Cannabinoids and Cancer:

a hot topic often surrounded by controversies.

As a prelude to the release of the third episode of the Beating Brain Cancer podcast I have decided to share my recent interview with Dr. Wai Liu, discussing his research into using novel agents to combat a number of difficult to treat cancers.

 

Dr. Liu is a senior Research Fellow at St. George's University Hospital. His work focuses on developing novel approaches against cancer.

His research focii includes, but is not limited to:

 

  • Investigating the immune-modifying effects of chemotherapy

  • In depth study of cannabinoids and their potential anti-cancer properties

  • The anticancer effects of naltrexone

Dr. Wai Liu

Amongst the main aims of Dr. Liu’s work is the development of new treatment strategies using pre-existing drugs that exploit unique combination regimens. As you listen to future episodes of the Beating Brain cancer podcast you will see that this subject is highlighted as a recurring theme, consistent with an idea of a multi agent approach to manage the disease, targeting multiple signaling pathways.

 

Dr. Liu is particularly interested in how drugs alter immune responses. We discussed how this relates to his work using low dose naltrexone and cannabinoids.

 

I hope the listeners will find the interview informative. Please find notes below. I have provided hyperlinks of main topics discussed in the interview (with timings) so that they are easy to find.

The audio recording of this interview is available here: 

Interview highlights and related subjects of interest:

Cannabinoids and the Warburg Effect

Cannabinoids and the Warburg Effect

Cannabinoids and the ketogenic diet

 

Cannabinoids and radiation

Cannabinoids and radiation

Complete remission- pancreatic cancer case study

Pancreatic cancer case study example

Pancreatic cancer case study

Transcript of interview:

 

Andrew:

 

Welcome Dr. Liu, its a pleasure to discuss your research here today at St. George’s. We have a captive audience for this one I’m sure. Would you be able to provide our listeners with a brief introduction please and a brief summary of your work?

 

Dr. Liu

 

Yes certainly. My name is Wai Liu, I work at St. George’s University of London and I am currently a Senior Research Fellow.

 

 

Andrew:

 

What projects are you currently working on and where do your biggest challenges lie moving forward in your research?

 

 

Dr. Liu:

 

Ok, so the type of research that I do at St. George’s really falls into two groups and I suppose one is to find ways we can use pre-existing chemotherapies and other molecules that can be used in cancer patients. We are trying to find better ways of using these drugs and these can involve different schedules, different regimens, or essentially just different ways you can use those in combination with each other.

 

and I suppose the second part of the work that we do is to develop new drugs that can modify the immune system as a way of tackling certain diseases, and the two compounds that I’m working on currently are predominantly cannabinoids CBD and THCs as well as a product known as low dose naltrexone (LDN).

 

In regards to the question about biggest challenges moving forward… it is really convincing others that your methodologies are sound, convincing others that your ideas will make sense and have a clinical impact, and really gain financial support to really prove and to test the concept and hypotheses that you have.

 

 

Andrew:

 

So, you mentioned financial support… how big of a challenge would you say that is and is it the financial support that is the main challenge or is it other people’s opinions on that research?

 

 

Dr. Liu:

 

It is, yes. I don’t know any scientist who wouldn’t ask for more money. I’m one of those people who would say that the more money have or the more money you have access to, the better models you can produce. In some situations you may have to make a decision based upon cost. You can’t use one model over another because it will cost you ‘x’ amount or…

 

Is it a challenge? It is a challenge but it is a challenge that can be overcome because all you do is that you adapt the way that you test certain things. There’s many ways you can skin a cat I suppose and so even though its a challenge, its something that you are conscious of but its not there from preventing the work that you need to do.

 

 

Andrew:

 

In terms of your research in general, what do you see as your most promising agents that you are studying? You mentioned cannabinoids and low dose naltrexone. In terms of these promising agents what do you see for the future and what are the main challenges (again!) that you are encountering with them specifically. We know that treatment with cannabinoids is a controversial area for many reasons. Would you be able to talk around that a bit?

