Can cheap drugs (up to a century old) be the new way to tackle cancer?

As a doctor, Lisa McGrath had always considered herself healthy, but when she was 42, she found a lump in her breast and was diagnosed with advanced breast cancer.

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It was, as Lisa remembers seven years later, a complete shock. "I've never smoked and barely drank," she says. "I run regularly and the most overweight I have ever been is 7-10 pounds. I have had four babies, all breastfed, and I have no family history of breast cancer. & # 39;

The cancer had spread in her left armpit and in most lymph nodes. "It was grown in a plate instead of a tight ball – a type of tumor that is harder to detect and often larger when found," she says.

After a breast amputation, Lisa underwent six cycles of chemotherapy and 25 radiotherapy sessions. At that time, her eldest son, Patrick, was 22, her next son, Euan, was 11, and her daughters, Sophie and Emily, were only ten and six.

Fighting: Lisa McGrath, 49, a mother of four children who is a GP with stage four breast cancer and secondary bones, uses metformin as a proven but not prescribed treatment to keep the condition at bay. She is currently fit and good, but the situation will return at some point

Fighting: Lisa McGrath, 49, a mother of four children who is a GP with stage four breast cancer and secondary bones, uses metformin as a proven but not prescribed treatment to keep the condition at bay. She is currently fit and good, but the situation will return at some point

"Chemotherapy made me terribly sick," she recalls. "I felt very sick and had severe pain in my hands and feet and terrible headache. I was exhausted and lost all my hair, eyelashes and eyebrows. & # 39;

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Although the treatment – which kills the cancer cells – cleared up the disease, Lisa was told six years later, in the spring of 2018, that it had returned and was now in six places in the bones of her legs, pelvis, spine and ribs .

Unfortunately, it is a story that far too many patients seem familiar. But what is unusual is what happened next. Because Lisa is a general practitioner, she has a better understanding of the mechanisms of cancer than many people.

She used this to explore other options that, in her view, combined with her regular treatment, not only helped her keep the cancer at bay, but even achieved a small amount of tumor shrinkage.

DIABETES PILL SEEMS TO GET THE TUMOR GROWTH

Central to this is metformin, a drug that has not been used for cancer for almost a century, but as a safe and routine treatment for type 2 diabetes.

In diabetes, it is used to stop the overproduction of glucose in the liver. In the treatment of cancer the precise mechanism is unclear, but metformin appears to block the supply of glucose that cancer cells need to grow and multiply; it also blocks the activity of enzymes used for the growth of cancer cells.

According to the American National Center for Biotechnology Information, a government agency, nearly 4,500 studies have been conducted since the early 1980s into the use of metformin as an additional drug in cancer treatment.

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Only last month did a study in the Carcinogenesis journal show that metformin in combination with a class of anti-cancer drugs, called CtBP inhibitors, reduced the growth of breast cancer cells by up to 76 percent.

However, the lead author of the study, Dr. Jeremy Blaydes, a cancer cell biologist at the University of Southampton, warned: "More work is needed – we need the results of more studies before we can think about recruiting patients into large human taste.'

This was repeated by Breast Cancer Now, the charity that financed this study. "There is not enough evidence to prove that metformin works," a spokesperson said.

This reflects the general picture, which is why the drug is rarely recommended by cancer specialists and is not available for cancer treatment on the NHS.

Indeed, Lisa has experienced this in her own general practice. "Metformin has not been proposed as an additional treatment for one of my own patients," says Lisa, whose surgery is at Wirral in Merseyside, where she lives with her husband, Conor, an anesthesiologist.

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& # 39; As a doctor, you should not recommend it – if patients were to ask for metformin, I could tell them to ask their oncologist about it, or say I believe it has an advantage, but that's all. & # 39; And yet she is convinced that, in her case, the drug has been the key and is convinced that the reason it is no longer widely used is because it is not in the financial interest of pharmaceutical companies to use it researching or promoting.

