Assembly line medicine.
Upon diagnosis, a patient is often given several treatment choices. None guarantees a cure, but all tend to inflict pain, immobility, mutilation, debilitation, risk of secondary complications (like stroke), and risk of secondary cancers (like leukemia).
Enlightened individuals face a particular degree of anxiety. They've heard about less toxic treatments that may be more effective. They often worry they are missing out on a curative therapy because of constraints placed on physicians by today's bureaucratic medical system that fosters inefficiency and mediocrity.
We at Life Extension[R] have long been aware of serious gaps that exist between what is discovered by cancer researchers and what is delivered to patients in the clinical oncology setting. When advanced cancer patients send us their medical records, we almost always identify treatment omissions that could have markedly improved odds of remission, improved survival, and even offered a cure.
One example is a drug called cimetidine. It functions via several mechanisms to inhibit metastasis and improves survival in colon cancer patients. (1-8) In 2002, results from a clinical trial on patients with an aggressive form of colon cancer were published in the British Journal of Cancer. Compared to controls, 10-year survival improved by a remarkable 2.7-fold in the group receiving cimetidine. (4)
Life Extension[R] has been recommending cimetidine since 1985 for certain types of cancer. Not once have we had a cancer patient approach us who had been prescribed this nontoxic drug by their oncologist.
An oncologist is a physician who specializes in the diagnosis, evaluation, and treatment of those afflicted with cancer. Cancer patients rely on their oncologist to utilize the best therapies to meet their individual needs. Regrettably, "managed care" has diluted the quality of care provided by many oncologists.
In a stunning new development, a health insurance company is offering oncologists $350/month for each patient that is put on the company's recommended regimen. (9) This will enable the insurance company to control treatment-related expenses of cancer patients, who will be afforded less individualized, creative, and comprehensive care.
In this month's issue, we reveal how to circumvent this backwards approach to cancer treatment.
Within 24 hours of you reading this article, 1,500 Americans will perish from cancer. (10) There will be no sensational media accounts of these travesties, just more statistics to confirm the grim failure of mainstream medicine to find cures for this epidemic killer.
We at Life Extension[R] have never ignored the threat that cancer poses to healthy longevity. Yet many people today are in a state of denial, as if this insidious disease only afflicts others.
The news media redundantly covers details of traumatic deaths such as airline crashes and terrorist attacks. My reaction to these headline news stories is that the number of victims pales in comparison to the estimated 585,000 Americans that die from cancer every year. (11)
As I wrote in a 2004 article titled "Are You Afraid of Terrorists?" over 2.4 million Americans die each year mostly from age-related disease. Yet one terrorist attack dominates media coverage. (12)
So here we are 10 years later, and terrorists have killed less than 100 people in the United States. The death toll from cancer in that same time period is around 5.8 million. One could argue from a mathematical standpoint that violent death threats could be disregarded and resources instead poured into more efficient cancer research.
My personal views don't directly relate to what you are about to read, but may help you understand how committed we are to eradicating cancer in the same way that smallpox was last century.
The Basics About Cancer Treatment
There are some basic rules about cancer that everyone should know.
When it comes to achieving a "cure," the best opportunity exists at the time of first treatment Once tumor cells have been exposed to initial therapies, or one's immune system has been compromised by surgical trauma, a malignancy can proliferate out of control and resist secondary therapeutic attempts. (13-20)
The best shot for a cure thus involves an individualized, multipronged plan of action to:
* Eradicate the primary tumor;
* Decrease fuels that feed metastatic growth;
* Turn off stimuli that encourage cancer stem cell proliferation;
* Block the escape routes used by residual cancer cells.
Some people erroneously believe they must try to eradicate their tumor immediately. A more intelligent approach is to take the time needed to:
* Ensure that the stage or extent of the tumor is within the boundaries of any ablative therapy (such as surgery or radiation);
* Investigate every mechanism an individual's cancer will use to ensure its survival;
* Then introduce agents into the treatment protocol to circumvent each of these tumor survival factors.
What I'm conveying here is that newly diagnosed cancer patients should take advantage of the relatively vulnerable nature of their "treatment-naive" tumor to implement a plan that addresses a wide range of escape routes that tumor cells utilize upon exposure to radiation, chemotherapy, hormone blockade, and even surgery. (21-25) To provide real world examples of this strategy being put into action, you're going to read about some remarkable case histories in this month's issue.