 

 

Dr. Liu:

 

Absolutely, so coming on to the cannabinoids that you mentioned Andrew… you are absolutely right there is a definite stigma attached to cannabinoids and everyone is aware of the psychoactive components of the drugs and I suppose that overwhelms any of the good that people see with cannabinoids. In laboratory studies, and also in animal studies its clear to a number of scientists that it can target cancer cells. certain pathways which cancer cells rely upon for their growth are actively targeted by cannabinoids so based upon that you would say its worth investigating, but the problem is, its cannabis, so you can’t investigate it so that kind of stifles and slows things right down so if I were… and I’ve used this analogy before, if someone had turned around and said to me I’ve discovered a brand new compound and we’ll call it ‘Andrew’s Oil’ for the sake of argument and no one mentioned cannabis at all, people would start to throw money at it, but because you mentioned cannabis we tend to step back a bit. Rightly. Or wrongly. But people will step back and if we can overcome that stigma I think it would help.

 

 

Andrew:

 

Yes, so the cannabinoids that you are looking at... just for people who don’t know much about cannabis oil, the simple way of explaining for what patients may be trying. Rightly or wrongly, again. Just what cannabinoids are you looking at and what are their applications?- What they are and what are their applications

 

 

Dr. Liu: 

 

Ok, so what we’re talking about is a class of compounds that have been derived from plants and so for that reason they are usually referred to as the phyto cannabinoids and that distinguishes them from the other components that are found naturally in your body. 

 

So what the cannabis plant is, is a product, its a substance that self contains many chemicals. These chemicals are known as cannabinoids and these cannabinoids have been shown in the past to interact with certain signalling pathways inside the human body, the endocannabinoid system.

 

So what we have, through evolution, is a series of communication networks inside your body and its main role is to direct communications from point A in the brain, for the sake of example, to point B in your fingertips. and so these so called communication networks have been set up through evolution. And some of these components, some of these communication networks, have parts to it which are made up of the endocannabinoid system and these are precise components that cannabinoids can target so we’ve shown that these cannabinoids derived from plants are capable of mimicking these endocannabinoids which are naturally found inside the body and turn on and turn off certain functions inside the body, which might be useful for certain diseases.

 

 

Andrew:

 

Lots of patients get very enthusiastic about cannabinoids for brain cancer in particular. I was just wondering how you could clear up some of the myths that may be out there surrounding treatment with these cannabinoids, what ratios you are using of the THC and CBD and just communicating to people who might be listening who are maybe patients, are perhaps getting overly enthusiastic about the benefits saying, you know, on its own its this fantastic cure and not maybe understanding the whole story about it so clearing up any confusion there might be.

 

So talking about the benefits but also the possible disadvantages as well, for example with some cancers some may say that in some situations it may not be effective as an isolated thing and for some cancers it appears to actually cause more cancer proliferation. More proliferation of those cells. Would you be able to have any ideas on that?

 

 

Dr. Liu:

 

Yes, that’s a very good question Andrew and again I would like to thank you for the opportunity to clarify this because there are lots of unknowns and myths surrounding the use of cannabis oil, and especially when cancer patients search the internet for more information about possible treatments for their cancer. They are completely open to all forms of treatment and cannabis oil tends to jump out at you because its cannabis after all and so the opportunity to clear this up is, I think, very very positive and useful.

 

If we look at a cancer cell and we simply look at the way a cancer cell grows and proliferates inside the human body, it requires certain elements to be activated and if we call these the ‘cancer causing systems’, what we’ve shown, or what scientists have shown, in the laboratory as well as in animal studies is that these cancer causing systems can be acted upon by certain cannabinoids.

 

THC is known to bind to certain receptors as well as entering the cell. And causing those cancer cell systems to change ever so slightly. What is the result of these changes Andrew? What can happen is that these cancer cells can undergo cell death. And if that is something you want to see inside a patient, then THC will do that.

 

The other component of cannabis that people talk about quite a bit, Cannabidiol (CBD), also does a similar thing, but it works on different cancer systems.

 

I mentioned that through evolution the body develops these communication networks, and its not just one network, its not just one Virgin Broadband, its BT, Virgin, Sky, its all these different types of networks that need to be impacted upon and it just so happens that THC hits one, and CBD hits another, and in concert you can actually get an effect that you want to see in cancer patients, especially with cancer cells inside the laboratory so that’s fact and that’s what we see inside a petri dish but to then extrapolate that into a patient becomes incredibly difficult because a human body is much more complicated than a few cells stuck down on a petri dish. And its somehow managing what we expect to see inside a petri dish into a patient which causes the anxiety and in some patients there is no doubt that there are some responses when these patients take cannabis oil… but is it down to the cannabis oil? Or is it down to the treatments that they normally take in combination with them? I don’t know. And unless we do more research we are never going to know and we are always going to fill the internet with these examples of fantastic results which I don’t doubt at all, and I have testimony from many many people, who’ve taken cannabis and swear by their uses but I can’t say with sureity, with any certainty, that its caused by the cannabis.

