July 12, 2023

The Truth About...Repurposed Drugs to Treat Cancer

Drug repurposing is using a drug previously approved for one condition to treat an entirely different condition (like cancer). In cancer care, repurposed drugs are usually gentler than FDA-approved cancer treatments. They include common drugs for diabetes, high blood pressure, infections, and more. Tina & Leah talk about who should consider this strategy and some of the most commonly used repurposed drugs.

Repurposing Drugs in Oncology- ReDo Project link
The Anticancer Fund
Care Oncology Clinic (we have no affiliation!) - good info & access to repurposed drugs
Thorough review of mechanisms for repurposed drugs in cancer
Cimetidine- early study suggesting benefit in colorectal cancer
Review of cimetidine in colorectal cancer
Review of better blood sugar regulation leading to better outcomes in cancer care
Metformin- early study suggesting benefit in ovarian cancer

Tell us your thoughts on this episode!

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THANK YOU!!

00:00 - Pandemic ripples... for better or worse.

04:27 - What are Repurposed drugs?

05:57 - Cimetidine (Tagamet)

07:37 - Metformin

10:10 - Blood sugar and outcomes

12:45 - Aspirin

18:50 - The big picture (Metro Map?)

24:21 - Blood pressure drugs

28:58 - Doxycycline

30:56 - Statin drugs

33:39 - Anti Parasitic drugs (Mebendazole, Ivermectin)

43:42 - The bigger picture

48:00 - Wrap up

WEBVTT

00:00:00.050 --> 00:00:00.320
Okay.

00:00:00.325 --> 00:00:00.680
Tina.

00:00:00.680 --> 00:00:10.789
So I know that you're not seeing as many patients, especially since, you know, like 2020 with the whole pandemic.

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That

00:00:11.480 --> 00:00:11.900
mm-hmm.

00:00:12.169 --> 00:00:15.314
kind of, you know, people might be familiar with that.

00:00:15.644 --> 00:00:26.128
Um, but I have found that a number of, I'm gonna call'em pandemic effects or covid effects that I have seen with patients.

00:00:26.428 --> 00:00:31.557
One of them being patients often saying like, well, I did my own research.

00:00:32.005 --> 00:00:32.515
Yes.

00:00:32.609 --> 00:00:37.018
There's always been a subset of folks who do their own research online with, uh, Dr.

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Google.

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Yes.

00:00:38.728 --> 00:00:45.006
But since Covid, you're right, there's definitely more people finding their own opinion online and educating themselves.

00:00:45.036 --> 00:00:50.021
And maybe not using the best, uh, the best, maybe not using the ideal resources.

00:00:51.011 --> 00:00:51.871
The most legit.

00:00:52.323 --> 00:00:59.789
Yes, that's a huge issue because there's a lot of information and you, as you know, you can find anything you want to find online.

00:00:59.899 --> 00:01:07.665
So parsing the information in medicine requires some level of discretion between the sources.

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Often there is a vein of truth within the information that they're getting, but then you have some sort of an expert with the big air quotes who.

00:01:17.897 --> 00:01:38.807
Promotes this and talks about conspiracies Anyways, so what I was gonna ask you about is, do you find there are patients that are coming to you who wanna take a different prescription medication, they want you to prescribe something for them that is not typically used for cancer.

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Yes.

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Like, like I have had a number of patients here who are taking some sort of antiparasitic.

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I mean, ivermectin is like, I mean that's such, it's such a hot topic, you know, especially like in this covid world that we are, you know, in.

00:01:55.870 --> 00:02:06.555
But even like mezo, like patients are getting these anti-parasitics and Wanting to take them, wanting to know if it's okay to take in place of their treatment.

00:02:06.555 --> 00:02:18.129
Not along with even, it's just, you know, they come, they hear about the treatment that they're supposed to get and then they come speak with one of the naturopathic doctors at the hospital and say, well, you know, I really wanna take this instead

00:02:18.490 --> 00:02:18.879
Yeah.

00:02:19.330 --> 00:02:19.599
Yeah.

00:02:19.604 --> 00:02:29.979
So they're going to their local farm and feed store or something to find it because there's versions that are for the large animals that people are using at home and themselves, and yeah, it's an issue.

00:02:30.125 --> 00:02:36.138
I think there's a time and a place for these drugs that are potentially useful in cancer, but you can't just take them

00:02:36.407 --> 00:02:37.548
willy-nilly.

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Yes.

00:02:39.617 --> 00:02:40.397
willy-nilly.

00:02:40.448 --> 00:02:40.747
Got it.

00:02:40.758 --> 00:02:41.478
In this episode.

00:02:41.807 --> 00:02:42.288
Yeah.

00:02:42.293 --> 00:02:47.856
Um, and I'm not really familiar with the use of, it's known as repurposing drugs.

00:02:48.371 --> 00:02:51.760
Amongst other names for it, but I'm not really familiar with it.

00:02:51.760 --> 00:02:53.110
But it is kind of a hot topic

00:02:53.621 --> 00:02:59.950
I've definitely prescribed drugs or had drugs prescribed with patients, but it's alongside a larger picture.

00:03:00.131 --> 00:03:03.371
It's not in lieu of conventional treatment so much as

00:03:03.491 --> 00:03:04.360
in conjunction,

00:03:04.610 --> 00:03:05.230
in conjunction.

00:03:05.591 --> 00:03:07.480
conjunction junction, what's your function?

