Traditional Chinese Medicine and Cancer Treatment
Cancer Newsline Audio Podcast Series
Date: September 28, 2009
Duration: 0 / 17:52
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Welcome to Cancer Newsline, a weekly podcast series from the University of Texas M. D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention; providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today we'll be talking about traditional Chinese medicine and the inroads that it's made in Western medicine and cancer treatment. My guests today are Lorenzo Cohen PhD. He is the director of the Integrative Medicine program here at M. D. Anderson, and Peiying Yang, PhD. She is an assistant professor in the General Oncology Department. Welcome to you both today.
Lorenzo Cohen PhD:
Thank you, good to be here.
Let's talk about traditional Chinese medicine and how prevalent it's become in Western practices and oncology practices, Dr. Cohen.
Lorenzo Cohen PhD:
Well traditional Chinese medicine, some argue, has been practiced for around 5,000 years. It's only recently that it is being integrated into Western medical practices, and in particular the use of acupuncture to help prevent disease and treat some chronic conditions. And it's estimated now that over 70 countries have acupuncture incorporated into medical care.
sorts of research has this relationship with
Peiying Yang, PhD:
we have the... got NCI funding a few years ago, Dr. Cohen director of the
Integrative Medicine Program. And he has led this program, we initially went to
set up the integrative... international... Chinese medicine
And what sorts of studies have you done? Has it been things like acupuncture? Has it been more like herbal supplements, or a mixture of both?
Oh, one of the main areas of traditional Chinese medicine... would be the herbal treatments and natural products that they work with - acupuncture, and then this sort of movement based mind/body type therapies such as Tai Chi and Chi Gong. They also have something that is often incorporated, that's called Twena which is a particular kind of pressure point massage. But we haven't been studying that, so we focused on looking at a particular natural product, looking at acupuncture for symptom control, and Chi Gong a movement based therapy. And so in the initial few years we started 3 clinical trials, and in subsequent years we finished those 3 and actually have started 4 others. And so over the past 6 years we've really been running 7 different clinical trials.
Can you kind of give us a rundown of the different subjects of these clinical trials?
So 1 of the areas is researching this natural product called HuaChanSu, which is the extract from the skin of a poisonous toad, a bufo toad, and we've completed a phase 1 clinical trial that is published in the Journal of Cancer, and we have an ongoing phase 2 clinical trial. In Chinese we've actually ran the studies, the patients in these studies, and patients weren't recruited for those studies from M. D. Anderson, but Dr. Yang has been doing very extensive pre-clinical research; so working with animals as well as cancer cells in petri dishes, to really understand the mechanisms behind this product HuaChanSu, and what it's benefits can be from the pre-clinical setting.
What are the applications of toad venom Dr. Yang?
Basically traditionally this has been used for many years, more than over 1,000 years really, to treat... it has been a cardiotonic agent, so because they have cardioglycoside in the skin of the toad. And then I believe about starting early 90, 80's, they start to explore the possible role of the cancer treatment using this toad skin. And so the HuaChanSu, the part we're using for the study, was approved by Chinese government in 1990 to be a standard treatment for... traditional Chinese medicine to treat cancer on pancreatic, lung, and... liver cancer.
What is it's action? Does it create apoptosis or what sort of action?
It does, it does. At the lower dose it induce cell cycle rest. But with higher dose they do induce apoptosis.
Quite interesting. And is this something, have the Chinese been using it for cancer in this 1,000 years?
do. If you go back to many, many years ago they have this very old pharmacopeia
of the Chinese medicine. They were saying that toad skin can be used to treat
for skin cancer. I think the initial use was that. They just put on the skin of
the patient and just see what happened. And then gradually they become more
popular to treat various cancer, and that's the 1 drug
where even Dr. Cohen... has feel that... collaborated from M. D. Anderson and
And what sort of pre-clinical work are you doing?
Basically we started with study anti proliferative activity of the HuaChanSu, all kinds of cell lines to see what is most effective. So basically can inhibit almost all the human cancer cell lines, but most effective in pancreatic cancer; particularly one like pancreatic, this is where we express high levels of sodium potassium ATPase, with obviously a subunit. And then we did annual studies conform this drug also active in the real model as well. And mechanism wise it does inhibit multiple oncogenic pathways, inhibit PI3 kinase. They are stage 3, which are very important oncogenic genes as well. We also did study with combination Gemcitabine, actually synthesize Gemcitabine anticancer in the pancreatic cancer as well.
Is this something... is it a rare frog? Are you taking the HuaChanSu or the venom, and are you synthesizing it or is it actually the natural venom?
It's a natural, it's extracted, it's hot water. You basically boil the toad with hot water.
Is this like a rare... I mean, are there issues with trying to get enough toads? I mean...