 

I think cannabis has an effect, cannabis has a role to play, but I don’t know what it is right now and the frustrating thing is, incredibly frustrating for me, is I haven’t been given the opportunity to do that for whatever reason through funding, through management. We can’t test that concept yet… but I sense there is a sea change. I sense that people are now recognising that cannabis does have an anti cancer effect, especially in isolation in petri dishes so we now need to drive forward into patients. And people are now starting to see that as being important.

 

 

Andrew:

 

Yes, and I guess that’s encouraging for the future.

 

 

Dr. Liu:

 

Very much so. And its because the more people that are pursuaded that cannabis has a role to play will start to change the way that it is viewed. It won’t be cannabis, the drug that you take in a nightclub or I don’t know where you’d take it. It will be cannabinoids, the drug that can be used to sensitise cancer cells to other treatments because one thing that people tend to overlook is cannabinoids as a chemical has a mode of action to target cancer cells directly, and that can cause that cancer cell to undergo its own destruction.

 

But what it can also do, because it interferes with these signalling pathways, it can actually sensitise, it can actually prime a cancer cell to other treatment and our recent work from 2 or 3 years ago actually shows that if you were to treat a mouse that had brain cancer with cannabinoids you could induce a small amount of cell death, nothing spectacular, but you could nevertheless induce cell death.

 

What was most exciting is that these mice that have been pre-treated with cannabinoids suddenly developed this strong sensitivity to irradiation. These mice would then respond much better to irradiation compared to if no cannabinoids were given. So that’s how I see cannabinoids used as a single agent to target cancer cells directly, and also in combination with other treatment modalities to improve treatment as a whole.

 

 

Andrew:

 

You mentioned CBD (cannabidiol), as the non psychoactive compound that seems to work on a number of signalling pathways along with the THC (tetrahydrocannabidiol). With CBD being legal, what benefits on its own, for example I’m thinking quality of life and benefits for brain cancer patients with epilepsy. How does this work and how could patients benefit from this, providing its legal, making it easier to discuss these things I suppose.

 

 

Dr. Liu:

 

Absolutely, the CBD is non psychoactive or has very, very little if any psycho-activitiy and for that reason it is completely legal to use. The good thing, if that’s the right phrase, about CBD is that it targets these signaling pathways that can drive cancer growth or at least support these cancers to proliferate. So if we were to use CBD in that regard in some situations, if the cancer type is of the right profile you can actually induce some level of cell killing.

 

And for other diseases, for other conditions such as epilepsy, CBD has recently been shown to be quite effective. With a certain type of epilepsy but this surely just reassures people that there is something to be looked into much more deeply if it can have an effect in some forms of childhood epilepsy.

 

There’s no doubt there are other conditions which would be quite responsive to CBD therapy and because its not psycho-active this will allow people to use it without fear. It always concerns me when a person who is worried because they have some forms of cancer and they feel they have lost control and they can’t control their own destiny and they can’t decide their own fate. The last thing they want is more worry and angst when they’ve decided in their own mind that they wanted to take one form of therapy that’s now not open to them because of other things which they shouldn’t need to worry about.

 

That’s something that always disappoints me but with something like CBD that hurdle is already cleared and if it works for them, and when nothing else works I don’t see fundamentally an issue with that. Of course there are other considerations but fundamentally there are issues that don’t need to be there.

 

 

Andrew:

 

Speaking of CBD again, would there be any possible interactions positively or negatively with the standard of care? I’m thinking of during radiotherapy. Would having CBD help to sensitise the tumour to radiotherapy more (in the human model) and how would that show itself?

 

 

Dr. Liu:

 

Again that’s a really good question because one thing that is important to consider is interactions of these drugs such as CBD with the standard treatment modality because the last thing you want to do is to antagonise or to counteract anything else that you are taking in concert with the treatments.

