Recurrence of Breast Cancer After Primary Treatment: A Matched Comparison Study of Disease-Free Survival in Women Who Do and Do Not Receive Adjunctive Naturopathic Oncology Care

Purpose:

To compare disease free survival experienced by women who received usual oncologic care compared to a cohort of women who received naturopathic oncology care in addition to usual care.

Methods:

Women with breast cancer who received naturopathic oncology (NO) care in Western Washington State (WA) (N = 176) were recruited to a prospective study of clinical health-related quality of life outcomes and then matched to women who received usual care (UC) only (N = 334).

Results:

Among 510 women with breast cancer stages 1 to 3, a total of 50 women (10%) experienced a disease-free survival (DFS) ending event within the observation period; 23 (6.8% of those in the UC cohort, and 27 (15.3% of those in the NO cohort (P < .05). Although, women in the 2 cohorts received similar surgical, chemotherapy, and radiation treatment, women with breast cancer who received naturopathic oncology adjunctive care were less likely to use anti-estrogen therapy, and experienced poorer DFS (logrank test, P < .05). However, differences in DFS could not be shown to be due to cohort differences in anti-estrogen therapy, baseline HRQOL, or naturopathic oncology therapies prescribed. The stage 3 women in the naturopathic oncology group had more advanced disease at diagnosis. They were more likely to have 5 or more metastatic lymph nodes at baseline (18.5%) compared to their usual care matched control group (13%). Women in the naturopathic oncology group also had higher grade tumors at diagnosis.

Conclusions:

Results show that recurrence of breast cancer was associated with more advanced malignant lymph node involvement; and that naturopathic oncology services provided in 2009-2015 did not improve disease-free survival in these high-risk breast cancer patients.

Abstract P2-11-03: Phase I/II randomized study of combination immunotherapy with or without polysaccharide krestin (PSK) concurrently with a HER2 ICD peptide-based vaccine in patients with stage IV breast cancer receiving HER2-targeted monoclonal antibody therapy

Natural killer (NK) cell defects, commonly seen in metastatic breast cancer (MBC) lead to decrease in dendritic cell (DC) maturation, proinflammatory cytokine production, and tumor infiltrating T-cells (TILs). This results in a protumorigenic Th2 immune microenvironment with low response rates to immunotherapy (i.e., immune checkpoint blockade) and standard chemotherapy. PSK, a potent TLR-2 agonist, activates NK cells to produce IFN-γ and IL-12 and promote DC maturation/differentiation toward a Th1 profile in the tumor microenvironment which results in antigen specific TIL that can eradicate tumor. The combination immunotherapy of PSK and HER2 directed therapy described here, aims at inducing Th1 immunity and tumor specific T-cells. This proposed regimen could eradicate microscopic residual disease and prevent recurrence in optimally treated HER2+ MBC patients. Moreover, the regimen could result in enhanced trafficking of TILs to the site of tumor and improve the efficacy of checkpoint inhibitors and other therapies. A phase I/II randomized 2 arm study of combination immunotherapy with oral PSK (or placebo) given with a HER2 peptide vaccine and HER2 mAb therapy (trastuzumab (TZ) +/- pertuzumab (PZ)) was initiated to assess the safety of the approach and evaluate the effect of PSK on NK cell activity, pro-inflammatory cytokine/chemokine profile; and HER2 vaccine-induced T cell immunity.

Methods: Up to 30 patients with HER2+ MBC who are without evidence of disease after definitive therapy and currently on maintenance TZ +/- PZ are enrolled and randomly assigned in equal numbers to 1 of 2 arms (15 patients/arm): Arm 1: HER2 ICD vaccine + placebo or Arm 2: HER2 ICD vaccine + PSK. All patients receive concomitant treatment with 4 months of daily oral PSK or placebo, 3 monthly intradermal HER2 ICD vaccinations and continued TZ +/- PZ. Toxicity is evaluated per CTEP CTCAE 4.0, during and post vaccination. Serial blood draws for immunologic evaluation of NK cell activity and antigen-specific T cell immunity via flow cytometry and IFN-γ ELISPOT, respectively; and pro-inflammatory cytokines/chemokines.

Results: 24 subjects have been enrolled and 60 vaccines have been given. 16 subjects have completed all 3 vaccines and PSK/placebo; and 6 subjects are currently in progress. 2 subjects received &lt; 3 vaccines and were taken off study. Of 144 reported adverse events (AEs), 97% were Grade 1-2; 66 (46%) were possibly, probably, or definitely related to study treatment. Most common AEs are injection site reaction and flu-like symptoms. There have been a total of four Grade 3 AEs, 1 episode of self-limited nausea/vomiting attributed to study treatment; and cognitive disturbance, fatigue, and lymphopenia all in 1 subject and attributed to disease progression. There have been no Grade 4 AEs. Immunologic analyses are ongoing and will be presented along with completed clinical data on all patients.