After her first diagnosis and successful treatment, Lisa returned to work as a doctor three days a week and went on with her life.

"As far as my doctors were concerned, there was nothing left to see after the treatment," she says. "I have treated as much as possible. Then, in February last year, I was out with friends and a few times I noticed that my hips were hurting.

"I only did 5 km to 10 km, no crazy distances, but I thought it was better to relax and the hip pain decreased. Then, in April, I had back pain that was new, and the hip pain had returned. I told myself it was wear, but it started to get pretty frightening and in June last year I contacted my oncologist at Clatterbridge Hospital, Birkenhead. I knew in my heart that the cancer had spread to my bones. & # 39;

When scans confirmed this, Lisa was determined to explore all options.

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In addition to her medical degree, she has a second degree in human cell biology.

"In the few years before I was diagnosed, I had read a lot about the effects of old drugs such as metformin and became interested in how they work," she says.

Living Evidence: Jane McLelland, a trained physical therapist, is someone who healed herself from cervical cancer who spread to her lungs 16 years ago

Living Evidence: Jane McLelland, a trained physical therapist, is someone who healed herself from cervical cancer who spread to her lungs 16 years ago

Living Evidence: Jane McLelland, a trained physical therapist, is someone who healed herself from cervical cancer who spread to her lungs 16 years ago

Lisa also came across a book on how to starve cancer without starving yourself, in which author Jane McLelland, a trained physical therapist, reveals how she used a combination of metformin and other 'old' medicines after cervical cancer spread to her lungs 20 years ago .

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At the time, Jane, a mother of two, had a 5 percent chance of survival. Now 55, she lives in Fulham, West London, has been in remission since 2004 and still takes metformin.

While her NHS oncologist prescribed a new chemotherapy drug, palbociclib, Lisa also takes metformin as part of a small cocktail of "old" metabolic drugs that are thought to disrupt the "feeding" of cancer cells. This cocktail contains aspirin and a statin that is normally given to control cholesterol.

"They do not expect palbociclib to reduce the tumor, but further progression will stop for three to four years," says Lisa. & # 39; But when my doctors examined me in March of this year, while there was no new progression of one of the tumors, there was also a little shrinkage.

"I assume that everything I do may have contributed to starving some cancer cells and caused this reduction," she says.

THE SPECIALIST STRUCK BY RESULTS

Another patient who says she benefits from metformin is Joanne Myatt, a 43-year-old social worker from Chorley, Lancashire. She was initially treated for breast cancer in 2006, but three years ago the disease returned to her liver and bones.

"I wrote myself off," she says. She started taking metformin nine months ago (in addition to conventional treatment) & there is some tumor shrinkage in my liver & # 39;

"I'm not saying that the metformin is a cure, but I do believe it is doing something."

Mary Nike, 62, an IT consultant from Brewood, Staffordshire, who was diagnosed with advanced breast cancer in 2014, told Good Health: "All specialists are surprised that my cancer has not spread. I think metformin is crucial. & # 39;

Success: Mary Nike, 58, a breast cancer patient who has had a remarkable result through the use of metformin, an inexpensive drug that is normally used for diabetes, but has been found by repeated studies to interrupt cancer growth

Success: Mary Nike, 58, a breast cancer patient who has had a remarkable result through the use of metformin, an inexpensive drug that is normally used for diabetes, but has been found by repeated studies to interrupt cancer growth

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Success: Mary Nike, 58, a breast cancer patient who has had a remarkable result through the use of metformin, an inexpensive drug that is normally used for diabetes, but has been found by repeated studies to interrupt cancer growth

Patients who use such medicines must find sympathetic doctors who are willing to offer them on their own prescription.

Lisa is being treated at the Care Oncology Clinic in London, one of the few centers in the UK that offers this so-called "cancer-hunger" approach.

It was founded five years ago by Dr. Robin Bannister, a pharmaceutical scientist who has put together a team of doctors to prescribe a metabolic anti-cancer regime, including metformin, to work with conventional chemotherapy.