Immune Status Should Be Assessed In All Cancer Patients
Once a tumor is established, it is difficult for the immune system to eradicate it. (26-29) That's why mainstream oncologists pay little attention to the immune status of their newly diagnosed patients. In other words, since bolstering immune function alone won't cure cancer, oncologists mistakenly think it is not of major importance.
Newly diagnosed patients often present with poor immune status even before immune-damaging chemotherapy, radiation, and/or surgery are initiated. (30-33)
Optimizing immune function prior to initiation of cancer treatment can be a critical component of comprehensive therapy with curative intent. (12, 34-37) This involves in-depth immune profile blood testing and when indicated, precise administration of expensive drugs like interleukin-2, (12,38-46) filgrastim (Neupogen[R]), (47,48) pegfilgrastim (Neulasta[R]), (49-58) and/or sargramostim (Leukine[R]). (59-62)
Health insurance companies are trying to reduce the cost of cancer care and would rather patients not know about the need to optimize immune function before, during, and after toxic therapies are administered. (63) The high cost of implementing comprehensive immune support is causing insurance companies to refuse to pay for it.
A large health insurance company is offering oncologists $350/month per patient as a reward to channel treatment towards the insurance company's "recommended regimen." We believe this will result in cancer patients dying sooner and using up fewer resources in the process. Oncologists following these cookbook protocols will be able to squeeze far more patients into their hurried schedules.
Under this new scheme whereby oncologists are paid $350/month for each patient placed on the "recommended regimen," insurance companies benefit financially, while patients are largely confined to chemo drug protocols that provide relatively minimal survival improvement in treating metastatic disease.
Impact Of Surgery On Immune Function
The first line of defense against malignancy is our natural killer cells (NK). Young individuals have high levels of functional natural killer immune cells, but this declines with aging. (64-72)
Natural killer cells originate in the bone marrow (like other immune cells) and go through a maturation process that enables them to participate in early control of microbial infections and cancers. (73-76)
In a study examining NK cell activity in women shortly after surgery for breast cancer, it was reported that low levels of NK cell activity were associated with an increased risk of death from breast cancer. (77)In fact, reduced NK cell activity was a better predictor of survival than the actual stage of the cancer itself. In another study, colon cancer patients with reduced NK cell activity before surgery had a 350% increased risk of metastasis during the following 31 months. (78)
The likelihood of surgery-induced metastasis requires a cancer patient's immune system to be highly active and vigilant in seeking out and destroying renegade tumor cells immediately before, during, and after surgery. Numerous studies document that cancer surgery results in substantial reduction in NK cell activity. (78-82) In one investigation, NK cell activity in women having surgery for breast cancer was reduced by over 50% on the first day after surgery. (81) A group of researchers stated that, " We therefore believe that shortly after surgery, even transitory immune dysfunction might permit neoplasms [cancer] to enter the next stage of development and eventually form sizable metastases." (80)
We know cancer surgery reduces NK activity. This means that NK cell activity becomes impaired when it is most needed to fight metastasis. With that said, the preoperative and perioperative periods present a window of opportunity to actively strengthen immune function by enhancing NK cell activity. Fortunately, validated interventions to enhance NK cell activity are available to the person undergoing cancer surgery.
While there are nutrients that can boost NK function, many cancer patients would benefit enormously with individualized courses of drugs like interleukin-2 (IL-2) and Leukine[R].
IL-2 directly promotes NK function, (83-85) while Leukine induces bone marrow production of macrophages. Since these drugs are expensive, insurance companies will often refuse to pay for them as they are not approved by the FDA for the creative interventions that published studies show may be effective.
How Off-Label Drugs Save Lives
In the world of conventional oncology, FDA-approved drugs are routinely and legally prescribed for "unapproved uses" to better treat the disease. (89,90) This is often referred to as using drugs "off-label."
A 2008 study found that eight out of 10 oncologists surveyed had used drugs off-label. (91) Studies have reported that about half of the chemotherapy drugs prescribed are for conditions not listed on the FDA-approved drug label. (92) The National Cancer Institute has stated, "Frequently the standard of care for a particular type or stage of cancer involves the off-label use of one or more drugs." (92)
Off-label drug use in many cases is the genesis of innovation. It enables oncologists to use their training and experience to design creative therapeutic protocols based on new scientific findings. When favorable results are found, the protocol may be published in medical journals so that other oncologists can emulate the treatment successes.
