wormwood

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wormwood: In-Depth

Artesunate is derivative from Wormwood (Artemesia): it is used as an anti-malarial treatment around the world. Because of its widespread use, the safety of it as an oral and IV agent is well known¹. Artesunate has excellent tolerability and no obvious side effects with even high dose, rapid infusions.

Artesunate is available in oral forms. IV administration of Artesunate has synergy with an IV treatment we offer: Intravenous Vitamin C "IVC." The effects of IVC cannot be replicated with oral dosing. IV artesunate dosing avoids any die-off reactions that can occur from oral Artesunate consumption interacting with gastrointestinal flora and infections.

Many cell studies demonstrate Artesunate’s anti-cancer effects against Glioma² (brain tumor), AML³ (acute myeloid leukemia), Ovarian Cancer⁴, Liver Cancer⁵, Breast cancer^6,7,9, Kidney Cancer⁸, Pancreatic cancer¹, Colon cancer¹⁰ and Lung Cancer¹²

It is thought that the primary mechanism of action of Artesunate is reactive oxygen species generation from reactions between the Artesunate and Iron that has accumulated in tumor cells¹ Because of the Oxygen dependence it is thought that Hyperbaric Oxygen can enhance the action of Wormwood derivatives. 

In a 2010 study, the hypothesis was whether Hyperbaric Oxygen enhances anticancer activity of artemisinin. "Molt-4" human leukemia cells were cultured in artemisinin and exposed for 90 min to one of three different conditions: control, room air control, or Hyperbaric Oxygen Therapy.

After 48 h of incubation, growth of cells treated with artemisinin alone or Hyperbaric Oxygen alone was 85% of that of cells grown under artemisinin-free control conditions. Combined artemisinin and Hyperbaric treatment resulted in an additional 22% decrease in growth. The authors concluded "Combined HBO(2) and artemisinin exposure may be an effective anticancer chemotherapeutic strategy."³⁰

Clinical trials

Although Artesunate has a broad range of cancers it has potential benefit in, our clinic uses the parent compound Artemesinin in Breast and Colon cancer and Melanoma. 

Two human studies have demonstrated Artesunate's efficacy in Breast cancer^11,23 and another in Colon cancer¹⁰.  

Artesunate has also shown efficacy in a small human case report series in Uveal (eye) Melanoma¹⁴.

We are beginning to consider wormwood derivatives in Lung Cancer as evidence was demonstrated in a human trial in combination with chemotherapy in advanced lung cancer¹³. Artesunate can potentially be used in Prostate Cancer as there is evidence of its efficacy for this condition^15.    

One double blind placebo controlled trial gave human colorectal cancer patients oral Artesunate prior to surgery. During a 42 month average follow up time, 1 patient in the Artesunate group had a recurrence of colon cancer compared to 6 patients in the placebo group¹⁰. 

Artesunate and survival probability in colon cancer

Preliminary data from Bastyr Integrative Oncology Research Center (BIORC) showed that IV Vitamin C with Artesunate made a substantial difference in patients with Stage 4 Breast cancer.  After 1 year the group that received IV Artesunate and Vitamin C has a 90% survival rate whereas the group receiving Naturopathic care without infusions had a 74% survival rate. By year 2 the results were even more profound as the group without IV treatment had a 68% survival rate compared to 90% in the treatment group.¹¹

Artesunate was also studied in breast cancer patients in a 2016 study where it was given in high doses daily for 4 weeks. However the study was not designed to comment on efficacy against cancer, it merely commented on potential ototoxicity (ear) from daily oral Artesunate dosing²¹ A 2014 study also investigated oral dosing of Artesunate in 23 breast cancer patients over 4 weeks but was not designed to evaluate tumor response²². 

A 2017 trial looked at Artesunate dosing in metastatic breast cancer patients alongside standard therapies. Twenty-three women received either 100 or 150 or 200 mg oral artesunate for 4 weeks. Some minor hematologic effects (changes in the blood counts) were seen in 3 patients with minor changes in hearing in 3 patients and vertigo in 1. Most importantly, stable disease was found in ten patients²³. Potential compatibility with: capecitabine, gemcitabine, pegylated liposomal doxorubicin, bisphosphonates, & trastuzumab was suggested by this study as well.

Improved survival in Stage IV Breast Cancer patients using Artesunate and IV Vitamin C

A lung cancer clinical trial with 60 patients receiving Artesunate + Chemotherapy were compared to 60 patients only receiving chemotherapy.  The disease control rate of the trial group was 88.2% compared to 72.7% in the control group and the trial group had a longer time to first progression.¹² This is fairly clear evidence of Artesunate efficacy in Lung cancer.