00:03:08.205 --> 00:03:13.694
So that's what we're gonna talk about today, is we're just gonna have a conversation about repurposing drugs.

00:03:14.175 --> 00:03:17.564
We are not making any specific recommendations.

00:03:17.564 --> 00:03:27.393
These are not things that I have ever talked with patients about other than, you know, cautioning them regarding side effects and interactions and that sort of thing.

00:03:27.603 --> 00:03:34.082
And I have had some cases that have been extraordinary and they happen to take off-label drugs, repurposed drugs.

00:03:34.323 --> 00:03:36.002
Was that why they were extraordinary?

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I don't know.

00:03:36.867 --> 00:03:37.900
Maybe, maybe not.

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intriguing.

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Cue music.

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I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

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and I'm Dr Leah Sherman and on the cancer inside

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And we're two naturopathic doctors who practice integrative cancer care

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But we're not your doctors

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This is for education entertainment and informational purposes only

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do not apply any of this information without first speaking to your doctor

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The views and opinions expressed on this podcast by the hosts and their guests are solely their own

00:04:09.862 --> 00:04:28.314
Welcome to the cancer pod Hey Tina.

00:04:28.786 --> 00:04:29.136
Hi Leah.

00:04:30.139 --> 00:04:34.009
So when we talk about repurposing drugs, what does that even mean?

00:04:34.863 --> 00:04:36.694
Well, it's pretty literal.

00:04:36.903 --> 00:04:43.983
We're taking a drug that is already used already, F D a approved and finding a new purpose for it.

00:04:44.043 --> 00:04:48.064
So a diabetic drug or a high blood pressure drug.

00:04:48.064 --> 00:04:57.389
These drugs that are already out there being used by people are now being found to work on some cancers, perhaps, especially in combinations.

00:04:57.764 --> 00:05:04.620
Often you don't use one repurposed drug, you do a few, but I wanna say this, there's a lot of synonyms for repurposed drugs.

00:05:04.836 --> 00:05:12.591
So they also are called off-label use of drugs, meaning it's being used for something other than its, uh, approved use.

00:05:12.762 --> 00:05:18.709
And the other one that you'll hear a lot, and you'll see a lot in the literature if you're looking this up, is repositioned drugs.

00:05:19.362 --> 00:05:25.067
Repositioned drugs is really a term that comes from the industry because they're talking to their marketing department.

00:05:25.247 --> 00:05:33.017
So they're saying, take this drug that's already used for anxiety or depression and we're gonna reposition that drug as a hot flash medication.

00:05:33.360 --> 00:05:41.310
So that's a really a marketing term when you're repositioning a drug, cuz you're really telling people you need to look at this differently, this and this is why you need it.

00:05:41.310 --> 00:05:47.122
So I don't like that term so much, but it does get used in the medical literature, so you need to know it if you're looking information up.

00:05:47.490 --> 00:05:54.226
repurposed really is the best word to use, I think, because it's most accurate and it's commonly used in the medical literature.

00:05:54.226 --> 00:05:57.257
So it'll bring you the results you're looking for when you're looking for info.

00:05:57.677 --> 00:06:08.860
I think the first time I heard of a non chemotherapy type drug being used along with certain chemotherapies, with certain cancers, was cine.

00:06:09.310 --> 00:06:09.850
Yes.

00:06:10.031 --> 00:06:11.021
It's one of the oldest,

00:06:11.141 --> 00:06:16.021
And what that, so that is, that's for gastric reflux.

00:06:16.021 --> 00:06:17.190
It's, it's a, it's a reflux.

00:06:17.605 --> 00:06:19.016
Anti-reflux medication.

00:06:19.045 --> 00:06:20.725
You don't wanna take a reflux medicine.

00:06:20.995 --> 00:06:26.065
You don't want something that gives you a reflux, but it's yeah, for like ulcers and, and gerd, that sort of thing.

00:06:26.485 --> 00:06:28.076
And I can never remember.

00:06:28.237 --> 00:06:29.497
it's, it's tagme.

00:06:29.910 --> 00:06:30.865
It's histamine blocker.

00:06:30.964 --> 00:06:32.072
It's a, yeah, yeah.

00:06:32.072 --> 00:06:35.036
It, it blocks stomach acid through the histamine pathway.

00:06:35.230 --> 00:06:38.769
And when they used it, they used it in very high doses.

00:06:38.980 --> 00:06:51.939
So this is something that with repurposed drugs, we always have to look at are they using it in a dose that's commonly used or are they taking something like cimetidine, which is that acid blocker and giving it in a different dose than you would normally take.

00:06:51.939 --> 00:06:54.009
And in that case it was, it was a lot.

00:06:54.009 --> 00:06:56.800
It was like 800 milligrams over the counter.

00:06:56.800 --> 00:06:57.670
It's only 200.

00:06:58.060 --> 00:07:03.432
And you know, it does seem to have some information about outcomes improving.

00:07:03.480 --> 00:07:08.189
In my recollection, colorectal cancer comes to mind as one of the cancers.

00:07:08.464 --> 00:07:16.086
I think the cimetidine was also given during surgery or not during, but you know, during the time of surgery or immediately after surgery.

00:07:16.307 --> 00:07:27.242
Well, well, well, that's, that's interesting because the one thing that I do know about it is that it can really affect the liver enzymatic pathway and so it can interact with drugs.

00:07:27.242 --> 00:07:34.978
And so yeah, I guess around surgery would probably be more appropriate because it is something that does affect the metabolism of other drugs.