Yes. So basically now that the manufacturer has been trying to improve their quality product for all these years, because the natural part always had this big challenge, the variation is always there because they're natural, they're not synthetic. Now they basically have their own... they raise them first in the manufacturer, and then they actually let them go to the wild. Then they collect them all, and that way they can control the quality of the product.
Is it too early to say what went on in the phase 1 and the early phase 2 trials of HuaChanSu?
So from the phase 1 trial that's been published and we presented the data, we saw out of the 15 patients 6 patients had relatively stable disease. What was quite remarkable is that 1 patient actually had a 20 percent shrinking of their tumor. Now that still classifies it just as stable disease, but the fact that a patient with stage 4 liver cancer with metastasis, of course outside of the liver, ended up having the main tumor shrinking more than 20 percent just receiving IV injections of this toxic toad venom. That was quite remarkable. Another patient with liver cancer with metastatic disease to the lungs has stable disease for over 8 months, again only receiving the HuaChanSu. The ongoing phase 2 study, it's too early to really look at that data, but we should be completing recruitment by the end of this year or mid 2010, and then we'll be able to analyze that data. That study is a 2 group design where half the patients will be getting HuaChanSu and Gemcitabine, and half will be getting Gemcitabine, a standard chemotherapy agent, plus placebo; all 4 advanced pancreatic cancer.
And I know probably any news is good news with pancreatic cancer, which we know is a very difficult cancer to treat.
Extremely difficult, and so... if we see something that's great and it would be a homerun, if there isn't activity in pancreatic cancer it doesn't necessarily mean that HuaChanSu isn't an interesting product to pursue, but it may have to be done with different cancers or within patients with different stage of disease. One thing that a lot of people may not be aware of when we look at something like traditional Chinese medicine, and in particular the natural products - the herbs or the animal products that we've been talking about, is that a lot of the conventional medicines that are used in our society today actually originally came from natural products, or they're actually the natural product itself. And that's the case actually for many conventional chemotherapies. Vincristine actually comes from the periwinkle plant, and the periwinkle plant is used currently to extract that drug. So things that may not seem conventional to us actually are quite conventional in the plant world, and the animal world has always been a source of new drugs... and major pharmaceutical companies in our world today are specifically exploring traditional Chinese medicine for novel therapeutic agents to help in our battle against cancer.
As far as integrating Chinese medicine into oncologic care, is M. D. Anderson ahead of the pack, kind of cresting the wave, or where are we in terms of our competitors with integrating Chinese medicine?
as a whole, our integrative medicine program is quite
large. We have a number of acupuncturists who work with patients for managing
symptom control. In terms of natural products we have a lot of natural products
that we're researching from the pre-clinical perspective, and some of them made
it into clinical trials, Curcumin being 1 example,
Oleander being another example. From Chinese medicine perspective, oleander I
don't think is part of the Chinese pharmacopeia. Curcumin
is but it's recognized more as part of Ayurvedic
some more about the... you say you have 7 active trials of
terms of the area of acupuncture we completed a trial looking at acupuncture to
help prevent prolonged postoperative ileus, which is
essentially chronic constipation after abdominal surgery. That trial actually
was a negative trial. We're always upset with negative trials, but the
interesting thing to note there is a comparable study that we did at M. D.
Anderson was also a negative trial. What was a little different is that the
trial done at M. D. Anderson most patients actually didn't develop ileus. So it was a difficult model to test this. With a
trial that we did at
Let's kind of go back to the toad venom just a little bit. Dr. Yang, I don't know if you've talked to any of the participants in the trial, but is it hard, because people are saying you're going to inject me with toad venom? I mean do people, the general public, have a hard time grasping Chinese medicine? Or is that changing?
because there's trials in
I guess 5,000 years of Chinese medicine can't be wrong.
Well yeah, well there's some... I really feel, because I have a background in Chinese medicine, so I think there is still some very unique thing from there we could explore to be beneficial to the public.
Great. Are there any final thoughts that either of you would like to leave us with before we go?
other area of research we focused on with our colleagues in
And M. D. Anderson offers many movement based, and other mind/body spirit things through the place of wellness. Correct?
Yes, many. From yoga, Tai Chi, Chi Gong, Pilates, many movement based programs.
Dr. Yang is there anything you'd like to leave us with?
I just want to say in general when we use Chinese medicine in China, we all face difficult cancer... always as adjuvant therapy most likely, because they can really reduce the symptoms from chemotherapy... so I would hope the Chinese medicine will eventually actually play the same role here as well for the patient benefit.
Well it sounds like it's well on it's way, at least here at M. D. Anderson. Thank you both. If you have questions about anything you've heard today on Cancer Newsline, contact Ask M. D. Anderson at 1-877-MDA-6789, or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.
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