As mentioned in our previous post, back in February, Dr. Block was one of 6 participants in an extended version of the Yes To Life (yestolife.org) radio show on UK Health Radio. We are posting a transcript of each of the questions Dr. Block answered here on our blog. To listen to the show in its entirety, go to: https://yestolife.org.uk/radio_shows/pioneers-of-integrative-oncology/
Hosted by Robin Daly, the first question Dr. Block answered was about chemotherapy, and whether or not we can justify its continued use, particularly in light of our expanding knowledge of its potential toxicity. This question is one Dr. Block is asked frequently by patients, as most, if not all, express a greater fear of chemotherapy than of the disease itself. In part 1 of his response, Dr. Block talked about how chemotherapy is used in the conventional medicine world; that is, as a “magic bullet,” the single tool that will battle what we now know is a complex, multi-faceted disease. As he explained, a disease as complex as cancer requires a treatment plan that is multilayered, individualized and comprehensive. You can read part 1 of Dr. Block’s response here: https://blockmd.com/2023/05/09/can-we-honestly-justify-the-continued-use-of-chemotherapy/
In Part 2, Dr. Block continues his discussion about the use of chemotherapy, about bringing chronomodulated chemotherapy to the Block Center, the importance of building a patient’s health integrity prior to starting their treatment, and the Center’s comprehensive approach to care.
You can read Robin’s question as well as part 2 of Dr. Block’s answer here:
Robin: “As our knowledge of epigenetics and nutrigenomics expands, it becomes increasingly clear that the DNA damage inflicted by some conventional treatments has the potential to significantly accelerate growth and repair pathways in ways that may be undesirable in people with active cancer. While my practice currently focuses on helping clients make the most of integrative care, I find myself wondering if our evolving understanding of cancer behaviour has arrived at a point where chemotherapy in particular may be considered to harm more people than it helps. Can we honestly justify its continued use?”
Dr. Block: I’m going to go in a little bit different direction just for a minute. Since opening our doors in 1980, we’ve been looking for research-based strategies that can help reduce toxicity, reduce treatment resistance, improve quality of life, and improve survival. A patient with greater health integrity, whether that’s nutrition, fitness, circadian health, sleep, bio-behavioural care, all of the different factors that make us up; the patient who has better integrity does better. There’s no surgeon on the planet that would have an argument with having a healthier patient on the table. Why should that be any different for a physician treating a patient for cancer?
” every drug has a window on a 24-hour clock that I would call the happy hour. It’s when the drug is the most effective and the least toxic “
In the 1990s, I came across a pioneer in the field, Dr. William Hrushevsky, who actually had the original idea of what today we call chronotherapy or chronomodulated chemotherapy, time sensitive drugs (chrono means time sensitive). Every drug has a window on a 24-hour clock that I would call the happy hour. It’s when the drug is the most effective and the least toxic. It’s significant enough that in some cancers you can get as much as a 400% improvement in five-year survivals based on existing randomised controlled research. That is a huge statement because so many of our drugs get licensed for sometimes as little as weeks, most often months. A large set of research that has been looking at trying to make better drugs and get better outcomes demonstrates that many of our drugs really have a very small impact.
So the importance of timing is essential because it speaks to reducing toxicity. If you implement drugs when the healthy cells are at rest and they’re the least vulnerable to chemotherapy, and you implement those drugs also when the cancer cells are the most active and most vulnerable, which turns out to be the same timing in terms of research, you get much, much better outcomes.
On a 24-hour clock, there’s a window that I refer to as a half happy hour, if I give you the drugs in that window, you get the best results, best response, best outcome, least toxicity. But if I give you those exact drugs 12 hours earlier or later, you get the most toxicity and the least benefit from the drugs.
But it’s not just the time of day. It’s also what we call the style of the infusion. As an analogy, what happens if you drop frogs in boiling water? They jump out to save their skin! But if you start with room temperature water and you sneak up on them with heat, by the time they recognise they’re being cooked, it’s too late, they already are. Now take cancer cells. Existing research tells us that if you drop them into a pool of chemotherapy, high concentration, just like the frogs that will jump out of the water, the cancer cells will shut their pores, they congregate and they go to sleep. What we do instead is we start with a tiny trickle of drug and that actually agitates cells. When they become agitated, they start gobbling up chemotherapy at two, three, four times the rate of a normal cell. When I say that, we’re talking 100% times the rate. We slowly, slowly, slowly increase the concentration in what’s called a sinusoidal wave. You need special technology to be able to give drugs this way. But by doing this, by the time those cells recognise that they’re being poisoned, it’s too late, they already are. We can capture far more cancer cells by giving drugs this way.