The problem for health insurance companies is that cancer drugs are outlandishly priced, sometimes costing over $100,000 each per patient. (93-95) Insurance companies don't want to bear the costs associated with creatively designed treatments. They want to limit their expenses by confining oncologists to chemo drugs that provide relatively little survival improvement in advanced-stage cancers. (63)
This helps explain why one insurance company is offering oncologists $350/month per patient to not prescribe drugs beyond the insurance company's " recommended regimen." (96)
Other health insurance companies are doing it differently by reimbursing oncologists less money when they prescribe newer, more expensive cancer drugs. (97)
Not All Off-Label Drugs Are Expensive
Some of the most effective off-label drugs are affordable out-of-pocket (without insurance company involvement). The problem occurs when oncologists are being paid ($350/month) to only offer an insurance company's "recommended regimen" This creates a disincentive to utilize Herculean initiatives to ensure their patients receive every therapy that could optimize outcomes with the goal of inducing a complete remission;in other words, the complete disappearance of all manifestations of the cancer.
From our review of the scientific literature spanning decades, many cancer patients would benefit by taking aspirin (98-100) and the antidiabetic drug metformin. (101-115) Aspirin of course is readily accessible, but cancer patients are unlikely to use it if their oncologist does not recommend it.
Metformin requires a prescription, and if the insurance company catches the oncologist prescribing metformin, which is not part of the "recommendedregimen," the oncologist might lose the $350/month stipend for that patient.
Even the use of aspirin requires the oncologist's involvement as chemo patients whose platelet count is reduced to fewer than 100 x 10[E.sup.3]/uL are at risk for hemorrhage. (116-119) Under these circumstances, aspirin should be deferred until platelet counts are restored.
There are numerous off-label drugs effective against certain cancers (such as COX-2 inhibitors, certain statins, hormone modulators, etc.) that require a prescription, yet we are rapidly regressing to a system where medical decision making is dictated by insurance company cost mandates and not physician dedication and experience.
The Insurance Company's "Recommended Regimen"
The chemotherapy drugs that insurance companies want oncologists to prescribe represent the most commonly used drugs in the industry and can be viewed as aggressive "cookbook medicine approach" treatments. Some of drugs listed, such as Adriamycin[R], are being limited by several oncologists at major medical institutions, such as MD Anderson, for use in adjuvant settings due to excessive toxicity. (121-123)
Progressive oncologists, with whom Life Extension[R] is working, are using mitoxantrone instead of Adriamycin[R] in their elderly patients since it has the same survival rate as Adriamycin[R], but is less toxic to the heart. (124-126)
Oncologists will be paid $350/month per patient by one insurer to prescribe chemo drugs such as Adriamycin[R], which was approved by the FDA in 1974. Another insurer is offering higher reimbursement to the oncologist when lower-cost chemo drugs are used.
All these chemo drugs are considered standard of care by the National Comprehensive Cancer Network, which is an alliance of 25 cancer centers in the United States, most of which are designated by the National Cancer Institute as comprehensive cancer centers.
Health insurance companies reward practicing oncologists for following the standard published protocols that minimize creative approaches for cancer treatment.
Perhaps the greatest failing of the chemo drugs that insurers are paying oncologists to prescribe is that they seldom cure advanced-stage cancers. Despite widespread availability of these chemo drugs, metastatic lung cancer kills 98% of patients within five years. (127) Metastatic colon cancer kills 94% within five years. (128) Those afflicted with metastatic breast cancer fare better, but 78% still die within five years. (129)
Clinical oncology practice clearly needs more innovation--yet health insurance companies are providing financial incentives for physicians to prescribe chemo drugs that fail to cure advanced-stage patients. This kind of backwards approach to treatment will stifle the discovery of breakthroughs so desperately needed to spare the lives of more than 585,000 Americans who perish from cancer annually.
I'm purposely leaving the names of the insurance companies out of this article because it is likely that other insurers will follow this pattern of scientific regression. What we are witnessing is clinical oncology practice being driven backwards by outlandish drug prices, along with the high cost of increased physician involvement when aggressive therapies are utilized.
