I await efforts by others to replicate this treatment in various countries, and I want to see the reported results.

Check out this remarkable open-access report, where you can join a live discussion.

That's my opinion. I am Dr George Lundberg, at large at Medscape.

PS: Last I heard, you could also find this therapy in Vienna, Austria, but not in the United States.

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