"We approach cancer treatment from a different angle," says Dr. Bannister.

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His wife, Ginnie, died in 2017, who was originally diagnosed with breast cancer in 2005, at the age of 41. It came back in her lungs in 2012, but he believes that the five years she survived were partly due to the additional treatment by the clinic.

He says: "We have just published a study in the journal Frontiers in Pharmacology, which shows an average survival of 27 months in 95 patients with advanced brain tumors when they followed our protocol, compared to 14 months with standard treatment."

He adds that although there are "some enlightened doctors who remember what they learned about cancer metabolism in the first year of medical school," the general view is that there is insufficient evidence to recommend metformin.

There is also the suggestion that the cancer industry itself is not interested in pursuing this re-use of old medicines.

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& # 39; Metformin slows tumor growth and provides a survival benefit of a few months, which is comparable to many of the £ 100,000 cancer drugs & # 39 ;, says cancer specialist Karol Sikora, dean of medicine at Buckingham University.

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"But it's very cheap and no one doing a test would get their money back through extra sales – that's why there's little interest in promoting it."

Author Jane McLelland agrees: "There is enormous resistance from the medical and pharmaceutical institution to these treatments because there is no money in them.

"Old medicines cost a few cents

instead of hundreds or thousands of pounds, so all research funds focus on the expensive new drugs. & # 39;

Dr. Bannister adds: "To do a research so that you can recommend them for cancer treatment costs money. If you just want to increase the sale of a cheap drug, no one is motivated to do so.

"Cancer Research UK tests aspirin, albeit extremely slow, but that's all."

Aspirin is believed to slow the progression of the disease by inhibiting a gene that promotes cell proliferation.

When Good Health contacted Cancer Research UK – according to whose accounts it receives hundreds of millions of pounds from pharmaceutical companies – Emma Greenwood, policy and public affairs director, rejected the suggestion that it is being influenced by the drug manufacturer's sales agenda. "The charity fiercely monitors its independence," she says.

"Now we understand much more about what drives cancer, there are more and more opportunities to reuse existing medicines and to look for new treatments."

This includes research into metformin for prostate cancer.

Lisa McGrath is not convinced. "I used to have a monthly direct debit for cancer research, but now I think it only promotes treatments that big pharma promotes.

"My oncologist is very helpful. He sees that I do many things that he was not aware of. I know I am in a bad situation, but it is better than doing nothing. & # 39;

The National Institute for Health and Care Excellence (NICE) confirmed: "We have only assessed metformin for type 2 diabetes and we have not yet received any reviews for cancer treatment."

FAMILY MEDICINAL PRODUCTS THAT MAY BE EFFECTIVE

Developing a new cancer drug can take ten years – and if they come through, they can be prohibitive. For example, the pembrolizumab drug for melanoma and lung cancer costs £ 100,000 a year.

However, the use of existing drugs means that the treatment may be available much faster – and often much cheaper. Because doctors already have information about their long-term use, they will entail fewer risks.

Imperial College London has used algorithms to investigate the anti-cancer potential of 1,500 existing drugs and 8,000 daily foods. The researchers have already found "different compounds that are not conventionally used as a cancer treatment that showed a high resemblance to cancer," according to their latest findings published this month in Scientific Reports.

They discovered that tea, carrot, celery, orange, grape, coriander, cabbage and dill contain a large number of molecules & # 39; with a high anti-cancer similarity & # 39 ;.

Medicines identified hitherto as anticancer potential include metformin as well as the antibiotic rosoxacin and the antifungal clinoquinol. However, the researchers emphasize that more work is needed to confirm these first results.

Other existing drugs have already been re-used for the treatment of cancer, including thalidomide. First put on the market in 1957 as a sedative, it was also given controversially to women to help with morning sickness, although this stopped after it caused birth defects.

In recent years, it has been reused as an anticancer medicine because it can stop the development of new blood vessels that the cancer needs to survive. It is now the first-line treatment for multiple myeloma, a blood cancer.

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