00:07:35.137 --> 00:07:38.047
Yes, cimetidine interacts with so many drugs,

00:07:38.122 --> 00:07:41.632
And then I guess, I guess metformin was the other one.

00:07:42.141 --> 00:07:45.622
You know what's so interesting is that as, as I'm thinking of the list,

00:07:45.672 --> 00:07:45.687
Uhhuh.

00:07:46.197 --> 00:07:52.526
some of these, I have patients coming in taking a lot of these maybe like it's not the dosage and that's not like I'm ever gonna talk to somebody about it.

00:07:52.526 --> 00:07:54.416
Oh, well you should think of increasing your dosage.

00:07:54.747 --> 00:07:57.747
Um, metformin can have a lot of side effects that patients.

00:07:58.107 --> 00:08:02.666
Are very uncomfortable, you know, taking and are trying to manage it on their own at their prescribed dose.

00:08:03.036 --> 00:08:08.497
but yeah, Metformin was the other one that was kind of like the big hot, I don't know, the hot, big hot number,

00:08:08.726 --> 00:08:11.466
So Metformin is a medication that diabetics take.

00:08:11.641 --> 00:08:15.362
It's for like people who are insulin resistant, blood sugar problems.

00:08:16.081 --> 00:08:18.482
In particular, insulin resistant diabetes.

00:08:18.661 --> 00:08:23.939
And what we saw in studies was that people who were taking metformin had better outcomes.

00:08:24.059 --> 00:08:32.219
So some of the earliest ones, and the ones that really moved the needle and got attention were some large studies and women with ovarian cancer and those who were taking metformin.

00:08:32.428 --> 00:08:33.509
This was what was interesting.

00:08:33.928 --> 00:08:38.631
Those who had diabetes and took metformin had better outcomes.

00:08:38.861 --> 00:08:43.601
Then those who didn't have diabetes, of course they weren't taking metformin cuz they didn't have diabetes.

00:08:44.111 --> 00:08:51.792
And so what moved the needle is normally diabetes and poor blood sugar regulation is associated with poorer outcomes.

00:08:52.392 --> 00:08:59.861
So this subset, they're like, huh, these people, this population has diabetes, they should have poorer outcomes.

00:09:00.282 --> 00:09:02.172
It must be the metformin that changed it.

00:09:02.802 --> 00:09:04.601
And so that really got everyone's attention.

00:09:04.601 --> 00:09:09.701
I think that really lit a fire under, you know, what was to date, smaller studies at that time.

00:09:09.792 --> 00:09:13.392
And since then we have had more and more information on metformin.

00:09:13.481 --> 00:09:19.772
Not only controlling insulin and blood sugar, but having other mechanisms controlling at least some cancer growth.

00:09:19.802 --> 00:09:24.692
Um, it's not a magic pill, it's not like a chemotherapy drug where you swallow it and it kills cancer cells.

00:09:24.932 --> 00:09:25.951
It doesn't work that way.

00:09:26.251 --> 00:09:32.158
All the repurposed drugs influence the cancer, but none of them that I know of.

00:09:32.489 --> 00:09:33.688
Wipe it out per se.

00:09:33.749 --> 00:09:34.918
You know, it's not like that.

00:09:34.918 --> 00:09:35.759
It's not that simple.

00:09:35.759 --> 00:09:36.749
It's not a magic bullet.

00:09:37.011 --> 00:09:42.201
So that's why they're often talked about in combination cuz you're trying to stifle growth

00:09:42.361 --> 00:09:43.971
Through different pathways.

00:09:44.182 --> 00:09:45.351
through different pathways.

00:09:45.356 --> 00:09:49.365
It's almost like you're, I don't know, like you're like a, like a cat with a mouse.

00:09:49.365 --> 00:09:53.489
Like you're trying to get it to do what you want it to do, which is not grow.

00:09:53.548 --> 00:09:55.948
You wanna influence it, but you're not gonna wipe it out.

00:09:56.214 --> 00:09:56.964
If you wipe it out.

00:09:56.964 --> 00:09:59.153
It's gonna be mostly your own body that does it.

00:09:59.158 --> 00:10:03.083
Your own immune system or, or the combination of several drugs at once.

00:10:03.083 --> 00:10:09.200
That I say stifle cuz of eventually if you stifle enough metabolic pathways at once, then it dies.

00:10:09.379 --> 00:10:09.799
The cell.

00:10:10.279 --> 00:10:17.187
So when I hear you talk about like, patients who were taking metformin, in, in the study had better outcomes.

00:10:17.187 --> 00:10:28.783
When I think of my own patients, so many are on metformin, but their blood sugar levels are so dysregulated, even before they came in for treatment because of diet or, you know, lifestyle.

00:10:29.052 --> 00:10:33.673
Maybe because of compliance, because of, you know, metformin causing diarrhea or whatever it is.

00:10:34.081 --> 00:10:40.393
And then once you're in treatment with the steroids, it's really hard to manage that blood sugar for patients who are on metformin.

00:10:40.393 --> 00:10:45.259
I mean, I've seen blood sugars go like super high with patients, so that's interesting.

00:10:45.259 --> 00:10:57.263
I wonder if it was the patients who were on metformin who were able to maintain healthy blood sugar levels, or was it like, it doesn't matter if your blood, if your blood glucose is 600, it's, you're still gonna do better

00:10:57.529 --> 00:10:58.090
You know what?