 

There are lots of studies to show that CBD can be used in combination with certain anti-leukaemic agents, favourably, but the flipside of the coin is that you can also antagonise so it really is a case depending on whether or not the particular profile and the particular type of cancer that the patient has, would it be susceptible to a reaction that is negative or positive so I suppose the take home message is that no one really knows, and that would be the honest answer so I’m not advocating the use of CBD with other treatments unless its been studied or at least spoken about with clinicians but on paper in laboratory based studies there are instances where you can get positive results if you were to combine certain things and I’ve already mentioned the benefits of combined CBD/other cannabinoids with irradiation in mouse models but I’ve also seen situations where you can also see a loss of an effect with a drug because CBD has interacted or interfered with that treatment so it is very difficult to know what the best combinations are and that’s precisely the reason why we need to do more studies.

 

 

Andrew:

 

Interesting question for you… are there other ways of activating the endocannabinoid system? For example I hear people talking about echinacea, and also even about dark chocolate in the form of 100% cacao and I’ve heard of athletes when they get a ‘runner’s high’, supposedly this is activating certain cannabinoid receptors. What’s you’re opinion on this?

 

 

Dr. Liu:

 

Yes, well I suppose this all stems back to the endocannabinoid system and again, in my simple interpretation of what it is, is these communication networks and as the human evolved through many millions of years these communication systems were laid down, and the building blocks of these communication systems and these communication networks, are varied. And they can differ from system to system, from network system to communication system throughout your body, so if one of them happens to be throughout the ilk of enconnabinoid, then anything which can act upon that can actually induce that ‘high’ or induce an effect that you want.

 

So you mentioned all these natural botanicals… I’m a firm believer that if you have a botanical chemical, a compound which is of the right shape and the right structure which can interact, like a lock and key, if you can get something like dark chocolate, I’m not too sure what the chemical of dark chocolate is, but if we were to call it ‘DC’ for the sake of argument, if ‘DC’ were to bind nicely as a key would fit a lock inside the endocannabinoid system you could activate it or inactivate it and the consequence would be something you desire so I strongly believe there are botanicals out there that are useful for you, there is presence for it.

 

We know about aspirin, that’s from a plant, we know about etoposide and that’s from a plant and that’s a drug that’s been used for 20, 30 years to treat certain forms of leukaemia. We’re taught that anti-malarials, there’s something called artesunate which comes from a plant which works fantastically and its used for malaria but its also has an anti cancer effect. Hang on, how did that come about? But because its biological in that regard, botanical in that respect, there are situations where it can bind to certain proteins inside the body, and so I have no doubt that there are many things out there that may be useful to fight certain diseases, its just locating the right ones, purifying them out so we have a pure form of that substance, and use it to our advantage to treat certain diseases and I believe that profoundly.

 

 

Andrew:

 

Many people anecdotally say that they get better sleep with CBD. How does this interact with melatonin production, keeping in mind that melatonin itself, produced by the pineal gland, has potent anti-cancer benefits on its own?

 

 

Dr. Liu:

 

Yes, quite a few patients report they have much deeper and better sleeps when they have CBD and a number of these patients can have epilepsy but if we separate them out first of all to epilepsy patients who take CBD they tend to sleep much better, it is because they are fitting less, therefore they will naturally have better sleeps, and so if we were to then turn to a patient who takes CBD not for epilepsy but for other reasons, they tend to have better sleeps because the setting inside them with regards to the endocannabinoid system is to one of sleep. And so that is why they tend to sleep better.

 

How does that interact with the release of melatonin? Yes, that’s right, melatonin does have anti-cancer activity, or purports to have anti-cancer activity. I think its an antioxidant of some kind am I right?

 

Andrew:

 

Yes, its a very potent antioxidant.

 

 

Dr. Liu:

 

Yes, a potent antioxidant, so in that regard if you have a compound that acts as an antioxidant, you can actually fight certain cancers. How does that interfere?

 

Well, if its true that you can only release melatonin when you’re asleep or awake and CBD interferes with that... you’re going to have a situation where they antagonise one another or support one another. I do see there being an interaction, I just don’t know whether or not its going to be that much of an issue because the amount, the change in sleeping patterns may not be as disruptive as it would be if it wasn’t used and that’s the reason why I think there may be an effect, but not significant enough so that one could say, you know what, I shouldn’t be doing that.

 

 

Andrew:

 

Do you know if there are any beneficial interactions with the Warburg effect? I am thinking of patients in particular who might want to combine the ketogenic diet with cannabinoids? Whether its CBD or other compounds. Let’s say CBD because its perhaps the easiest to talk about without problems. Are there any benefits to combining those two ideas?