Health insurance companies argue their "recommended regimens" will improve patient care. We at Life Extension[R] disagree and advocate that more (not fewer) individualized, creative, and comprehensive treatment approaches could spare numerous lives.
Most Effective Brain Tumor Drug Not Approved To Treat Any Cancer
Perhaps the most frightening malignancy one can be diagnosed with is a form of brain cancer called glioblastoma. This type of brain cancer has a dismal prognosis, with median overall survival of 12 to 14 months, and a two-year survival rate of 15 to 26%. (131)
Senator Ted Kennedy was diagnosed with glioblastoma in May 2008. Despite intervention by some of the best brain tumor experts, Kennedy died in August 2009--a merd5 months later.
A study published in the New England Journal of Medicine on September 5, 2013, may represent the most significant advance yet discovered in treating glioblastoma. (131)
What follows is an overview of a drug that is not approved to treat any cancer, and thus is likely to be rejected by insurance company mandates:
* Valganciclovir (Valcyte[R]) is an FDA-approved drug used to treat cytomegalovirus infection. (132-135)
* Cytomegalovirus has been suspected as facilitating the initiation and promotion of brain cancers. Some 50 to 80% of adults in the US show exposure to cytomegalovirus, but relatively few harbor active viral infection. (135)
* Doctors followed 75 glioblastoma patients and found the median overall survival of those with low-grade cytomegalovirus infection was 33 months. In patients with high-grade cytomegalovirus infection, median overall survival was 13 months. (131)
* All but one of the 75 glio-blastoma patients studied had active cytomegalovirus infection, indicating that this virus may be involved in the development of this lethal malignancy. (131)
* In glioblastoma patients with high-grade cytomegalovirus infection, median two-year survival was 17.2%. Patients with low-grade cytomegalovirus infection had median two-year survival rates of 63.6%. (131) This suggests that high-grade, active cytomegalovirus infection accelerates tumor progression.
* In a double-blind clinical trial of valganciclovir involving 42 patients with glioblastoma, an exploratory analysis of 22 patients receiving at least six months of antiviral therapy showed 50% overall survival at two years compared with 20.6% of contemporary controls. This study showed that valganciclovir-treated patients had a median overall survival of 24.1 months compared to 13.7 months in patients not treated with valganciclovir.
* Owing to the promising results of this pilot study, physicians at the world-famous Karolinska University Hospital administered valganciclovir to glioblastoma patients and results were then compared to a control group. Both groups received standard conventional therapy and both groups had a similar disease stage and surgical-resection grade.
* The researchers retrospectively analyzed the data on 50 of these brain cancer patients and found the two-year rate of survival in the valganciclovir group was 62%, whereas two-year survival was only 18% in the control group. (131)
* In 40 glioblastoma patients who received valganciclovir for at least six months, the two-year survival rate was 70%, with a median overall survival of 30.1 months. (131)
* In 25 glioblastoma patients that received continuous valganciclovir treatment after the first six months, the two- year survival rate was 90%, with a median overall survival of 56.4 months (4.7 years)! (131)
* The current median survival of glioblastoma patients is only 12 to 14 months (1.0 to 1.16 years). (131) The efforts made to prolong Senator Kennedy's life by the experts at The efforts made to prolong Senator Kennedy's life by the experts at The efforts made to prolong Senator Kennedy's life by the experts at The efforts made to prolong Senator Kennedy's life by the experts at Duke University Medical Center was a survival of 15 months (1.25 years)--3.45 years less than the median survival in the 25 glioblastoma patients who received continuous valganciclovir treatment as detailed above.
The implication from these findings is that treating active cytomegalovirus infection may dramatically reduce progression, and significantly increase survival time, in patients suffering from the deadly brain cancer glioblastoma. Most exciting is the intriguing data from this retrospective study showing that in glioblastoma patients with active cytomegalovirus, a treatment protocol employing valganciclovir resulted in a median survival of 4.7 years!
Not only does this retrospective data involving the continuous use of valganciclovir substantially extend survival in glioblastoma patients, but it provides an opportunity to incorporate additional complementary therapies that could improve survival even more!
