Recent research has begun to illustrate insights into how we may use and expect DCA to support individuals dealing with cancer. In the following article, “Long-term stabilization of stage 4 colon cancer using sodium dichloroacetate therapy”, by authors A. Khan, D. Andrews, and A. Bernecke, we are shown just that.
In this article, the authors review a remarkable patient case report example to illustrate how over more than a four-year period, a stage 4 colon cancer case’s use of DCA and associated naturopathic supports helped to stabilize her condition and enable her to continue to live a full life. To begin, let’s examine more of the background around DCA’s mechanism of action, extant research and some of the case particulars to better understand the findings.
Promising Potential of Sodium Dichloroacetate (DCA) in Cancer Treatment: Observational Insights
Sodium dichloroacetate first started to gain attention of researchers and practitioners alike in the cancer realm due to initial positive research first published in 2007. Illustrated to show benefit to cancer patients by inducing programmed cell death by blocking something called ‘anaerobic glycolysis’ (i.e. oxygen deficient sugar usage), early studies and research were limited by the fact that in vitro (i.e. in test tubes or cell lines, not in actual human subjects) concentrations of DCA used were not necessarily reproducible and feasible to achieve in people.
However, additional studies revealed that at lower concentrations more attainable to achieve in patients, DCA could be cytostatic (i.e. tumor stopping) and could represent a relatively low risk. It would become a reasonably low toxic therapy that could be combined with other agents to inhibit tumor cell proliferation and extend life.
Observational data collected in the clinic of primary author A. Khan, using this level of dosage, illustrated 60-70 percent of individuals getting clinical benefit (out of a total of 300 patients). Also, 20-25% of these individuals developed low-grade neuropathy on this particular protocol of 2 weeks on and one week off utilizing a dosage of 20-25 mg/kg of body weight for each patient.
This article, which importantly does not feature any financial conflicts of interest, specifically examined the use of DCA in conjunction with a supplemental naturopathic protocol of nutraceuticals to minimize neurotoxicity (specifically benfotiamine, alpha lipoic acid, and l-carnitine) in a 57-year-old, stage four colon cancer patient. Notably, in a case of stage 4 colon cancer, the normal survival time would be between 9-12 months with a conventional chemotherapy regimen.
However, in this case report, the authors illustrated disease stabilization and lack of progression over a four-year period while this patient continued to dose DCA in several different formats and dosages.
Integrative Stage 4 Colorectal Cancer Treatment: DCA and Naturopathic Support with Chemotherapy
This patient was diagnosed in mid-2010 with stage 4 colorectal cancer with multiple metastases to the liver, microscopic metastases to the lungs and an annular rectal carcinoma that was difficult to measure via CT imagery. Before presenting to the author’s clinic and initiating DCA and naturopathic supportive therapy, the patient underwent a loop ileostomy procedure to bypass the obstruction, and the rectal tumor was not removed.
That surgery was followed by chemotherapy (i.e. FOLFIRI + bevacizumab). Initially the patient responded to chemotherapy with a reduction in liver metastases, a reduction of the primary rectal lesion, and a reduction of blood carcinoembryonic antigen (CEA) marker from 260.9 ng/mL before chemo to 3.5 ng/mL just prior to DCA therapy initiation. The response to chemo then began to plateau. By the time the patient presented to the author’s clinic, chemotherapy was causing minimal disease reduction, and was essentially just maintaining stability.
The patient previously had reported being healthy but did feature a 20-year history of smoking and had a family history of gastric and colon cancer. She also reported the following symptomology when presenting to the clinic: mild mouth sores related to the ongoing chemotherapy, mild diarrhea (expected with an ileostomy) and mild periodic rectal bleeding. There was also some aching, burning lower back and sacral pain up to 6 out of 10 intensity, and mild right shoulder-tip pain exacerbated by chemotherapy.
Since the chemotherapy was still effective, and the patient was not experiencing any serious side effects, the initial approach was to support the patient’s existing therapy, not replace it when she came to the author’s clinic in March 2012. An integrative plan was made in cooperation with a naturopathic physician (D. Andrews).
The plan consisted of addition of high dose oral vitamin D at 10 000 international units per day, a change of oral vitamin C to vitamin C 50 g intravenous (i.v.) weekly, and addition of dichloroacetate sodium (DCA) 3000 mg i.v. (49 mg/kg) weekly.
