Chemotherapy of advanced epithelial cancer--a critical review

[Medicine 4.0, the importance of electronics, information technology and microsystems in modern medicine - the case of customized chemotherapy]

A paradigm shift seems to emerge, not only in industrial engineering ("Industry 4.0") but also in medicine: we are on the threshold to "Medicine 4.0". For many years, molecular biology had a leading position in life sciences, but today scientists start realizing that microelectronic systems, due to an increasing miniaturization, are reaching the scale of human cells and consequently can be used for therapeutic approaches. This article shows how microelectronics can play a major role in modern medicine, through the example of customized chemotherapy. This consists in determining, before the beginning of the treatment, what kind of chemotherapy or drug combination will be most effective for a given patient, and at which dose. This of course allows the lessening of a patient burden during treatment, but also to be more efficient and, in the long run, to save money. In order to do this, we have developed the Intelligent Microplate Reader (IMR), which allows us to accurately test different drugs on living cells by mimicking part of their usual environment.

Sensor-based cell and tissue screening for personalized cancer chemotherapy

Personalized tumor chemotherapy depends on reliable assay methods, either based on molecular "predictive biomarkers" or on a direct, functional ex vivo assessment of cellular chemosensitivity. As a member of the latter category, a novel high-content platform is described monitoring human mamma carcinoma explants in real time and label-free before, during and after an ex vivo modeled chemotherapy. Tissue explants are sliced with a vibratome and laid into the microreaction chambers of a 24-well sensor test plate. Within these ~23 μl volume chambers, sensors for pH and dissolved oxygen record rates of cellular oxygen uptake and extracellular acidification. Robot-controlled fluid system and incubation are parts of the tissue culture maintenance system while an integrated microscope is used for process surveillance. Sliced surgical explants from breast cancerous tissue generate well-detectable ex vivo metabolic activity. Metabolic rates, in particular oxygen consumption rates have a tendency to decrease over time. Nonetheless, the impact of added drugs (doxorubicin, chloroacetaldehyde) is discriminable. Sensor-based platforms should be evaluated in explorative clinical studies for their suitability to support targeted systemic cancer therapy. Throughput is sufficient for testing various drugs in a range of concentrations while the information content obtained from multiparametric real-time analysis is superior to conventional endpoint assays.

Evidence-based medicine: four fundamental problems with the randomized clinical trial (RCT) used to document chemical medicine

Randomized clinical trials (RCT) have been accepted as the golden standard of testing, thus making chemical medicine "evidence based". The RCT is based on four assumptions: 1) The placebo effect is represented by a placebo pill, 2) it is possible to make a double-blind test with biologically active drugs, 3) beneficial and harmful effects of drugs are fairly measured in RCTs, and 4) an appropriate time frame for the test is used. We have found problems with these assumptions: 1) The placebo effect provided by close relationships to a physician is stronger than an inert pill, 2) double-blind tests cannot be made with biologically active drugs, as these leave an internal clue in the patient that destroys the blinding (active placebo), 3) lack of global outcome measures makes toxic effects invisible for the test and magnifies minor effects to make clinically insignificant positive effects look important, and 4) RCTs are used in such a brief time frame that side effects and harm are not properly detected. The four errors combine into a serious error: The RCT-procedure induces a strong bias in favor of any toxic drug tested. RCTs can turn drugs that are only toxic and not beneficial at all into products sold as.useful chemical medicine. Many pharmaceutical drugs on the market today are tested only with this flawed RTC-procedure, and we recommend that these drugs be tested again using a rational method. If drugs are not more helpful than placebo, then we should return to classic psychosocial holistic medicine.

Positive effects, side effects, and adverse events of clinical holistic medicine. A review of Gerda Boyesen's nonpharmaceutical mind-body medicine (biodynamic body-psychotherapy) at two centers in the United Kingdom and Germany

To review adverse events of intensive, clinical holistic medicine (CHM) as it is practiced in holistic body-psychotherapy in England and Germany. Gerda Boyesen's "biodynamic body-psychotherapy" (BBP) is an intensive type of holistic mind-body medicine used by Boyesen at two centers.

METHODS

About 13,500 patients were treated during 1985-2005 period and studied for side effects and adverse events. The first author worked closely with Boyesen 1995-2005 with full insight in all aspects of the therapy and provided the data on side-effects.

RESULTS

Therapy helped chronic patients with physical, psychological, sexual, psychiatric and existential problems to improve health, ability, and quality of life (NNT (number needed to treat) = 1-3). Effective in the treatment of mentally ill patients (schizophrenia, anxiety, poor mental health, low general ability). For retraumatization, brief reactive psychosis, depression, depersonalization and derealization, implanted memories, side effects from manipulations of the body, suicide/suicide attempts, hospitalization for physical and mental health problem during or 90 days after treatment, NNH (number needed to harm) > 13,500.

INTERPRETATION

Intensive, holistic non-drug medicine is helpful for physical, sexual, psychological, psychiatric and existential problems and is completely safe for the patient. The therapeutic value TV = NNH/NNT > 5,000. Altogether about 18,000 patients treated with different subtypes of CHM in four different countries have now been evaluated for effects, side effects and adverse events, with similar results.