Why Brain Tumor Patients Are Denied Valganciclovir
It is illegal for the maker of valganciclovir to promote it as a treatment for brain cancer. The regulatory system in the United States requires that the maker of a drug conduct extensive clinical trials for each disease a drug claims to treat and then submit the trial results to the FDA for approval.
It is not illegal, however, for an oncologist to prescribe valganciclovir to treat glioblastoma.
The problem is the annual cost for valganciclovir is around $50,000. Many health insurers will refuse to pay this outlandish price. If an oncologist tries to prescribe it for a patient it will not be one of the insurance company's " recommended regimens," and the oncologists will likely lose his $350/month stipend because he or she did not adhere to the treatment protocols designated by the insurer.
We fear that 12,000 Americans will continue to die prematurely from glioblastoma every year despite impressive findings showing that valganciclovir could extend the survival times of many of these patients diagnosed with this deadly disease. (136)
Changing Cancer Care For The Worse
What we are seeing before our eyes are physicians who will give up years of education, creativity, and understanding of the individual patient to instead be directed by an insurance company and rewarded with a monthly stipend of $350 if he or she follows the insurers financially biased "orders."
The term now used for physicians in such a context is "provider." They provide the treatment, but are not involved in deciding what treatments to use. Thus, the physician has given up his or her role as "Decider" to become the "Provider."
The $350/month per patient could possibly be a significant income for the oncologist. Assume that oncologist has 400 active patients and that 100 of them are on the insurers "approved" chemo program. That's $35,000 per month or $420,000 per year. In most major cities, that's about what the average medical oncologist makes annually. If the oncologist surrenders his decision making to the insurer, he is doing less work and has fewer worries regarding patient outcome since he was only "following orders." The insurance company decided on the regimen. Thus, the trade-off to surrender physician autonomy for a substantial monetary reward that involves less stress on the physician becomes an irresistible temptation for far too many highly educated and highly trained medical oncologists.
Another concern is what will the insurer decide regarding the use of supportive care therapy, such as antiemetic and immune protective treatment prior to chemo. What will the insurer mandate regarding which imaging studies can or cannot be done, what laboratory studies are to be obtained and how often, and which immune-augmenting drugs are to be used? Where does the direction of care involving cost cutting stop?
In this newly perverse system brought about by outlandishly high medical prices, why bother using physicians to treat cancer patients? Given this form of cookbook medicine, costs could be further cut by using nurse practitioners or physician assistants to deliver standard care chemo drugs.
Blame The Broken System ... Not Just Insurance Companies
A number of health insurance companies are looking into aggressive ways to cut the soaring costs of cancer drugs by seeking to reduce payments to oncologists if they prescribe pricier drugs.
As I wrote earlier this year in an article titled "Unsustainable Cancer Drug Prices," of the 12 new cancer drugs approved in 2012, 11 were priced above $100,000 a year! Over a hundred oncologists signed a protest letter that concluded that the prices of many of these drugs "are too high, unsustainable, may compromise access of needy patients to highly effective therapy, and are harmful to the sustainability of our national healthcare systems." (137)
Just six months after my article was published, we are seeing insurance companies rebel by offering incentives to oncologists to prescribe chemo drugs they perceive as being less expensive. Here is a quote from the insurance company's oncology medical director: (138)
"This program--while sharing best practices and evidence-based medicine--also helps to support oncologists who require large staffs to treat these complex patients and provides the practice with enhanced reimbursement to offset the lower fees they receive when prescribing less expensive drugs."
According to the IMS Institute for Healthcare Informatics, in 2013 the United States spent $37 billion on cancer drugs, which is more than any other category. Overall costs for treating cancer are well over $100 billion annually and mounting steadily, according to researchers at the National Cancer Institute. Hospital, diagnostic, and pharmaceutical prices are beyond exorbitant.
A patient under the guidance of the International Strategic Cancer Alliance (ISCA) was recently charged $2,500 for a bone density outpatient test at a prestigious university hospital. The going rate at a diagnostic testing center is around $250. When ISCA responded by threatening to pay for an advertisement in the New York Times indicating this abuse by the university hospital, the hospital drastically reduced their price to this patient (but not to other cash-paying patients).
