If Only I Could

My coughing is coming back off and on. One thing that has not changed is the blood stain clots in the phlegm. Hope it will not get worst. This is to be expected since my cancer has spread to another part of the lung. I can't do anything now because my HIFU treatment has not healed yet. Starting another treatment is not recommended. I have contacted the hospital in China and the doctors say each patients reacts differently. They suggested that I get some pain killers to manage the pain. I feels like I am a sitting duck now. Helpless and in a hopeless situation.

Yesterday, a friend who is also a breast cancer survivor called me. She asked whether I am free around lunch time. She would like to take me to attend a lunch time stand up show. It's going to be hilarious and she thought that I would feel better after that. I thank her very much. Last two days, my abdominal pain has been acting up again. I told her it would be a bit difficult for me at this moment to enjoy the show and I suggested a future date instead. She said there will be only one show. What a shame that I have to give the show a miss.

I never thought I would write about this. But in life, never say never. Personally, while in China, the doctors have used very low dose chemotherapy and radiotherapy for my treatment. The TAE procedure is to inject a very low dose of chemotherapy directly into the blood vessels supplying blood to the kidney tumor to block the blood flow. I also had an IPT procedure where the doctors also injected very small doses of radioactive particles directly into the new right lung tumor.

This metronomic chemotherapy treatment was introduced to me by a reader from Hong Kong. Strangely, I wonder why some of our doctors back home does not know this treatment. Anyway, she has used it and reported that she managed to get rid of the lymph nodes and lung metastasis within three months of usage. I am encouraged by her success. I have also done some further reading and discovered something startling. How about some low dose chemotherapy that does not target cancer and normal cells, no side effects but yet more effective than high dose conventional chemotherapy?

Metronomic Chemotherapy
In 2000, two cancer research groups published a remarkable observation, in tumor-bearing rodents, low-dose chemotherapy, too low to evoke side effects or have a meaningful direct impact on tumor cells, when given on a daily or near-daily schedule, could markedly retard tumor growth.

This proved to be true even when the tumors were known to be resistant to the chemotherapeutic drugs employed. The solution to this riddle was that the chemotherapy was slowing or preventing angiogenesis. During angiogenesis, new endothelial cells are extremely fragile as they branch off from existing blood vessels, multiply, migrate into a tumor in response to chemical signals secreted by tumor cells, and eventually form themselves into tubular structures to give rise to new vessels. Whereas the endothelial cells lining established vessels only rarely multiply, are stabilized by growth factors provided by neighboring cells, and are rarely killed by clinically feasible doses of chemotherapy drugs. The endothelial cells engaged in angiogenesis are extremely sensitive to killing by these drugs, much more so than most cancer cells. Thus, when low-dose chemotherapy is administered on a daily schedule (known as "metronomic" because it is regular and even like the beat of a metronome) the continual death of endothelial cells attempting to form new blood vessels can substantially disrupt the angiogenic process, slowing it down notably.

One of the particular merits of this metronomic approach centers around cancer drug resistance. Whereas conventional, high-dose chemotherapy tends to select tumor cells that are resistant to the drugs used, metronomic chemotherapy targets normal endothelial cells that do not grow resistant to the drugs. In other words, metronomic chemotherapy keeps on working when conventional therapy fails. Tumors may be able to adapt to a degree by increasing their production of pro-angiogenic factors that promote endothelial cells survival. This explains why cancers, which initially regress in response to metronomic therapy sometimes grow back despite continuing therapy. The cancer confers this relative resistance; not the endothelial cells themselves.

Recently, a further benefit of metronomic chemotherapy has been established. It tends to selectively kill a population of immune cells, called "T-reg" cells, that function to suppress the activity of immune cells capable of attacking the tumor. These are the natural killer (NK) cells and T-cytotoxic cells. T-reg cells often congregate within tumors and secrete hormone-like factors that "turn off" the immune cells trying to attack the cancer. Thus, metronomic chemotherapy has emerged as a useful adjuvant to therapeutic strategies intended to boost the tumor-killing capacity of NK and T-cytotoxic cells.

The utility of treating rodent tumors, including transplanted human tumors, with metronomic chemotherapy has now been confirmed in a great many studies. In some of these studies, combining such chemotherapy with other measures attacking the angiogenic process has led to complete remissions of pre-existing aggressive tumors. Other studies also showed that metronomic chemotherapy can be useful when used in conjunction with conventional chemotherapy.

The most extensive published clinical experience with metronomic chemotherapy regimens has been provided by oncologists in Milan, who have documented the long-term responses of patients with metastatic breast cancer to a metronomic regimen involving daily cyclophosphamide (50mg) and two weekly doses of methotrexate (5mg per dose). From the patients using this regimen, 32% achieved either a complete or partial remission, or a stabilization of disease lasting at least 24 weeks. In about 16% of patients, no tumor progression was noted for over a year. Even in the patients in whom progression did occur, it seems likely that the therapy was often slowing the spread of the disease. The especially good news, since metronomic chemotherapy is intended for long-term use, is that this regimen was essentially free of annoying side effects. Only a mild suppression of white cell count was observed in a small minority of the treated patients.

Since metronomic therapy is directed against endothelial cells, not cancer cells, a metronomic regimen that works well with one type of cancer should work well with all types of cancer dependent on angiogenesis for growth.