00:10:58.149 --> 00:11:00.909
I think you hit the nail on the head because I just.

00:11:00.909 --> 00:11:04.720
Did a lecture, that was a research review, and there was a paper.

00:11:05.019 --> 00:11:10.419
It looked at a blood parameter that measures your three month average of glucose.

00:11:10.534 --> 00:11:11.424
like an a1c.

00:11:11.509 --> 00:11:14.258
Yes, it's called hemoglobin a1c.

00:11:14.263 --> 00:11:16.868
It's called glycohemoglobin A1c.

00:11:17.378 --> 00:11:17.707
Right.

00:11:17.787 --> 00:11:21.326
So when the a1c, the cutoff was 7%.

00:11:21.760 --> 00:11:24.226
Now 7% technically is still diabetic.

00:11:24.616 --> 00:11:33.923
When people had a lower than seven on average, lower than 7% glycohemoglobin a1c, they had better outcomes.

00:11:33.923 --> 00:11:35.903
And we're talking everything.

00:11:36.203 --> 00:11:41.144
We're talking cancer recurrence, dying from your cancer, and overall mortality.

00:11:41.291 --> 00:11:46.527
So if someone can keep that A1C under 7%, this is.

00:11:46.663 --> 00:11:49.994
With metformin, with whatever drugs, with diet and exercise.

00:11:49.994 --> 00:11:57.976
Of course, if they can keep it under seven, statistically there's much better outcomes and even longevity, literally more longevity.

00:11:57.976 --> 00:12:03.654
And this was a systematic review study, so it was a compilation of many studies into one review paper.

00:12:03.985 --> 00:12:10.479
And so the data is very consistent in that controlling your blood sugar over time is definitely linked to better outcomes.

00:12:10.479 --> 00:12:12.489
And so maybe Metformin's just one piece of that.

00:12:12.494 --> 00:12:14.469
And that early study tipped us off to that too.

00:12:15.624 --> 00:12:27.864
So this is gonna lead to people being like, so sugar does feed cancer, and we're gonna say, go listen to our episode on does sugar feed cancer?

00:12:27.864 --> 00:12:28.793
Because

00:12:28.869 --> 00:12:29.229
yeah.

00:12:29.318 --> 00:12:29.558
We have a

00:12:29.573 --> 00:12:30.653
we did a whole episode on it.

00:12:30.653 --> 00:12:31.254
So we're not even gonna,

00:12:31.448 --> 00:12:32.828
I'm like, I'm like, what episode?

00:12:32.828 --> 00:12:34.418
Oh, it's literally called that.

00:12:35.078 --> 00:12:35.288
Yeah.

00:12:37.178 --> 00:12:37.869
Do you see my face?

00:12:37.869 --> 00:12:38.798
I'm like, we talked

00:12:38.994 --> 00:12:39.653
Yeah.

00:12:39.653 --> 00:12:40.400
Oh my gosh.

00:12:40.403 --> 00:12:41.663
This is, what are we up to now?

00:12:41.668 --> 00:12:42.953
This is episode 64.

00:12:42.984 --> 00:12:45.413
We've been talking a lot over the last couple years.

00:12:45.923 --> 00:12:47.376
It's almost our anniversary.

00:12:47.427 --> 00:12:50.519
but let's keep going because the next one is personal to me.

00:12:50.701 --> 00:12:51.916
Oh, what is the next one?

00:12:52.224 --> 00:12:53.303
The next one's aspirin.

00:12:53.445 --> 00:12:54.261
Do you remember?

00:12:54.331 --> 00:13:01.107
It was, I believe it was February, 2020 and there was an oncology, naturopathic oncology.

00:13:01.258 --> 00:13:03.357
Oh, here you're going is it's going back in time.

00:13:03.486 --> 00:13:05.460
It's like from Wayne's World.

00:13:08.798 --> 00:13:16.903
yeah, we had the, on K n p, the oncology, you know, naturopathic physician conference right before the world shut down.

00:13:16.962 --> 00:13:23.884
there was a, there was a woman who lectured, she was a scientist I believe, And she talked about, aspirin and breast cancer.

00:13:23.884 --> 00:13:32.182
I was working the, the table for a nonprofit that you and I were working on and I don't know how many of my friends came up to me afterwards and they're like, are you taking aspirin?

00:13:32.309 --> 00:13:33.120
Are you taking aspirin?

00:13:33.322 --> 00:13:39.220
Because for those of you who just tuned in and have not listened to one episode, I'm a breast cancer survivor.

00:13:39.490 --> 00:13:46.210
So, cause I don't mention that enough, but just in case somebody, this is the first episode you've ever listened to, that's what's going on.

00:13:46.480 --> 00:13:46.870
So yeah.

00:13:46.870 --> 00:13:50.080
So I had a lot of people coming up and saying, you need to be taken aspirin.

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And so I did.

00:13:51.129 --> 00:14:00.591
I started to take a baby, baby aspirin daily until I had such bad GI issues that I had to stop cuz it didn't matter how I took it.

00:14:00.591 --> 00:14:04.806
And it just kind of like, my stomach did not like it, but So why Tina?

00:14:04.806 --> 00:14:06.216
Why was I taking aspirin?

00:14:06.972 --> 00:14:07.903
Why did I do that?

00:14:07.903 --> 00:14:09.133
Everyone's telling me it was a good idea.

00:14:09.393 --> 00:14:09.753
oh, you know what?