Still another reason why medical costs are spiraling upwards are large hospitals that are buying out individual oncology practices so higher "hospital" prices can be billed to Medicare, Medicaid, and health insurance companies. When chemo is administered in an oncologist's private office, the cost is less than compared to a hospital setting. Now hospitals are employing oncologists to make sure patients receive chemo in the hospital's oncology outpatient facility and billing insurance company's higher prices, which means you will be paying higher health insurance premiums, along with higher co-pays and deductibles.
The financial coffers of insurance companies are being plundered by the excess charges of hospitals and outrageously high drug prices. Insurance companies are responding by seeking to pay doctors to provide less costly treatments. This is bad news for cancer victims.
It is important to point out that in many clinical oncology settings, the insurance company's new "recommended regimens" may not be any worse than what patients are getting anyway. Bureaucracies have replaced the "special" physician, the one that comes up with creative approaches and who devours the literature looking for clues to help save his or her patient. Mainstream mediocrity has become the "standard of care" in too many instances and the public apathetically accepts it until they or a loved one is stricken with cancer.
The major factor responsible for the decay and dysfunction of sick care in the US is the powerful pharmaceutical lobby, the health insurance industry, and the burdensome legislation enacted by Congress that stifles innovation in the medical arena. None of these revelations should surprise Life Extension[R] members, who long ago learned how regulatory strangleholds inflict harsh economic pain, along with needless suffering and death.
What We Are Doing To Save Lives
For over 30 years, we at Life Extension[R] have relentlessly combatted the high cost of medicine, along with conventional oncology's less-than-optimal approach to cancer treatment.
We offer two services for members who develop cancer. One is free phone/email access to our cancer advisors. There is seldom a call where we can't suggest validated ways to improve survival, sometimes as simple as adding aspirin and metformin to conventional treatment. To speak with a cancer advisor, call l-866-864-3027| .
The second option is concierge oversight provided by the International Strategic Cancer Alliance (ISCA). This service has collectively lost us millions of dollars since its inception, but in the process has saved lives and added life- years. The main cost when using the International Strategic Cancer Alliance has been the high hourly rates charged by top-notch oncologists and other personnel involved in developing personalized and creative treatment strategies. New health insurance exclusions may also increase the patient's out-of-pocket costs when utilizing ISCA's Personalized Treatment Protocols. To reach out to the International Strategic Cancer Alliance, call l-610-628-3419| .
In this month's issue, you're going to read a case history of an advanced stage pancreatic cancer patient who contacted us in time for aggressive innovative therapies to be initiated. Another case history whereby our team of experts saved the life of a very "terminal" head and neck cancer patient can be read on the next page.
We were also going to publish in this month's issue an update on the successes we are seeing with breast cancer patients using innovative therapeutic approaches we helped develop. We are deferring that article until at least next month because when we reported on these treatment successes two years ago, the clinic was overwhelmed and had to stop taking new patients. I was informed this clinic should be ready to accept at least some new patients starting around October 15th of this year.
For longer life,
HOW POSITIVE RESPONSES TO CANCER THERAPY ARE DEFINED
* Partial remission (PR) indicates 50% or greater reduction in all measureable evidence of tumor dimensions and tumor markers.
* Complete remission (CR) indicates a disappearance of all measureable indicators of tumor activity.
* Cure indicates complete disappearance of all manifestations of disease activity that is sustained over years and insures a high probability that the disease will not return.
Cancer Patients Can Derive Survival Benefits when Adjuvant Therapies are Combined with Conventional Treatments
THE PROBLEM WITH CYTOTOXIC (CHEMOTHERAPY) DRUGS
When chemotherapy drugs were developed in the 1950s to 1970s, there was optimism that a pharmaceutical cure for cancer might soon be found.
These chemo drugs killed cancer cells in the petri dish and shrank tumors in cancer patients. The side effects, however, were horrific and survival improvements were negligible for most solid malignancies.
Medical oncologists are now being offered $350/month per patient to prescribe chemo drugs that, in some cases, were introduced before many of you reading this article were born.
There are drugs in the insurance company's "recommended regimen" that are new and considered cutting-edge, but provide average survival improvements often measuring less than one year.