Fever, cancer incidence and spontaneous remissions

OBJECTIVE

Accumulating evidence exists for (1) an inverse correlation between the incidence of infectious diseases and cancer risk and (2) an inverse correlation between febrile infections and remissions of malignancies. This review is part of an effort of the Office of Alternative Medicine at the National Institutes of Health to examine this evidence.

METHODS

A review of the literature to a key word search was undertaken, using the following key words: fever, infectious diseases, neoplasm, cancer incidence and spontaneous remission.

RESULTS

The data reviewed in this article support earlier observations on the topic, i.e. that the occurrence of fever in childhood or adulthood may protect against the later onset of malignant disease and that spontaneous remissions are often preceded by feverish infections.

CONCLUSION

Pyrogenic substances and the more recent use of whole-body hyperthermia to mimic the physiologic response to fever have successfully been administered in palliative and curative treatment protocols for metastatic cancer. Further research in this area is warranted.

The kinetics of cancer cells and of HIV1: the problems of cell and virus rebounds and of latency

The kinetics of non treated and especially of treated HIV1 is compared to that of non treated and of treated cancer cells. Contrary to Skipper's scheme, based on constancy of cancer cell proliferation or post-chemotherapy decrease slope, the same chemotherapy successive cycles decrease in fact less and less the proportion of cell number reduction, and the hope of killing the "last cell" is a utopian concept. Hence, the very poor global benefit in cancer medicine registered in the last 50 years. The only cures are seen in child tumors and young adults testis cancer: the immunity reaction being stronger before 40 years of age than after 40 may explain this difference with age. The a priori systematic opposition to active immunotherapy of cancer from some authorities has been a grave fault. Such fault should not be committed for the treatment of HIV1-AIDS complex. The continuous HIV1 so called intensive virostatic chemotherapy is complicated by severe toxicities, and resistances of relapses and virus re-activation when it must be discontinued. The widely accepted triple therapy only affects two virus targets (retro-transcriptase and virus protease), which is insufficient, as we have shown. We have also observed that the constant and most rapid VL decrease to < 200 or < 20 RNA copies/mL is obtained when four virus targets are affected, including some concerning DNA provirus (which is the case of acriflavine and methylhydroxy-ellipticine). As in acute lymphoid leukemia, two treatment phases can be distinguished: a) the VL reduction to 20 copies; b) the maintenance of the residual < 20 copies of viruses. Excellent results as far as VL decrease and maintenance at < 20 copies have been obtained with a follow-up between 1 1/2 and 6 years, without any toxicity nor global resistance, with combinations of four drugs affecting four viral targets, applied in short (3 week) sequences, different from each others owing to drug rotation. This can be compared with the 65% remission rate obtained with alternative different cycles of cancer chemotherapy in tumors resistant to conventional modalities. The possibility of repeating for ten patients the evaluation of viral load and of immunologic parameters has allowed us to discover that some VL decrease curves are fractal. As well, maintenance 20 copies are not rarely interrupted by short and reversible HIV1 rebounds as those we had described in "cured" acute lymphoid leukemia patients. Of utmost importance, all HIV1 rebounds were associated with the presence of one cofactor: chimerism, chronic hepatitis, CMV, herpes 8, herpes 6, and influenza are those we observed. The problem today is not to "kill the last tumor cell in cancer" or "the last HIV1 particle" in HIV1-AIDS complex. It is to keep the residual cells or virus in latency. Active immunotherapy and other biologic interventions, such as hypermethylation, should be studied in this aim, as they are also able to do so.

The efficacy of surgical treatment of breast cancer

The purpose of the analysis was to resolve the two opposing claims regarding the efficacy of surgical treatment of breast cancer, namely the course of the disease is not affected by surgery because breast cancer is an incurable systemic disease, as shown by a previous analysis, results of randomized breast cancer treatment trials and long-term follow-up of breast cancer patients; and breast cancer can be cured if detected early, as shown by reduced breast cancer mortality observed in results from randomized breast cancer-screening trials using mammograms. Seven randomized breast cancer-screening trials commonly cited as having produced evidence for reduced breast cancer mortality were analysed to identify any flaws in the trial design that would lead to confounding factors that could have affected the results. Flaws were identified in all trials in that the treatment protocols, by requiring that the type and degree of treatment depended on the stage of the tumour at diagnosis, required that up five factors were varied in each trial, confounding the results. Correlations were sought between some of these factors and the breast cancer mortality reduction observed in some screened groups to determine which factors had the main influence on the observed results. No correlation was found between reduced breast cancer mortality and earlier surgical intervention. In fact, the trial with the most earlier surgical intervention had the smallest reduction in mortality; and that with the least earlier surgical intervention had the largest reduction in mortality. This demonstrates that the earlier-diagnosis hypothesis is invalid. Some correlation was established between reduced mortality and reduced use of radiotherapy, suggesting that radiotherapy had a greater influence on mortality than surgery. Analysis of deaths from other causes suggests that there are at least two effects involved: immune suppression caused by radiotherapy, and increased classification of breast cancer deaths as deaths from other causes following ischaemic heart damage caused by radiotherapy. Claims that mammographic screening reduces breast cancer mortality are therefore unproven. The conclusion from the previous analysis, that surgery has not been shown to reduce mortality for any form of cancer, is therefore still valid. Surgery for breast cancer should therefore be considered as a palliative measure and radiotherapy should be avoided as a routine technique.