00:14:09.753 --> 00:14:26.885
I think I had taken it before too, and the GI thing happened and then there was the talk and I started to take it again, but I think I asked, what about taking willow bark, which is what aspirin was derived from, and it's got a lot of that same kind of anti-inflammatory action.

00:14:26.885 --> 00:14:30.273
And then the, I remember the lecturer was like, I'm not sure.

00:14:30.932 --> 00:14:32.102
So anyways, okay.

00:14:32.441 --> 00:14:33.100
aspirin.

00:14:33.341 --> 00:14:33.671
Yeah.

00:14:33.880 --> 00:14:35.668
So, yeah, let's talk about aspirin.

00:14:35.668 --> 00:14:40.587
Can we talk, so willow bark and, and other, you know, poplar buds have the.

00:14:40.772 --> 00:14:44.505
Agent that once upon a time Bear, yes.

00:14:44.505 --> 00:14:56.056
The bear company that we still have today, like 120 years ago, figured out how to extract the natural agent, which is a salicylic acid, and basically tweak it just a little bit and put into a little pill.

00:14:56.086 --> 00:14:57.316
And that's what became bear aspirin.

00:14:57.571 --> 00:15:03.730
So they, they got the medicine from the herbalist because everyone at that time knew that willow bark worked.

00:15:03.916 --> 00:15:10.837
Anyways, little aside, the willow does come with buffers, which is why if you asked that woman at the lecture, she doesn't know about it.

00:15:10.837 --> 00:15:15.008
But willow bark not only has the active ingredient, it has natural occurring buffers that would protect

00:15:15.133 --> 00:15:19.163
Right that, that one I was familiar with and it's an herb, so there might be potential for that.

00:15:19.163 --> 00:15:22.883
It could interact with medications, but aspirin, oh my gosh.

00:15:22.883 --> 00:15:25.253
Look at the interactions for aspirin.

00:15:25.533 --> 00:15:26.043
Yeah.

00:15:26.332 --> 00:15:31.942
And you know, there was, there's some interesting information on, now when we say aspirin, this is baby aspirin.

00:15:32.812 --> 00:15:44.393
So by and large, even when people take it for prevention of the spread of their cancer, and there's some data on baby aspirin help reduce the risk of breast cancer.

00:15:44.393 --> 00:15:44.932
Yes.

00:15:45.232 --> 00:15:48.472
And colorectal cancer, there's quite a bit of information on that one.

00:15:48.893 --> 00:15:51.562
And those two have the most information out there that I know of.

00:15:51.562 --> 00:15:56.828
There might be others when they looked at this, this is observational data as far as I know.

00:15:56.828 --> 00:16:10.548
So they look at population-based studies and a lot of countries like the UK or Sweden, other countries have national registries where they watch or they can see every prescription everyone gets over their lifetime.

00:16:10.548 --> 00:16:14.605
So just so you know, just a baby aspirin, there's no reason to take more than that.

00:16:14.605 --> 00:16:24.052
Cuz when studies show benefit to anyone as a repurposed drug, it's just a baby aspirin in, it's working on keeping the cells from, um, clustering.

00:16:24.263 --> 00:16:30.379
So when someone has a spread of a cancer, the cells break loose and then they cluster together.

00:16:30.379 --> 00:16:33.860
They stick together and make a little micro metastasis.

00:16:33.860 --> 00:16:36.740
We can't see this on any scans or anything like that.

00:16:36.745 --> 00:16:37.460
It's tiny, tiny.

00:16:37.663 --> 00:16:44.755
And it then goes into the limb for the bloodstream and finds its way to those classic organs where metastasis happens.

00:16:44.936 --> 00:16:49.975
So it'll land literally in the liver, the lungs, the bone, whatever.

00:16:50.143 --> 00:16:56.543
So what the playlists do, one of the mechanisms, and there's like eight different ways it can happen, is to keep those cells from from

00:16:56.998 --> 00:16:58.048
from being sticky.

00:16:58.250 --> 00:16:58.700
thank you.

00:16:58.826 --> 00:16:59.996
I couldn't think of a good word.

00:17:00.148 --> 00:17:00.418
Yeah.

00:17:00.418 --> 00:17:00.748
Sticky.

00:17:00.778 --> 00:17:01.317
Uh, the whole time.

00:17:01.317 --> 00:17:03.851
I'm thinking Sticky, sticky, um, yeah.

00:17:03.937 --> 00:17:04.538
Aspirin.

00:17:04.542 --> 00:17:04.928
And, and

00:17:05.173 --> 00:17:07.573
That's cuz you, that's cuz, go ahead.

00:17:08.202 --> 00:17:11.653
I was gonna say, and as I said, it's cuz you, we were just talking about sticky notes and I still couldn't think of

00:17:11.667 --> 00:17:13.077
yeah, it's true.

00:17:13.407 --> 00:17:19.309
No, so, so aspirin in general, like when people take it to prevent, cardiac events, right?

00:17:19.309 --> 00:17:23.210
I mean, people take it to prevent all kinds of cardiovascular type things.

00:17:23.287 --> 00:17:25.652
because it makes your blood, your platelets less sticky.

00:17:25.865 --> 00:17:26.085
Yes.

00:17:26.144 --> 00:17:29.554
And of course it's an anti-inflammatory and we always harp on this.

00:17:29.554 --> 00:17:33.364
Anything that's anti-inflammatory in a general sense can have some benefit.

00:17:33.394 --> 00:17:35.074
So, and there's a few other mechanisms.