In the May 21, 2014, edition of the Journal of the American Medical Association, a study was published showing that lung cancer patients survived 1.1 years longer when aggressive genomic testing was done and drugs that specifically target an individual tumor are added to standard chemo regimens. (120) These newer drugs target what's known as "oncogenic drivers," which are genetic abnormalities critical for tumor development and maintenance. The survival improvement in response to these "targeted" therapies is certainly welcomed news, but a far cry from a cure. The side effects from these newer cancer drugs are similar to old-line chemo drugs, meaning the patients endure significant suffering in exchange for added time.
Our scientific understanding of molecular oncology has grown exponentially over the past 40 to 50 years, yet relatively little of this knowledge is being delivered to the cancer patient. Clinical oncology practice, in fact, has progressed so slowly that many old-line chemo drugs are still considered first-line therapy at cancer institutions today, despite their failures to produce cures in the majority of advanced cases.
The problem is that consumers with health insurance may not have a choice. If their oncologist follows the insurers "recommended regimen," they will be prescribed chemo drugs that have historically provided relatively minimal survival improvement. These patients might better benefit from creative therapies that health insurance companies now balk at paying for.
On the right side column is a list of chemotherapy drugs that one insurance company wants most of its insured customers restricted to, along with the dates of each drug's approval and how many years each of these drugs has been in use.
Some of these drugs were approved more than 60 years ago. That does not mean they are not still useful against certain malignancies. The invariable question is whether certain patients who would benefit from more comprehensive and creative approaches will instead be prescribed these " standard-of-care" drugs because of the financial incentives being offered to oncologists.
To receive their $350/month stipend per patient, oncologists have to stay with the insurance company's "recommended regimen" for that patient. This financial incentive comes to $4,200 a year per patient treated following the insurer's protocol!
Drug Name Approval Date Years In Use Leucovorin June 20, 1952 62 Cyclophosphamide November 16, 1959 55 (Cytoxan[R]) (Manufacturing changes in 1976, 1977, 1979,1984, 1987, 2000) Cytoxan[R] (lyophilized) equivalent Fluorouracil (5-FU) April 25, 1962 52 DoxorubicinHCL August 7, 1974 39 injectable (Adriamycin[R]) Cisplatin (Platinol[R]) December 19, 1978 35 Carboplatin (Paraplatin[R]) March 3, 1989 25 Paclitaxel (Taxol[R]) December 29, 1992 21 (Manufacturing change or addition 1993, 1994, 1997, 1998, 2001) Vinorelbine (Navelbine[R]) December 23, 1994 19 Docetaxel (Taxotere[R]) May 14,1996 18 Gemcitabine (Gemzar[R]) May 15, 1996 18 Irinotecan (Camptosar[R]) June 14, 1996 18 Capecitabine (Xeloda[R]) April 30, 1998 16 Trastuzumab (Herceptin[R]) September 25, 1998 15 (Manufacturing change 2012) Epirubicin (Ellence[R]) September 15, 1999 14 Oxaliplatin (Eloxatin[R]) August 9, 2002 11 Pemetrexed (Alimta[R]) February 4, 2004 10 Bevacizumab (Avastin[R]) February 26, 2004 10 Erlotinib (Tarceva[R]) November 18, 2004 9 Panitumumab (Vectibix[R]) September 27, 2006 7 Lapatinib(Tykerb[R]) March 13, 2007 7 Pertuzumab (Perjeta[R]) June 8, 2012 2 Regorafenib (Stivarga[R]) September 27, 2012 1 Ado-trastuzumabemtansine February 22, 2013 1 (Kadcyla[R]) Afatinib (Gilotrif[R]) July 12, 2013 1 Average age of chemo drug 19
INDUSTRY ACTUARIES GUIDE YOUR CANCER TREATMENT
The practice of medicine has largely devolved to a place where physicians no longer take the lead in guiding treatment.
Consider a scenario that plays out day after day in modern cancer treatment.
An experienced oncologist sees a Medicare patient suffering from an aggressive cancer. The oncologist realizes that there are several viable options, and that the best therapy is not the usual, cost-effective standard-of-care choice covered by Medicare. Rather, it's a more expensive and newer option with compelling data that shows better results. However, the newer, more expensive treatment option--the one that's best for the patient in the opinion of the treating oncologist--is not standard of care and therefore, is not covered under Medicare.
The patient is treated with the Medicare-approved drug. In this case, the federal government's actuaries at the Center for Medicare & Medicaid Services have been the guiding force in treatment of this patient, not the experienced oncologist.
