Pancreatic Cancer
naturopathic treatment

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Background

Pancreatic cancer has been become synonymous with a dismal prognosis with five year survival rates estimated to be 5% if metastases are found at the time of diagnosis.  Peak incidence is seen in the sixth and seventh decades of life however we have seen cases of dramatically younger patients.

80% of patients have tumors that cannot be removed by surgery at time of diagnosis. 80% of patients present with advanced disease with unexplained jaundice, stomach or back pain, and weight loss.

CT can localize a mass and is the principal diagnostic modality.

Smoking, a high fat diet, obesity, diabetes are some lifestyle risk factors.

Screening

Unlike Breast, Colon and Prostate cancer, screening modalities are not usually recommended for patients without a family history of pancreatic cancer or a known cancer predisposition syndrome (eg. BRCA mutation or  PALB2mutations).

The blood cancer marker CA-19-9 (cancer antigen 19-9 (CA 19-9, carbohydrate antigen) tumor marker is of use after or during treatment or for testing symptomatic patients in conjunction with imaging studies.

We work with a lab in Florida to run CA 19-9 to assess responses to alternative treatments and IV Therapy.

An abnormal CA 19-9 is found in up to 80% of all patients with pancreatic cancer, but only in 20% of those with stage I cancer, and thus is inadequate for screening.

Chemotherapy

Chemotherapy for advanced pancreatic cancer is given with noncurative intent.

The pancreatic cases we’ve seen will often have stent insertions (via ERCP) to relieve jaundice and digestive symptoms as well as blood thinning treatments to reduce chances of clotting. Furthermore, opioid medications are often seen to relieve local and referred pain which is extremely common.

Chemotherapy is the standard treatment of choice for unresectable or metastatic pancreatic cancer. Single-agent or two-drug or three-drug combination regimens may be used.

We’ve seen common use of gemcitabine with or without erlotinib.

The use of single-agent gemcitabine shows an improvement in quality of life in patients with stage IV pancreatic cancer. Gemcitabine monotherapy is generally well tolerated, even in older or frail patients. 

Three human trials suggest synergy between Gemcitabine and Curcumin the most recent of which (2011) demonstrates significant life extension from the combination in patients that have gemcitabine resistant cancer. The other two studies admit to obvious limitations from the use of poorly absorbed curcumin preparations. However, currently a number of well absorbed Curcumin preparations are now available that result in dramatically higher blood curcumin levels than those used in the aforementioned studies. 

Often times pancreatic cancer patients have digestive difficulty as well as pain and nausea with eating therefore we offer Curcumin IV Therapy at our Edmonton clinic to bypass the oral route.

Gemcitabine and erlotinib have also been shown to improve survival in patients with advanced pancreatic cancer compared to single-agent gemcitabine.  Both are given once weekly.

Integrative Support: IVC & Chemotherapy

Our Naturopathic Doctors often suggest concurrent administration of Vitamin C IV Therapy and Gemcitabine and Erlotinib. The evidence for these combinations is extremely encouraging.

IV Vitamin C and Gemcitabine with Erlotinib were evaluated in a 2012 Study by Monti “Phase I evaluation of intravenous ascorbic acid in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer.

14 subjects with metastatic stage 4 pancreatic cancer were recruited to receive an eight week cycle of IV C (3 infusions per week) along with gemcitabine and erlotinib chemotherapy. Nine subjects completed the study (others were unable to complete) because of progression of the underlying cancer.

Seven of nine patients had stable disease while the other two had progressive disease. Eight of nine patients had a reduction in size of the primary tumor.

The authors noted: these findings are not typical with treatment using gemcitabine alone or with gemcitabine plus erlotinib.

Gemcitabine and Erlotinib and IVC

A 2013 trial by Welsh combined Vitamin C IV Therapy with Gemcitabine “Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial.”

Nine subjects received twice-weekly intravenous ascorbate (IV Vitamin C between 15-125 g) and concurrent gemcitabine. Vitamin C IV treatments were given each week (50 to 125 g twice weekly) of the four week cycle; weekly gemcitabine infusions for 3 consecutive weeks with one week rest. Six of the nine treated subjects maintained or improved their performance status. Average treatment duration was 6 months. Time to progression was 26 ± 7 weeks, while overall survival was 13 ± 2 months. The authors concluded  Initial data suggest synergistic efficacy with regards to the combination of IV Vitamin C Therapy and Gemcitabine which confirms what was seen in the study discussed above.

Historic survival is 5.65 months, mean survival with IVC is 12 months.

The average progression free survival was 26 weeks and overall survival of just over 12 months compared to the original data of Gemcitabine alone with a progression free survival of 9 weeks and overall survival of approximately 6 months.

For comparison, the progression free survival in the 2012 trial was 12.7 weeks and overall survival of 6 months.

In summary the data in both studies is stronger than what is seen statistically using gemcitabine alone.

Our clinic generally suggests IV Vitamin C alongside chemotherapy for pancreatic cancer for our Edmonton patients. However, we usually suggest IV Alpha Lipoic Acid and LDN (low dose naltrexone) through our referral relationships. 