Conclusion: Combination immunotherapy with PSK/placebo and concurrent HER2 directed therapy is safe and well-tolerated. Further ongoing immunologic studies will help define the immunogenicity of the approach.

Citation Format: Salazar LG, Higgins D, Childs J, Coveler AL, Liao J, Stanton S, Gooley T, Standish LJ, Sasagawa M, DISIS ML. Phase I/II randomized study of combination immunotherapy with or without polysaccharide krestin (PSK) concurrently with a HER2 ICD peptide-based vaccine in patients with stage IV breast cancer receiving HER2-targeted monoclonal antibody therapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-11-03.

Use of alternative medicine by children with cancer in Washington state

BACKGROUND

Use of alternative medicine is widespread among adult cancer patients, but considerably less is known about the use of these therapies by pediatric cancer patients. Our objective was to investigate the distribution and patterns of alternative medicine use by children diagnosed with cancer in Washington State.

METHODS

Pediatric cancer patients (< or =18 years) with first primary neoplasms were identified from the Cancer Surveillance System of western Washington. Telephone interviews were conducted with parents of 75 patients to obtain data on the prevalence and types of alternative medicine used, satisfaction with conventional and alternative medicine, motivations for use of alternative medicine, adverse effects, and costs.

RESULTS

Seventy-three percent of patients used at least one alternative treatment or therapy. Twenty-one percent of patients consulted an alternative provider (e.g., acupuncturist, naturopathic doctor), and insurance companies covered 75% of these costs. Twenty-eight percent used high-dose dietary supplements such as vitamins C or E, and 35% used herbal preparations. Although use of alternative medicine was associated with parental dissatisfaction with their child's physician (P = 0.02), no patient used alternative medicine as a substitute for standard medical care. Most patients used alternative medicine to cope with disease symptoms or the side effects of the medical treatments.

CONCLUSIONS

Pediatric oncology patients use alternative treatments as adjuncts to conventional care. Both researchers and health care providers should remain informed about the benefits and adverse effects of alternative therapies in order to discuss treatment options with patients and their families and to monitor treatment efficacy.

Alternative medicine use in HIV-positive men and women: demographics, utilization patterns and health status

Between 1995 and 1997, 1,675 HIV-positive men and women using complementary and alternative medicine (CAM) were enrolled into the Bastyr University AIDS Research Center's Alternative Medicine Care Outcomes in AIDS (AMCOA) study. Funded by the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) and National Institute of Allergy and Infectious Diseases (NIAID), the AMCOA study collected information on participant demographics, health status and use of conventional and CAM therapies. Participants from 46 states completed a baseline questionnaire, while additional clinical information (such as CD4 count and HIV-RNA viral load) was obtained from laboratory records. AMCOA participants reported using more than 1,600 different types of CAM therapies (1,210 CAM substances, 282 CAM therapeutic activities and 119 CAM provider types) for treating HIV/AIDS. Approximately two-thirds (63% n = 1,054) of the AMCOA cohort reported using antiretroviral drug therapy (ART) during the six-months previous to completing the baseline questionnaire, while 37% (n = 621) indicated they were not using ART. Of those not using ART, 104 subjects reported never having used any conventional medications for their HIV and 12 subjects used only non-prescription diarrhoea medications. The most frequently reported CAM substances were vitamin C (63%), multiple vitamin and mineral supplements (54%), vitamin E (53%) and garlic (53%). CAM provider types most commonly consulted by the AMCOA cohort were massage therapists (49%), acupuncturists (45%), nutritionists (37%) and psychotherapists (35%). CAM activities most commonly used were aerobic exercise (63%), prayer (58%), massage (53%) and meditation (46%). The choice of CAM therapies among the AMCOA cohort does not appear to be solely based on scientific evidence of efficacy of individual therapies. The majority of AMCOA subjects could be characterized as using integrated medicine, since an overwhelming proportion of the cohort consult with both conventional and CAM providers and use both conventional and CAM medications, yet few subjects reported that their conventional and CAM providers work as a team. These data and this cohort set the stage for conducting studies of health status changes associated with specific CAM therapies.