"Insurers are changing how they pay for cancer care, aiming to blunt soaring costs and push oncologists to adhere to standardized treatment guidelines." (130)
Wall Street Journal, May 27, 2014
AGGRESSIVE APPROACHES CAN CURE TERMINAL CANCER
In April of 2000, a patient came to us with advanced head and neck cancer with a primary location in the sinus and infiltration to the brain and orbital (eye) cavity. The tumor was the approximate size of a baseball and every oncologist consulted stated the patient had only months to live. Hospice was recommended as there was no conventional therapy that could treat this patient due to the complex anatomical locations of the tumor.
Just imagine the challenge of treating a tumor of this size growing inside someone's head. The tumor's location made it untreatable, according to every oncology expert. The only advantage we had is that no treatment had yet been administered, meaning the tumor was "treatment naive," and thus vulnerable to eradication by multimodal therapies. Our dilemma was figuring out how to administer therapy to this delicate anatomical region of the body without blinding the patient and creating permanent brain damage.
The hospital wanted to administer systemic cisplatin chemotherapy, which would have temporarily shrunk the tumor, but at the cost of horrific side effects and the mutation of the tumor to a virtually invulnerable stage. We stopped the patient from getting the systemic cisplatin in the nick of time.
The scientific team at Life Extension[R] devised an unprecedented protocol that involved inserting a catheter into the patient's femoral artery. The catheter was directed into the aorta and from there threaded into the external carotid arteries. Using the catheter as a chemotherapy delivery system to the tumor, a relatively massive dose of cisplatin was initially used to target the tumor. It would have been impossible to deliver enough of this highly toxic chemo drug in any other way. Even by delivering cisplatin directly into the tumor, there were still some side effects (renal impairment) which were able to be reversed.
Following initial direct-to-the-tumor cisplatin therapy, the chemo drug paclitaxel was administered via this same intra-arterial route for four additional weeks.
These intra-arterial chemotherapy sessions were immediately followed by proton beam-accelerated radiation and the use of numerous drugs not approved to treat this cancer. For example, to enhance the tumor-killing effects of the proton beam-accelerated radiation, the radiation sensitizer 3-chloroprocainamide (3-CPA) was used. This had to be synthesized in our lab, as it was not commercially available to us. To further enhance the proton-beam therapy, the patient ingested 18 grams of arginine before treatment and breathed pure oxygen during treatment. The objective was to thoroughly oxygenate the patient in order to induce maximal tumor cell death during the proton-beam therapy.
It took until late June 2000 (the patient was diagnosed in April 2000) to initiate this complex therapy. By September 2000, there was no sign of active tumor. The patient was in complete remission, meaning there was no sign of tumor activity in the patient's body. Oncologists at Loma Linda Medical Center were so impressed that they used this same protocol on another patient with advanced sinus cancer. We were informed that in this patient a complete remission was also attained.
Our client was prescribed a three-year follow up cyclical dosing of interferon alfa-2b and 13-cis retinoic acid to mop up any residual tumor cells that may have escaped the aggressive proton beam and intra-arterial chemo that was delivered over an eight-week time period.
Within two years, our client developed radiation necrosis of the brain, which was caused by the high dose of proton beam radiation therapy. This is a common side effect when the brain is irradiated. Once again, conventional doctors pronounced our client "terminal," since there was no recognized treatment to overcome the raging inflammatory fires destroying the brain.
The scientific team here at Life Extension[R] went back to work and identified two drugs (cabergoline and pentoxifylline), both not approved to treat radiation necrosis. The two-drug combination suppressed the radiation necrosis, and once again to the doctor's amazement, this patient was cured of a side effect that had been pronounced terminal. Our client remains alive today, 14 years since the original "terminal" diagnosis was made.
To make more of these kinds of lifesaving therapies available, I helped set up the International Strategic Cancer Alliance (ISCA) to speed innovative cancer treatments to patients who are unable to be helped by conventional oncology.
QUOTE FROM AYN RAND REGARDING DOCTORS
"I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind, yet what is it that they expect to depend on, when they lie on an operating table under my hands? Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it--and still less safe, if he is the sort who doesn't."
From Atlas Shrugged by Ayn Rand
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|Title Annotation:||As We See It; cancer treatment|
|Date:||Oct 1, 2014|
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