To reduce the risk of DCA side effects, 3 natural supplements were prescribed:
• intravenous Alpha lipoic acid 500 mg with each DCA dose,
• oral R-alpha lipoic acid 150 mg 3 times a day,
• oral acetyl L-carnitine 500 mg 3 times a day,
• oral benfotiamine 80 mg twice a day.
Infusions were planned around chemotherapy infusions (separated by at least 2 days from chemotherapy) to avoid any potential interference or drug interactions. Lipoic acid was not given on chemotherapy days, or within 2 d before or after chemotherapy since it is a powerful antioxidant and has the potential to reduce chemotherapy efficacy.
Initiation of DCA Therapy and Case Progression
No side effects were noted, so DCA was increased to 4000 mg i.v. (66 mg/kg) weekly. The only side effect noted at the higher DCA dose was mild post-infusion sedation. A few additional meds were added such as metformin and pregabalin for extra support and regular bloodwork was done to monitor the situation. After 4 months of integrative therapy as described, a new CT scan was performed, which was reported as “stable and unchanged”.
By September 2012, increasing chemotherapy side effects including fatigue, nausea and vomiting were noted. A new CT scan revealed that all the liver lesions were “either smaller or no longer identified”. There were no new lesions identified. After review of the CT scan, the patient decided to stop all chemotherapy as well as adjunctive meds bevacizumab and metformin. DCA (i.v.) was continued, and the dose was increased to 4500 mg i.v. weekly.
After stopping the chemo, the patient reported complete resolution of nausea and vomiting while pain was staying well controlled. A further CT scan 3 months later showed no progression of liver metastases or other growths.
There were some minor side effects such as elevated liver enzymes and mild neuropathy, so she took a 3 month break of DCA while starting 5 nutraceuticals (benfotiamine, Alpha lipoic acid, curcumin, honokiol, and acetyl l carnitine) to support repair from the neuropathy and to support disease control. During this break, there was only a slight increase in CEA while neuropathy resolved, and liver enzymes normalized.
Shortly thereafter this time, due to cost constraints, the patient opted to switch from IV therapy to oral DCA therapy of 500 mgs twice daily. She also reduced her pain medication use by approximately 70 percent. The patient continued this regimen with regular CT scans every 3 to 6 months. Gradually, due to busyness, the patient was less compliant with regular blood testing.
That said, she remained highly functional with mild, well-controlled chronic neuropathy. She attempted to increase DCA to 500 mg 3 times a day, but this resulted in significant liver enzyme elevations and increase in neuropathy. As a result, a DCA dose of 500 mg twice a day was resumed after a brief therapy interruption. Ongoing CT scans continued to reveal stable disease with no new lesions appearing.
Overall, CEA did not significantly change from the initiation of DCA therapy (CEA of 3.5 at the start of DCA therapy, to CEA of 3.7 after nearly 4 years of therapy). Her general blood panel was also favorable at the 3-year mark and after the 4-year mark.
Remarkable 6-Year Survival in Terminal Colorectal Cancer with DCA and Chemotherapy Combination
After beginning with conventional chemotherapy for approximately 18 months, the patient received intravenous DCA therapy with concurrent chemotherapy for approximately 6 months, followed by intravenous and oral DCA therapy with no conventional cancer therapy for nearly 4 years.
During the treatment with oral DCA, the patient experienced stable disease evidenced by CT scans and CEA tumor markers. As noted in the beginning of this article, this represents a dramatic extension of life span and quality of life compared to what would be typical with a conventional chemotherapeutic regimen. Additionally, she was able to maintain the lower dose of pain meds, keep neuropathy minimal and continue on with her life, running her business.
The duration of stability while on DCA without other active chemotherapy is currently 46 mo (nearly 4 years as of publication date in 2016), with a survival time since the initial diagnosis of stage 4 colorectal cancer of 6 years. Based on the National Cancer Institute’s cancer statistics, the 5-year relative survival rate for females diagnosed with stage IV colon/rectal cancer is 14.4%.
While one cannot conclude with absolute certainty that DCA was responsible for this result, given the averages with typical chemo regimens for this staging and type of cancer, the probability of this occurring would be quite low. As of the date of publication, the patient remained well and continued her DCA therapy.
References
- Akbar Khan, D. A. (2016 Oct 16; 4(10)). Long-term stabilization of stage 4 colon cancer using sodium dichloroacetate therapy. World J Clin Cases, 336–343.
- Fotios Loupakis, C. C. (2014 Oct 23). Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. The New England Journal of Medicine, 371(17):1609-18.