It’s a different model of care from that perspective. The timing, along with nutritional and nutraceutical support can actually have a profound effect on countering resistance. Drugs work better, work longer, and we get diminished adverse effects, which is one of the main reasons patients abandon treatment or their doctors reduce dosing or delay treatment, all of which leads to significantly poorer outcomes.
So I would argue that there is a way to give chemotherapy. I would argue it shouldn’t be done alone. It should be done as part of an entire comprehensive system of care. I would argue that nutritional support, whether it’s oral, whether it’s dietary, whether it’s infusional, in my case, I would say all of the above, whether certain off-label drugs can be used and can be enormously helpful, not only for tolerance, but for synergistic value for boosting the effectiveness. Maybe more importantly, we know that infusional nutrition, I refer to a lot of IV nutrition, not just vitamin C, but a tremendous number of compounds that we use are pleiotropic, these compounds have the ability to multitarget. They grow in nature in a pleiotropic model or manner that allows them to hit not 1, or 2, or 15, but sometimes hundreds and hundreds of targets with the same agent, same formulation. That adds to the therapeutic potential because it can both enhance the effectiveness of the drugs as well as diminish the toxicity at the same time. But they also have the capacity to multitarget the disease, the underlying disease itself.
This is one example that we know because of multiple randomised controls that were done with lung cancer patients. These patients received a platinum-based chemotherapy regimen and in 32 randomised controlled trials over 2,800 patients, when a platinum is given, a Chinese herbal formula (also European) called astragalus, or a Chinese formula that contains astragalus with it … the research showed a marked decrease in the risk of death, of mortality, and an increase in response and outcome. It’s one of these kinds of examples that are really very relevant.
In addition to that, there’re many natural products that we use to protect the heart from HER2 type drugs, these HER2 new inhibitors like Herceptin and Pergetta and Lapatinib and others. These drugs can cause cardiac damage. We know that the drug Adriamycin can have damaging consequences to the heart muscle. But we can give agents like Hawthorne, Coenzyme Q10, a number of antioxidant compounds that can protect and even sometimes reverse some of the damage that has occurred with patients from taking those drugs. I like to use those drugs prophylactically, preventatively, so that we’re not chasing the problem after the fact, but preventing it upfront.
“… walking 3 to 5 hours per week in breast cancer patients was enough to cut mortality by half; in colon cancer patients, getting upwards of 6 hours a week of walking was enough to cut mortality by 61% “
But just as I say we can deal with adverse effects, there’re compounds we can give to reduce resistance so your drugs work better and longer and there’re agents we can use that are synergists that, like the astragalus example, enhance the effectiveness of drugs. These are not petri dish examples that I’m giving. These are clinical trials that have been done to really assess the potential value. Even something like fitness, we have fairly good data to show that keeping patients who are going through chemotherapy really active can make a big difference in reducing toxicity as well. For example, in one study, walking 3 to 5 hours per week in breast cancer patients was enough to cut mortality by half. In colon cancer patients, getting upwards of 6 hours a week of walking was enough to cut mortality by 61% and cut recurrence by more than half. So, we know that these compounds can have an effect and these lifestyle alterations, making better dietary choices … all can really make a big difference for patients. It’s from my perspective a comprehensive model of care that is essential and a system that is directed at multitargeting but selectively and specifically. I do not believe you can throw the kitchen sink at a patient. I don’t think that works. I’ve seen enough examples of patients that have come through the door trying to follow alternative, complementary “integrative” programs that got themselves into deep trouble by overdoing it in what I would call a non-systematic manner, in ways that actually can be unfortunately detrimental rather than therapeutic. But done right, you can get enormous benefits. I would argue that chemotherapy has a place still, and I don’t think that that’s going to disappear anytime soon.