00:17:35.074 --> 00:17:40.670
We won't go into all the, nitty-gritty details, but, I have recommended a baby aspirin for a lot of patients.

00:17:40.700 --> 00:17:47.170
And I will sometimes say any effects, whether it's GI effects or easy bruising, take it down, do it every other day.

00:17:47.200 --> 00:17:48.563
Do it three times a Pick your days.

00:17:48.942 --> 00:17:52.865
and I tried doing that too, and it just like, I don't know, I have a, for me, it did not work.

00:17:53.105 --> 00:18:02.095
Um, one of the things I did look up at, the mechanism behind aspirin because it was something that I did take because, you know, everybody was telling me to do it.

00:18:02.099 --> 00:18:03.835
So I'm my own Guinea pig.

00:18:04.238 --> 00:18:16.231
it blocks something known as mTOR, which I thought was really interesting because there is a drug it's, it's chemotherapy that, or there are several chemotherapies that actually block that pathway.

00:18:16.531 --> 00:18:22.892
So I think that, um, that's always really interesting when you look at how these work.

00:18:23.971 --> 00:18:36.179
Sometimes it's, oh, that, I know that pathway, that pathway is, You know, PD-L1 receptors or mTOR pathway, you know, like those kinds of things so, yeah, so, so I mean that's kind of, I think that's interesting.

00:18:36.358 --> 00:18:41.818
Again, we're not saying this because that's like, oh, don't take your drug, take aspirin instead.

00:18:41.818 --> 00:18:48.881
But it's just kind of, I think it's kind of, it's kind of cool that something that people take for pain has all of these other effects.

00:18:49.820 --> 00:18:50.240
Mm-hmm.

00:18:50.555 --> 00:18:57.402
And it's interesting in that, so right now there's a big push to target like that pa, like mTOR.

00:18:57.432 --> 00:18:58.751
Okay, how do I target that?

00:18:58.757 --> 00:19:05.142
And you can look up all sorts of drugs, all sorts of natural agents that have been found to target it.

00:19:06.102 --> 00:19:07.521
A lot of times it doesn't.

00:19:08.201 --> 00:19:10.269
Pan out the way you would expect.

00:19:10.480 --> 00:19:15.880
So for me, when I'm looking at repurposed drugs, I'm looking at results first.

00:19:16.329 --> 00:19:29.210
Are there studies, even observational studies in humans that showed somebody with a a given cancer took a certain drug or combination of, uh, repurposed drugs and had a benefit?

00:19:29.569 --> 00:19:32.900
That's my first and foremost, and that's the strongest information.

00:19:32.998 --> 00:19:37.623
There is a lot of people out there trying to create what they call a metro map, right?

00:19:37.623 --> 00:19:39.799
That book that came out, remember that book?

00:19:40.087 --> 00:19:40.377
Nope.

00:19:43.428 --> 00:19:44.208
No, I don't.

00:19:44.398 --> 00:19:49.409
There's that book by Jane, I think it's McKellen, how to Starve Cancer.

00:19:49.409 --> 00:19:50.519
How to Starve Your Cancer.

00:19:50.804 --> 00:19:52.183
Oh, I think I know that name.

00:19:52.189 --> 00:19:57.518
I think that was in that, um, in that article I just read I think they kind of really like tore her apart.

00:19:57.738 --> 00:19:58.192
Oh sure.

00:19:58.374 --> 00:20:08.127
But cuz in, cuz it seems okay, I've been doing biochemistry since 1990 something, 92, 94, whenever I got my undergraduate degree.

00:20:08.458 --> 00:20:18.661
So it seems logical in our minds to say, okay, if I have these aberrations in my cancer, all I need to do is target those aberrations.

00:20:18.711 --> 00:20:21.681
It seems like if you just target things, it should work, but it doesn't.

00:20:21.861 --> 00:20:23.240
It's not that simple.

00:20:23.387 --> 00:20:31.902
It's just, it's not as simple as saying, oh, if I just target X, Y, and Z with these three agents over here, that should stop the cancer growth.

00:20:32.258 --> 00:20:38.409
It doesn't work that way cuz there's an entire human body immune system factors we don't even know about yet in between.

00:20:38.413 --> 00:20:44.537
So we can't go from target to treatment, it's really not gonna work that well.

00:20:44.567 --> 00:20:54.039
You really wanna go from outcomes pan way back, go 40,000 feet up, say, okay, get my given cancer, breast cancer, colon cancer, prostate cancer, whatever.

00:20:54.400 --> 00:20:59.890
What in the repurposed drug world has some data in humans to show that it's potentially useful.

00:21:00.181 --> 00:21:03.807
And you go from there and you look at the data and then you look at the strength of the data.

00:21:03.837 --> 00:21:09.130
Then you look at your own case, pros and cons, what's going on with you personally.

00:21:09.400 --> 00:21:14.019
And it's always a risk benefit analysis, but I think it's dangerous to go from mechanism.

00:21:14.380 --> 00:21:21.285
All the way inside the cell down to that gene, you know, some screwed up gene inside the cell and goes all the way to treatment.

00:21:21.411 --> 00:21:26.445
Nine, I didn't even know, it's probably 99 times out of a hundred, maybe even 999 times out of a thousand.

00:21:26.564 --> 00:21:27.542
It doesn't pan out.

00:21:27.575 --> 00:21:29.702
And that's, that is, that is drug discovery.

