The Blog

Fighting Cancer: New Uses for Old Drugs

Opportunities are being missed, and time and money are being wasted. We all know people who are struggling with cancer and the intense challenges of the current treatment protocols. The needs are urgent and the time to act is now.
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Imagine that you are diagnosed with cancer. You learn of a safe, effective, and inexpensive treatment without "chemo" side effects. Although the medication is widely available at any local pharmacy, your doctor can't prescribe it for you.

What's going on here?

Vikas P. Sukhatme, M.D. Ph.D. knows. He's professor of medicine at Harvard Medical School, chief academic officer at Beth Israel Deaconess Medical Center, and a co-founder of GlobalCures, and he describes the following. There are low-cost and commonly-prescribed medicines with amazing cancer-fighting properties, but unfortunately they can't be used to treat cancer. Funds to speed research are lacking, and needed policy changes are ignored. In the meantime, Americans are dying from cancers that might be effectively treated.

I've heard Dr. Sukhatme speak and read his reports, and the data is compelling. This is a story that must be shared.

New studies into cancer cell metabolism are revealing a variety of secrets about how these cells multiply and spread. Two mechanisms in particular are susceptible to treatment.

Like all the cells in our bodies, cancer cells need sugar for energy. But cancer cells consume more sugar -- up to 10 times more than normal cells. A diabetes medicine called metformin appears to utilize this difference to stop cancer's growth.

Metformin been in common use for over 40 years, with nearly 50 million prescriptions filled annually in the United States. Its effects and side effects are well known, and its cost is only about 30 cents a pill.

By lowering blood sugar, metformin harms a population of cancer cells called cancer stem cells. These cells appear to be particularly reliant on sugar metabolism and are hard to kill by conventional chemotherapy. In animal studies, metformin has been shown to be effective against solid tumors: breast, ovarian, colon, and pancreatic cancer.

Despite the promising evidence, oncologists are reluctant to use metformin because studies in human cancer patients have not been conducted. Before we get to the reason why these studies haven't happened, here is another example.

It has been demonstrated that stress (such as the stress that comes from undergoing surgery) accelerates the progression of cancer. Researchers speculate that stress causes a release of hormones that trigger a signal to microscopic pockets of cancer cells to "turn on" from their dormant state.

The mechanisms for this response are being analyzed, but in the meantime there are safe medicines that blunt some of the stress reaction. One is called propranolol, and it's been in common use for decades to treat high blood pressure, angina, and heart rhythm disturbances. Its cost is less than 25 cents a pill. In one study, women with breast cancer who happened to be on propranolol for other reasons were compared to patients with similar cancers who were not on propranolol. The ones taking propranolol had much better survival rates, in some cases up to two or three times better.

Why aren't more studies being done on these and other commonly-used medicines to find out the best way to use them? The answer is simple: money.

Under our current structure, pharmaceutical companies only undertake costly and time-consuming product development if they can recoup their expenses by making significant profit on the resulting medications. But investigating new uses for already-existing inexpensive medicines does not lead to cash flow. The FDA process to evaluate new uses of old medicines offers little flexibility, and strict rules limit how doctors can recommend "off-label" uses. Doctors are reluctant to prescribe medicines when the best ways to use them are not yet well defined.

This logjam must be broken. We need an open and inclusive public discussion to realign incentives so that promising new treatments do not go ignored because they may be less profitable. While market incentives have helped to spur the development of many life-saving drugs, we cannot allow it to control all pharmaceutical research.

In the case of metformin and propranolol, because these medicines have been around for so long and are well understood, Dr. Sukhatme believes it is possible to expedite the study process and find ways to make this financially affordable. His goal is to democratize the process, to help patients find their best treatment options, share their clinical outcomes, and fund promising therapies.

In the meantime, patients are suffering and dying unnecessarily. Opportunities are being missed, and time and money are being wasted. We all know people who are struggling with cancer and the intense challenges of the current treatment protocols. The needs are urgent and the time to act is now.

For more by Dan K. Morhaim, M.D., click here.

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