In "Pharmacological Ascorbic acid and Hyperbaric Oxygen Therapy Target Tumor Cell metabolism via an Oxidative Stress Mechanism" the authors conducted experiments with regards to potential synergy between IV Vitamin C and Hyperbaric Oxygen Treatment. Using <0.5mM "sub-cytotoxic" doses and Hyperbaric Oxygen had enhanced cytotoxicity compared to all other treatments. 

The group concluded the oxidative mechanism of IV Vitamin C Therapy is therapeutically exploited by Hyperbaric Oxygen Therapy.

Our Naturopaths have significant experience with the administration of intravenous vitamin C. We typically begin Vitamin C IV Therapy at a dose of 25g and titrate the dose to 50-85g although occasionally we take doses to 125 grams. It is an extremely well tolerated therapy and the apparent synergy with gemicitabine and erlotinib is an excellent option to enhance a standard chemotherapy regimen.

Advanced Therapies: Mistletoe

In terms of improving immune function our Naturopathic Doctors often work with injectable mistletoe. A 2010 case report combining mistletoe with gemcitabine and oxaliplatin in metastatic pancreatic cancer showed showed no evidence of tumor progression 10 months after her initial surgery. The authors suggest that the mistletoe was the reason for the unusually positive result. We often suggest co-administration of mistletoe with many chemotherapies to offset the depressed white blood counts. However a 2014 clinical trial suggests that Mistletoe can be used in pancreatic cancer patients after standard treatments have ended to improve quality of life.

220 patients with locally advanced or metastatic pancreatic cancer who were receiving no further treatment for pancreatic cancer were included in this trial. Data on quality of life and body weight were obtained from 96 patients treated with mistletoe and 72 control patients. Those treated with mistletoe did better on all 6 functional scales and on 7 of 9 symptom scales, including pain, fatigue, appetite loss, body weight and insomnia the authors concluded mistletoe treatment significantly improves the quality of life in comparison supportive care alone and that mistletoe is an effective second-line treatment for this disease.

Mistletoe is extremely cost effective and is usually given three times per week however, but that may lessen depending on individual responses. IV vitamin C and Mistletoe are complimentary non-competing therapies and we can administer the Mistletoe intravenously at on days of IV Vitamin C infusions.

Advanced Therapies: metabolic treatment

The most compelling evidence for alternative cancer treatments is from a series of case reports using intravenous lipoic acid and an oral medication called low dose naltrexone, commonly abbreviated as LDN. These are "metabolic treatments" that exploit the preference for cancer cells to use glucose through aerobic glycolysis. Hyperbaric Oxygen is thought to be synergistic with metabolic treatments. We have two Hyperbaric chambers at our Edmonton office. 

A 2009 Article from Berkson discusses three cases that responded impressively to this protocol.

“Revisiting the ALA/N (alpha-lipoic acid/low-dose naltrexone) protocol for people with metastatic and nonmetastatic pancreatic cancer: a report of 3 new cases”

Case A: Alive and well 78 months after initial presentation (a patient from an earlier report)

Patient 1: is alive and well 39 months after presenting with metastases to the liver.

Patient 2: presented with liver metastases and after 5 months of therapy, PET scan demonstrated no evidence of disease.

Patient 3: Presented with metastases to the liver and one other region. After 4 months of the ALA/N the

A similar response was described in a 2006 journal article by the same group. 

Hyperbaric oxygen is complementary to Lipoic Acid IV Therapy as they both stimulate oxidative phosphorylation over aerobic glycolysis. 

LDN is made available through relationships with prescribing professionals. 

In a 2020 study, 25 patients with stage IV pancreatic cancer received Metabolically supported chemotherapy "MSCT" with either gemcitabine-based or FOLFIRINOX. Ketogenic diet, hyperthermia, and Hyperbaric Oxygen were part of the protocol. 

Median overall survival and median progression-free survival of these pancreatic cancer patients was 15.8 months and 12.9 months versus 11.1 months and 6.8 months in a different study where FOLFIRINOX and gemcitabine group were used in isolation therefore MSCT clearly provides a survival advantage. 

Poff and D’Agostino (2013) studied the VM-M3 mouse model found combining the Ketogenic diet with Hyperbaric Oxygen elicited an additive decrease in tumor growth rate, with a 77.9% increase in mean survival time. 

There is evidence to suggest synergy of Alpha Lipoic Acid and Gemcitabine and another natural agent called Hydroxycitrate. An 80 year old pancreatic cancer patient with liver metastases had a predicted survival between 3 and 6 months. As of March 18, 2010, the patient was still alive, meaning that she had survived for 8 months following the treatment. The patient was also on Celebrex and Melatonin which also can have modest anti-cancer activity. The patient was also on Celebrex and Melatonin which also can have modest anti-cancer activity. The authors note that a worsening in March 2010 was potentially due to withdrawal of the Lipoic acid and hydroxycitrate and Celebrex by the patient. It is hypothesized that Hyperbaric therapy would further enhance the effects of this protocol due to additive actions. 

Do You Have Questions?

Call Us 780-757-8378