00:21:29.732 --> 00:21:31.143
We just defined drug discovery.

00:21:31.292 --> 00:21:34.323
They pick a target, they take an agent, they're like, oh, that should work.

00:21:34.532 --> 00:21:38.992
You know, it worked in test tube and then they take it to an animal model and then finally to humans.

00:21:39.022 --> 00:21:41.747
But most drugs fail along the way, the vast majority.

00:21:41.949 --> 00:21:49.719
So it's kind of hubris to think that, oh, we can go look at this little pathway and say, oh, well berberine targets that pathway.

00:21:49.778 --> 00:21:51.638
We should be good taking berberine.

00:21:51.888 --> 00:21:52.969
I wish it was that simple.

00:21:53.148 --> 00:21:55.578
If it was, it would be a lot easier to treat cancer.

00:21:55.818 --> 00:22:01.548
So if you're doing research on repurposed drugs, look at human data outcome data, clinical trial data.

00:22:01.548 --> 00:22:06.042
Actually there is a, an entity that tracks this called the anti-cancer fund.

00:22:06.242 --> 00:22:08.012
Anti-cancer fund.org.

00:22:08.883 --> 00:22:16.588
They're tracking all the clinical data and in a, what is a gigantic Excel type file, so you can look at your cancer or you can look at a given drug.

00:22:16.588 --> 00:22:18.509
I think they have over 300 drugs on there right now.

00:22:18.661 --> 00:22:32.973
And just for to reiterate, like you were saying, just because something works in a lab, in a test tube or Petri dish or whatever it is that they're looking at, they're taking a specific part of a cancer, a cancer cell, whatever they're looking at.

00:22:33.067 --> 00:22:37.084
And they don't have the complexity of a human being around it.

00:22:37.184 --> 00:22:37.815
Exactly.

00:22:37.859 --> 00:22:49.834
And so that's why when you read articles and they're like, oh, this agent kills cancer in a lab, and then people start taking it, it's the whole like alkaline environment thing, right?

00:22:49.834 --> 00:22:54.364
cancer thrives in an acidic environment, you know, you're just taking it out of context.

00:22:54.753 --> 00:22:57.913
You're taking like a word out of a novel,

00:22:58.038 --> 00:22:58.429
Right.

00:22:58.624 --> 00:23:00.273
you know, and trying to explain a story.

00:23:00.513 --> 00:23:02.433
So that's a really good analogy.

00:23:03.153 --> 00:23:09.286
Anyways, I just, I just ha, I just always wanna like, like clarify that a lot of things kill cancer in a lab.

00:23:09.884 --> 00:23:15.490
And unless you're looking at human data, then it's really, I mean, even mice, it's different, but yeah, you gotta look at, you gotta look at human data.

00:23:15.625 --> 00:23:15.955
Yeah.

00:23:16.135 --> 00:23:16.375
Yeah.

00:23:16.381 --> 00:23:19.375
And I know people are gonna wanna research this stuff, and that's fine.

00:23:19.375 --> 00:23:24.296
I think it's a good idea because I can tell you now, conventional doctors are not gonna bring it to the table.

00:23:24.455 --> 00:23:30.375
There just very few conventional doctors will ever bring up a repurposed drug or even condone it.

00:23:30.425 --> 00:23:35.826
unless you have, for example, high blood pressure and you're like, can I do this high blood pressure drug?

00:23:36.155 --> 00:23:39.303
Because you've got high blood pressure, you need a prescription for it.

00:23:39.603 --> 00:23:43.756
You may as well do something that could be beneficial in preventing recurrence at the same time.

00:23:43.816 --> 00:23:44.685
Like that kind of thing.

00:23:44.685 --> 00:23:48.762
You could probably get them to, you know, talk them into with some, you know, persuasion.

00:23:48.843 --> 00:23:52.833
But if you just said, oh, I wanna take this metformin, they're gonna be like, you're not diabetic.

00:23:52.837 --> 00:23:53.913
Why would you take metformin?

00:23:54.148 --> 00:23:57.424
That's not gonna probably fly with most oncology doctors.

00:23:57.830 --> 00:24:02.988
Okay, so let's take a break and when we come back, you mentioned, um, like a beta blocker.

00:24:02.988 --> 00:24:04.258
I think you mentioned what.

00:24:05.290 --> 00:24:06.520
What did I talk about?

00:24:06.641 --> 00:24:06.941
Oh,

00:24:07.327 --> 00:24:07.837
hypertension.

00:24:07.867 --> 00:24:08.077
Yeah.

00:24:08.077 --> 00:24:11.057
You talked about um, drugs for hypertension, high blood pressure.

00:24:11.057 --> 00:24:14.284
So we're gonna come back and talk about more repurposed drugs.

00:24:21.326 --> 00:24:29.253
Tina, you had talked about anti-hypertensive that, Are repurposed in an oncology setting.

00:24:29.375 --> 00:24:41.615
And this is something I also have a personal experience with, not for that reason, but my oncologist had prescribed me metoprolol, which is a beta blocker, which kind of slows the heart rate.

00:24:41.615 --> 00:24:46.593
It's used for, you know, different cardiovascular conditions, AFib, those kinds of things.

00:24:46.657 --> 00:24:56.150
but he prescribed it to reduce the risk of the potential cardiovascular risks that can come along with adriamycin slash doxorubicin, you know, that is known for,

00:24:56.189 --> 00:24:56.836
Heart toxicity.