A phase I trial of andrographolide in HIV positive patients and normal volunteers

A phase I dose-escalating clinical trial of andrographolide from Andrographis paniculata was conducted in 13 HIV positive patients and five HIV uninfected, healthy volunteers. The objectives were primarily to assess safety and tolerability and secondarily to assess effects on plasma virion HIV-1 RNA levels and CD4(+) lymphocyte levels. No subjects used antiretroviral medications during the trial. Those with liver or renal abnormalities were excluded. The planned regimen was 5 mg/kg bodyweight for 3 weeks, escalating to 10 mg/kg bodyweight for 3 weeks, and to 20 mg/kg bodyweight for a final 3 weeks. The trial was interrupted at 6 weeks due to adverse events including an anaphylactic reaction in one patient. All adverse events had resolved by the end of observation. A significant rise in the mean CD4(+) lymphocyte level of HIV subjects occurred after administration of 10 mg/kg andrographolide (from a baseline of 405 cells/mm(3) to 501 cells/mm(3); p = 0.002). There were no statistically significant changes in mean plasma HIV-1 RNA levels throughout the trial. Andrographolide may inhibit HIV-induced cell cycle dysregulation, leading to a rise in CD4(+) lymphocyte levels in HIV-1 infected individuals.

Botanical medicines with gynecological anticancer activity: a literature review

This article reviews the existing scientific literature reporting effects of botanical substances on the prevention and treatment of gynecological cancers. Anticancer effects were reported for 14 of 27 herbal substances searched for, 8 of which had reported effects specifically in gynecological cancer models. Research reviewed included in vitro studies in gynecological cancer cell lines, animal studies, an ex vivo study, and an epidemiological study. No clinical trials on gynecological cancer prevention or treatment were found for any of the 8 identified agents. Despite the increasing use of botanical medicines in the prevention and treatment of cancer in general, there is a paucity of studies describing their efficacy or safety in gynecological cancer. Given the prevalent use of botanical medicine in complementary and alternative cancer therapy, the need for research to evaluate safety and efficacy using both in vitro and in vivo methods is pressing.

Most frequently used alternative and complementary therapies and activities by participants in the AMCOA study

This literature review examines the current state of the scientific evidence published in peer-reviewed journals indexed in MedLine for the 10 most commonly noted alternative activities reported by the first 1,016 eligible participants in the Alternative Medical Care Outcomes in AIDS study. The most frequently used activities are aerobic exercise (64%), prayer (56%), massage (54%), needle acupuncture (48%), mediation (46%), support groups (42%), visualization and imagery (34%), breathing exercises (33%), spiritual activities (33%), and other exercise (33%). Despite frequency of usage, clinical research is not reported on MedLine to support the use of most of these activities for HIV/AIDS. The limitations of using MedLine as the sole source for this review are discussed.

Treatment of human immunodeficiency virus-positive patients with complementary and alternative medicine: a survey of practitioners

OBJECTIVE

To investigate complementary and alternative medicine (CAM) practices provided to human immunodeficiency virus (HIV)-infected individuals, provider experience in HIV disease, patients' characteristics, provider perceptions of treatment effectiveness, and feasibility and interest in future studies.

DESIGN

Mailed survey.

PARTICIPANTS

117 providers, recruited from professional associations and conferences, who offer CAM therapies to HIV-infected individuals.

OUTCOME MEASURES

Provider credentials, patient descriptors, treatments prescribed and their perceived effectiveness, health service information, medical information charted, and research participation capability and interest.

RESULTS

Providers are treating patients at all stages of HIV disease with a variety of CAM practices, claiming a mean of 6.5 years of HIV disease treatment experience and 105 HIV-positive patients in treatment per provider (solo practice or clinic). Eighty percent of respondents report holding state licenses to practice. A total of 115 different CAM therapies with an average of 12 treatments per provider were used. Ninety percent of providers claimed their therapies were "somewhat" to "very effective" on all disease stages, indicating effectiveness for symptom management (96%), quality of life (98%), raising or maintaining CD4+ lymphocyte levels (66%), slowing progression to acquired immunodeficiency syndrome (AIDS) (69%), and extending survival (73%). Research readiness and willingness was reported by a majority of respondents.

CONCLUSIONS

Providers with substantial experience treating HIV disease with a range of CAM practices claim effectiveness for their methods. Providers are generally willing to participate in studies that would examine such claims and appear to have the capacity meaningfully to contribute. These claims should be investigated.