In a 2011 trial, ten cervical cancer patients (stage III or IV) were treated with oral Dihydroartemesinin (DHA) also known as Artenimol for 28 days. DHA is the active metabolite that both Artesunate and Artemesinin convert into. DHA induced clinical remission with a median time for the disappearance of the symptoms (pain and vaginal discharge) being 7 days²⁹.

Mild adverse effects (grade 1 or 2) were noted in 5 of the patients. Six patients experienced clinical relapse at an average of 6 months(four patients did not relapse). Four of six patients with relapse were challenged with a second 28-day treatment period, which again resulted in clinical remission²⁹.

Case Reports

In Uveal melanoma, Artesunate was used in the treatment of two metastatic patients in combination with standard chemotherapy who were progressing on chemotherapy alone. The first patient had a temporary response after the addition of artesunate to his chemotherapy. The second patient first experienced a stabilization of the disease after the addition of Artesunate to his chemotherapy, followed by objective regressions of spleen and lung metastases.¹⁴

In prostate Cancer, as described in a 2015 case report, a patient with metastatic advanced prostate cancer presented with a  PSA level >800 µg/l. The combination of bacalitumide (anti-androgen for 14 days) and long-term oral treatment with Artemesia capsules the PSA level dropped down to 0.98. However, re-emergence of the PSA did occur 7 months later¹⁵. Furthermore there is cell study evidence of Artesunate for prostate cancer^{16,17,18,19,20}.

A 47-year-old stage 4 breast cancer had tumor regression on CT scan upon Artesunate treatment; another breast cancer patient had a comparable experiences²⁴. A 47-year-old patient with liver cancer and abdominal ascites was still alive 2.5 years after taking taking artesunate²⁴. However exact details of these were not able to be found.  

Another case report described the artesunate therapy of a laryngeal squamous cell carcinoma patient. 15 days of artesunate (60mg by injection) was followed by 50mg orally for at least two months. After 2 months the tumor reduced in size by 70%²⁵.

Clinical use

Wormwood derivatives are an option for Colon¹⁰, Breast^11,23, Melanoma¹⁴ and Lung Cancer¹². 
There is also potential for Laryngeal²⁵ and Liver Cancer²⁴.

Wormwood derivatives can be used in conjunction with IV Vitamin C as their effects are both considered oxidative in nature and therefore synergistic and the research from BIORC in Breast Cancer patients. Because of the oxygen dependent reactions involved, Wormwood derivatives are thought to be enhanced by Hyperbaric Oxygen Therapy. Our Edmonton office has two Hyperbaric Chambers.

Hepatoxicity developed in one patient taking temozolomide, artesunate and Chinese herbs; of which one of the herbs are associated with hepatotoxic effects as well as two medications the patient was taking²⁷. Also death from hepatotoxicity occured in a patient taking DCA and artesunate²⁶. DCA cause a rare rapid increase in hepatic enzymes but not to dangerous levels from a single administration. Although simultaneous administration of DCA and Artesunate is not a commonly suggested protocol and the patient was on 4 other medications and had finished temozolomide chemotherapy a few months prior²⁶. Two of the medications, valproic acid and levetiracitam for seizures are associated with hepatotoxicity²⁷. Also the patient passed after initial hepatotoxicity stabilized and systemic signs of infection, and a series of epileptic seizures started and the family denied further medical intervention²⁶.

Although liver toxicity is not a typical concern with Artesunate^23,27.

To be cautious we suggest occasionally monitoring liver enzymes in patients undergoing wormwood derivative treatment. 

We currently monitor patients that are using wormwood derivatives for possible blood and hearing abberations although the incidence is mild and infrequent²³. It is also suggested that wormwood derivatives can alter blood iron studies but that it is rarely of clinical significance²⁹. However, we have seen occasional drops in red blood cell counts and therefore run a CBC within the first few weeks of treatment.

Adminstration suggestions vary. Daily oral use of wormwood derivatives has been seen in some of the case reports¹⁴. Oral dosing of wormwood derivatives is also suggested in an "on-off" fashion: 3-4 days "on" and 4-3 days "off" to allow for cellular repletion of iron.

IV Artesunate administation is usually done twice weekly alongside IV Vitamin C^1,29,13.

However, we use the oral parent compound Artemesinin. 

Questions about treatment?

Call Us 780-757-8378