00:24:57.208 --> 00:25:00.315
So that, that's a good example of an off-label use of a drug.

00:25:00.348 --> 00:25:02.929
So these terms all blend together a little bit.

00:25:02.991 --> 00:25:12.592
he wasn't repurposing for the cancer, and it's probably not an approved use to say, oh, beta blockers are an approved drug for preventing cardiovascular toxicity from this chemo.

00:25:12.711 --> 00:25:14.061
That's not really F D a.

00:25:14.061 --> 00:25:15.471
Never sanctioned that.

00:25:15.719 --> 00:25:18.838
and the off-label use of drugs is super duper common.

00:25:19.618 --> 00:25:20.429
Really common.

00:25:20.548 --> 00:25:27.989
All the time like, like a lot of drugs are used off label, meaning they're being prescribed for something other than their FDA approved use.

00:25:28.348 --> 00:25:38.162
Well, yeah, so, so beta blockers, I remember learning this in school, in pharmacology, that people will take a beta blocker before they go out on stage or like have to make a speech.

00:25:38.162 --> 00:25:43.398
Like people who have super high anxiety have been known to take beta blockers it kind of chills'em out.

00:25:43.403 --> 00:25:44.719
It helps to regulate their heart rate.

00:25:44.828 --> 00:25:45.128
Yeah.

00:25:45.128 --> 00:25:52.239
I think what the beta blocker does is make it impossible to have a sympathetic nervous reaction to have that adrenaline rush.

00:25:52.778 --> 00:26:01.644
I was talking to somebody who was put on a beta blocker and they do these incredibly difficult, not even double diamond skiing, but like off the beaten path, over the rocks.

00:26:01.644 --> 00:26:02.545
Crazy skiing.

00:26:02.862 --> 00:26:07.932
And normally when you sit on the precipice of that and you're looking down, you're about to like launch.

00:26:08.201 --> 00:26:09.821
He said, everyone's like, you go.

00:26:09.826 --> 00:26:10.122
You go.

00:26:10.126 --> 00:26:11.652
You like it's, it's super scary.

00:26:11.652 --> 00:26:13.683
You're looking straight down, took a beta blocker.

00:26:13.790 --> 00:26:14.404
Looked straight down.

00:26:14.404 --> 00:26:15.694
I was like, nothing.

00:26:15.845 --> 00:26:16.595
He's like, I'll go first.

00:26:17.450 --> 00:26:25.819
Yeah, but at least in, okay, so I don't know about skiing, but I know in theater you need a little bit of anxiety If you know you, you need that.

00:26:25.819 --> 00:26:29.690
Otherwise, you know you're gonna like throw yourself down a mountain that maybe you shouldn't have.

00:26:30.019 --> 00:26:35.569
So, so, so, so, but maybe not in the oncology setting.

00:26:35.599 --> 00:26:39.845
I mean it so, And there are side effects of taking this.

00:26:39.845 --> 00:26:47.063
I know people who have taken, um, beta blockers and they do have, you know, different side effects of their blood pressure going too low.

00:26:47.063 --> 00:26:50.268
And, you know, these are all things that you need to, to, consider.

00:26:50.897 --> 00:26:56.028
And they were prescribed it for whatever reason and they were on it and they're like, Ugh, my blood pressure drops too low.

00:26:56.028 --> 00:27:03.468
But, um, and all of these things that we're talking about have interactions and side effects, and that's why it's not something that is to be taken

00:27:03.749 --> 00:27:04.929
Willie Nelly.

00:27:07.548 --> 00:27:25.159
So, On this point of beta blockers, before we move on, there is certain, cancers, ovarian cancer subtypes come to mind, have receptors on them that cause anxiety and really a high stress level to promote the growth of those cancers.

00:27:25.519 --> 00:27:40.128
And so I think of o ovarian as one of those that I would look at these beta blockers and somebody who's highly anxious especially if they're taking something else for their hypertension, I would say, well, let's talk to your cardiologist about changing that over to a beta blocker and getting a couple benefits from it.

00:27:40.429 --> 00:27:46.830
The earliest studies that I can remember were done on lung cancers, and they found that people who were taking beta blockers were having better outcomes.

00:27:47.131 --> 00:28:03.509
And so a lot of times were tipped off by these observations or retrospectives where they do a chart review retrospective at a, particular hospital, cuz some astute clinician, medical oncologist notices, huh, how can I have this particular subset of patients who are doing better and they'll do a chart review.

00:28:03.762 --> 00:28:07.692
Um, doesn't happen so much anymore, but that's how, that's the old fashioned way of figuring it out.

00:28:07.928 --> 00:28:09.958
Well, now everybody collects data, right?

00:28:09.958 --> 00:28:10.528
I mean, I was having.

00:28:10.617 --> 00:28:20.827
Conversation with some people last night about how to access this data from patients' charts to, you know, to do things like that for, chart reviews or for outcomes or whatever.

00:28:21.323 --> 00:28:21.613
Yeah.

00:28:21.617 --> 00:28:24.923
And this is where I will say socialized medicine where.

00:28:25.282 --> 00:28:34.502
A single entity, like the entire country is tracked on a registry, does help with data collection, but data is only as good as it goes in, right?

00:28:34.502 --> 00:28:45.031
Somebody's inputting the data, so it all starts with data input and for whatever reason, I would say the majority of charts that I look at, if the patient reads their own chart, they're like, well, that's not true.

00:28:45.041 --> 00:28:46.142