A scientific plan for the evaluation of alternative medicine in the treatment of HIV/AIDS

The Bastyr University AIDS Research Center was established in October 1994 through a 3-year cooperative grant with the Office of Alternative Medicine, National Institutes of Health. The mission of the Center is to (1) describe forms and patterns of use of alternative medical therapies for HIV infection and AIDS prescribed by practitioners and self-administered by HIV-positive patients in the United States, (2) screen and evaluate therapies for HIV/AIDS from five program areas of alternative medicine, and (3) provide consultation and support in the scientific evaluation of alternative therapies. To meet these goals, the Center has established a network of cooperating alternative medicine clinics and is recruiting HIV-positive men and women who are using alternative medicine to participate in the study. It is collecting data every 6 months from 1500 HIV-positive patients throughout the United States and has created a centralized database to compare outcomes (CD4+ lymphocytes, HIV RNA, CDC class progression, weight, quality of life, and survival) for a variety of alternative therapies. The Center will determine whether patients who use both conventional medicine and alternative medicine have different outcomes from patients who use only conventional medicine. The occurrence of AIDS-related opportunistic infections and neoplasms in HIV-positive patients who are using specific alternative therapies will be compared with the incidence in those who use other medical treatment. This article describes the scientific plan for the study.

CL 218-872 pretreatment and intervention block kainate-induced convulsions and neuropathology

Two experiments were conducted to test the antiepileptic properties of CL 218-872, a triazolopyridizine reported to have anxiolytic and anticonvulsant effects without accompanying sedative and ataxic effects. In Experiment 1 pretreatment with CL 218-872, a recently synthesized and potent triazolopyridizine, reduced kainic acid-induced convulsions and subsequent neuropathology in rats given ip doses of 25 mg/kg or greater. CL 218-872 at doses of 50 mg/kg or greater was more effective than a high dose of diazepam (20 mg/kg) in blocking status epilepticus-like convulsions and the associated widespread neuropathological sequelae. Moreover, diazepam pretreatment was associated with a higher mortality rate than CL 218-872. In Experiment 2 the efficacy of intervention with 20 mg/kg diazepam was compared with that of 50 mg/kg CL 218-872 in suppressing ongoing convulsions and reducing subsequent brain damage following a convulsant dose of kainic acid. Although CL 218-872 and diazepam were equally effective behaviorally (i.e., in suppressing kainic acid-induced convulsions), CL 218-872 was superior in its ability to reduce subsequent neuropathology, especially in the hippocampus and neocortex. Because kainic acid has been suggested as a model for human status epilepticus, CL 218-872 may be a potentially therapeutic treatment for this disorder.

Behavioral effects of phencyclidine and ketamine alone and in combination with other drugs

The behavioral effects of phencyclidine (PCP) and ketamine administered alone and in combination with naloxone, atropine, methyl atropine, chlorpromazine and d-amphetamine were studied in squirrel monkeys trained to press a response lever under a fixed-ratio 30 schedule maintained by the termination of a stimulus associated with electric shock presentation. Under non-drug conditions, a period of high-rate responding in the presence of the stimulus associated with shock presentation was followed by a period of no responding during a 40-s timeout scheduled between fixed-ratio components. Mean rates of responding during fixed-ratio components decreased monotonically as PCP dose increased from 0.1 to 0.56 mg/kg, and doses of 3.0 and 5.6 mg/kg ketamine produced decreases in mean response rate comparable to doses of 0.3 and 0.56 mg/kg PCP. The dose-effect functions revealed that ketamine was approximately one-tenth as potent as PCP. The present data also characterized the time-course effects of PCP and ketamine, with the former having effects that were slower in onset yet more persistent in time. None of the drugs studied in combination with PCP and ketamine provided evidence of a pharmacological antagonism of the behavioral effects of the latter two drugs. Rather, the data indicated an enhancement of behavioral effects when certain drug combinations were studied.

Neuroanatomical localization of cells containing gonadotropin-releasing hormone messenger ribonucleic acid in the primate brain by in situ hybridization histochemistry

Using in situ hybridization histochemistry, we have mapped the anatomic localization of perikarya containing mRNA that codes for GnRH and GnRH-associated protein (GAP) in the forebrain of four male macaques, Macaca fascicularis. DNA oligomers, with sequences complementary to either the GnRH or the GAP portion of the mRNA sequence, were synthesized and hybridized to paraformaldehyde fixed, coronal sections of the basal forebrain and hypothalamus. GnRH mRNA was found in the same population of cells as those containing GAP mRNA. GnRH/GAP mRNA-containing cell bodies were observed consistently in the medial septal nucleus, the diagonal band of Broca, the medial preoptic area, supraoptic nucleus, and ventromedial-infundibular region. We detected the presence of GnRH mRNA and GAP mRNA within the same neuroanatomic regions previously shown to include perikarya containing immunoreactive GnRH. The ventromedial-infundibular region and the medial preoptic region contained the greatest number of GnRH/GAP mRNA-containing perikarya (37.0% and 22.5%, respectively). The diagonal band contained 21.0% and the supraoptic nucleus 13.0% of the cells, while the medial septum contained the fewest number (6.7%). This study demonstrates the feasibility of using in situ hybridization as a strategy to study the developmental and steroidal regulation of GnRH gene expression in the nonhuman primate.

