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Are you looking for alternatives to chemotherapy?

Targeted therapies allow cancer patients to avoid chemo and benefit from treatment that is more effective, and less invasive, than standard treatment – including chemo and radiation. A good example of this is the success story of Margaret, a CTOAM patient with breast cancer. Using a unique precision oncology process, CTOAM helped Margaret delay palliative chemotherapy for two years. During that time she went on targeted therapies and was able to benefit from a longer, and higher quality, life.

In sharing Margaret’s story, many people have asked an important question.

What’s So Great About Postponing Chemo for Two Years?

CTOAM’s cancer expert, Alex Rolland, explains why delaying palliative chemo – and finding evidence-based alternatives to chemotherapy – is so important.

1. Palliative Low Dose Chemo is Usually Ineffective: It’s Often Given for its Placebo Effect

“Doctors often offer dying patients palliative low dose chemo. Margaret, for example, had been offered palliative xeloda by her public oncologist when we first met her. However, it turns out that this would have been useless for her cancer.

When cancers are at an advanced stage, there is typically a lot of variation in the molecular features of the individual tumour cells. This means that any one drug will only suppress a small population of cells. Typically, these drugs [i.e. palliative low dose chemo] are given to reduce some of the side effects of tumour growth, such as inflammation and blood clots.

Additionally, the oncologist usually chooses a drug that the patient initially responded too, with the hopes that it may provide some comfort: in most cases, the drugs are given for a placebo effect and to help the patient feel they are still being treated and cared for.

They are usually drugs [like xeloda] with minimal side effects that may slightly slow the speed of tumour growth – however, more often than not, it’s ineffective (due to the reasons above).

So, the first point is that we were able to postpone the inevitable – i.e. palliative chemo – with Margaret for a couple of years.

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2.a) Using Targeted Therapies Re-Sensitizes the Cancers

Secondly, there are two important related issues.

Using targeted and immune therapies modulates and changes the way a cancer responds to other drugs, including chemotherapy. So even if these approaches fail to get a response, or only get a partial response, they still succeed in re-sensitizing the cancers. This allows the cancer to respond to chemo drugs that the patient previously did not respond to.

2. b) Combining Immunotherapy with Chemotherapy Has a Synergistic Effect

Important new data shows that combining immune agents (cytostatic) with chemo drugs (cytoxic) has a synergistic effect, where the patient responds to the combination at a higher rate than they would with either drug individually.

For example, ER positive breast cancers do not respond to PD-1 immunotherapy using Pembrolizumab – which has a low Overall Response (OR) rate of approximately 8% or less. However, if you add the chemo agent, Paclitaxel, the patient has a much higher OR rate (34% vs 13%) compared to standard chemo alone.

This is the strategy that CTOAM used with Margaret. Here’s how it works.

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How Immunotherapy and Chemotherapy Work Together

Specifically, tumours avoid detection from the immune system via the CTLA4, IDO, and PD-1 pathways. Currently, the PD-1 pathway is of great interest because there have been remarkable responses from drugs that inhibit this pathway.

PD-1 (or, programmed death one) is a protein that cells use to protect themselves, since it disables certain arms of the immune system, such as T-cells. Normal cells express PD-1 in order to tell the T-Cells that they are part of the normal body system. Tumour cells upregulate PD-1 and create a bubble of it around them – so when a T-cells comes to investigate it, they’re tricked into thinking the tumour is part of the body’s normal functioning. PD-1 inhibitors, such as Pembrolizumab, interfere with the PD-1 signalling pathway, allowing the tumours to be recognized by the immune system.

Studies show that the higher the level of PD-1, the better the response is with these drugs [PD-1 inhibitors]. The issue, though, is that tumours only need to use this process transiently in order to permanently disable the immune response. In other words, a specific tumour will only use the PD-1 bubble once – and, at different times – in disease progression.

However, we now know that certain chemo drugs increase PD-1 signalling immediately after they leave the body. Therefore, combining them with PD-1 inhibitors can result in a much better response rate to these drugs, because it tricks the tumours into producing a high amount of PD-1. Of course, there are other processes involved; this is a simplified explanation to give you a general overview.

Margaret was on both immunotherapy and chemo for these reasons.

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Getting a Second Opinion for Your Cancer Care

As you can see, there’s a lot more to cancer treatment than meets the eye and many evidence-based alternatives to chemotherapy that currently exist. There are different reasons why an oncologist might recommend a certain treatment. Many times it’s based on what they’re able to offer within the time constraints and financial limitations of the standard health care system.

That’s why more and more patients these days are opting to hire their own personal cancer expert, such as CTOAM, to access these advanced tests and treatments that are still unavailable through standard care. Having an advocate in your corner ensures you get the best treatment possible – and often with little or no travel involved.

Further, many of our patients are able to get their treatment covered with the data we provide that proves they need it! You can see breast cancer survivor Lisa’s success story and interview for a good example of this.

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Discover Your Best Evidence-Based Treatment Options

Don’t wait another day to start moving forward with a greater sense of peace. Register today for your Precision Second Opinion and learn how precision oncology can help you live longer, with a better quality of life.

You can also read our in-depth interview with Margaret, where she generously shares her personal insight into her journey with breast cancer.

And check out Damian’s success story to see another example of using immunotherapy to treat an otherwise difficult-to-treat case of colon cancer.

CTOAM, Precision Oncology Specialists: The future of cancer treatment, now.
Published by on May 11, 2018
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