The development of motoneurons in the embryonic spinal cord of the mouse mutant, muscular dysgenesis (mdg/mdg): survival, morphology, and biochemical differentiation

Motoneuron development was studied in the spinal cord of the mouse mutant, muscular dysgenesis, between embryonic days (E) 13 and 18. Dysgenic embryos are characterized by the absence of neuromuscular activity (motility) and exhibit a number of other striking changes in neuromuscular development. Many of these changes have also been observed in chick embryos chronically treated with neuromuscular blocking agents that suppress motility. Motoneuron survival, as well as several other aspects of neuronal development, was examined in the thoracic and lumbar spinal cords of mutant and control embryos. There was a significant decrease in motoneuron numbers in control embryos indicating the presence of naturally occurring cell death in the mouse spinal cord. At all ages examined, the dysgenic embryos had significantly more healthy and significantly fewer degenerating motoneurons than controls. There were no differences in the number of dorsal root ganglion neurons or in any of the other morphometric parameters examined between mutant and control embryos. Creatine kinase activity, a marker for myofiber maturation, was significantly reduced in the limb musculature of mutant embryos. Choline acetyltransferase activity was significantly increased in the spinal cord of mutant embryos. No significant differences were observed in spinal cord levels of acetylcholinesterase activity between control and mutant embryos. The absence of muscle contractions in the dysgenic mouse is associated with a number of changes in neuromuscular development, including a substantial reduction of naturally occurring motoneuron death.

The paradoxical effect of central nervous system stimulants on hyperactivity: a paradox unexplained by the rate-dependent effect

It has been proposed, most recently in an article by L. Green and D. Washauer entitled, "A note on the 'paradoxical' effect of stimulants on hyperactivity with reference to the rate-dependency effect of drugs" (J. Nerv. Ment. Dis., 169: 196-198, 1981), that the rate-dependency effect of drugs explains the paradoxical reduction of motor activity by central nervous system stimulants administered to hyperactive children. Research indicates that the effects of these drugs on the behavior of animals or humans are not presently understood and that such proposals confuse an explanation with an empirical results.

Differential effects of chlordiazepoxide on conditioned and unconditioned behavior in mice with septal lesions

The time course of action of repeated daily doses of chlordiazepoxide (CDP) was examined in mice with septal lesions. Bilateral septal lesions produced changes in both conditioned and unconditioned behavior. These lesions increased rate of operant responding on a VI-40 s schedule and produced hyperreactivity to tactile stimuli. The effects of repeated administration of CDP on these two classes of behavior were observed to follow different time courses. In a dose dependent fashion, CDP first reduced VI response rates in septal mice, but after several daily doses the response rate increased above post-surgical baseline levels. The suppressant effects of CDP on septal hyper-reactivity were quite different. Hyper-reactivity was persistently attenuated by all CDP doses tested during the eight-day drug regimen. The pattern of drug effects suggested that serotonin antagonism was involved in CDP's effects on lesion produced hyper-reactivity.

Axon-sparing brain lesioning technique: the use of monosodium-L-glutamate and other amino acids

Infusions of monosodium-L-glutamate into the rostral hypothalamus, believed to contain neurons mediating satiety, produced persistent hyperphagia and obesity, thus suggesting that a brain lesion had been produced. Similar infusions into the caudal hypothalamus, believed to contain unmyelinated axons of passage that mediate satiety, failed to alter food intake or body weight. Histological examination of the affected tissue confirmed the behavioral evidence that suggests that this technique spares axons but destroys cell bodies. Infusion of several other amino acids also damaged neurons while sparing axons of passage.

DRL performance, extinction, and secondary reinforcement: role of appetitive value of food in mice with septal lesions

Normal mice and mice with septal lesions were trained on a differential-reinforcement-for-low-rates-of-responding (DRL 8-sec) schedule for the reinforcement varying in incentive value. Dilution of diet increased the number of reinforcements received by mice with septal lesions. In Experiments 2 and 3 the effects of septal lesions on resistance to extinction and continuous reinforcement training and the strength of secondary reinforcement were investigated. Changes in reinforcement value modified the septal lesion effects in both cases. All three experiments demonstrated the alteration of the septal lesion effect through a change in the appetitive value of the reinforcement. The results suggest that one of the mechanisms by which septal lesions impair DRL performance is an enhancement of reinforcing properties of food.