 

 

Dr. Liu: - Cannabinoids and the Warburg effect

 

The Warburg effect and results to energy metabolism is a particular area by which people researching CBD and other cannabinoids are looking into and there’s lots of data to suggest there is a link between CBD use and the manipulation of energy metabolism, so its difficult for me to say any more unfortunately because this is unfortunately for me, an area which is a little bit hush hush because it really is something that cannabinoid researchers are actively pushing at the moment because there is so much data to suggest that there interaction between those two elements, but suffice to say that energy metabolism and the control of that and alterations of such is very, very useful in regard to a large number of disease types and the way that CBD can interact with the Warburg concept, or the way things are moving, is incredibly promising Andrew.

 

I’m in contact with a number of people who are actively looking into this and have set up quite a few symposia to explore this in greater detail and Andrew all I’ll say is people are convinced it does work and all I can say really is watch this space, that’s how positive it is at the moment.

 

 

Andrew:

 

That’s great. You mentioned other cannabinoids. Are you studying these as well or is it purely focused on CBD and THC. I know you’ll probably get lots of people who will say, ‘Oh, well if you’re no using the actual drug (the pro drug) you’re not having all the benefits of all these different cannabinoids when you’re just looking at a few in isolation (active compounds).’ What is your opinion on this? - pro drug (whole plant), versus purified forms (isolation of active ingredients.

 

 

Dr. Liu:

 

Yes, you are absolutely right. I get lots of emails that say the entourage effect, the whole concept that the cannabis plant itself is the way that nature intends to it and you have these 80-100 different cannabinoids that need to interact with each other to get the overall benefit. And I don’t dispute that at all and I’m not going to argue with that at all because I would be in quite a weak position to because they are absolutely right. There is something to be said about a whole plant product vs the purified forms but I’m not here to fight the corner of pure vs the botanical drug substance, what I’m more interested in is to prove the concept that certain cannabinoids, be it THC and CBD, has anticancer activity and if I can show that THC and CBD do and can convince others that is the case, I feel that step forward is much more important than saying we should be using cannabis as the whole plant because that would open the doors up to people who want to legalise cannabis for other reasons and its not an argument that I want to get in to.

 

What I am here for is to try to determine the best way of using these chemicals in patients who have cancer and other diseases and if others want to use that as a platform to legalise cannabis then that’s they’re prerogative but that certainly isn’t mine at all. The last thing I want is for people in power, people who can make the decisions, to prevent research into cannabis as a medicine because the people who shout for cannabis as a recreational drug to be legalised has destroyed that argument. I suppose its a selfish position on both parts and me wanting there to be not a loss of investigations of this compound as a medicine, whilst others want to legalise it so that’s an argument that I think other people can have but I’m just here to prove the concept that these drugs do work and let’s take it from there.

 

I think I’ve used this example in the past, and I think its aspirin, is from white willow, and no one would ever now dare suggest you chew on a white willow plant if you have a headache, no one would suggest that at all, but everyone would rather use that pill that contains the purified form. To me, you have a concentrated form of the drug that you know is pure.

 

 

Andrew:

 

Yes, the active ingredient.

 

 

Dr. Liu:

 

You’re absolutely right Andrew. The active ingredient. So why would people then turn around and say you’ve got to chew on cannabis or take cannabis when we can possibly get the active component and make it a much better drug.

 

To me that is sensible. Is it right? I don’t know. I’m not here to say. But what I’m saying I think is a sensible way forward in this moment in time.

 

There may be other studies that show that you do need different ratios and combinations of all these other minor cannabinoids and when that day comes, fair enough, but we haven’t even convinced others that cannabinoids alone are active and we’re arguing about whether we should combine everything else with each other. We’re trying to run before we can walk and when that happens you spoil the whole thing for everyone.

 

 

Andrew:

 

Yes, and you are getting results with the active compounds, so that is proof in the pudding I guess, so you don’t necessarily need to consider other things at the moment.

 

 

Dr. Liu:

 

That’s a very good point. We’ve got a hit with one thing, so we could either A, spend time looking at and digesting every single component out there or B, focussing all our energies on working on one that works.

 

 

Andrew:

 

Yes. It would take many, many years to look at all of the cannabinoids.

 

 

Dr. Liu 

 

Exactly. And one other thing you need to consider as well is these other cannabinoids, a large proportion of those, when they get into the body, they are processed and broken down to give you exactly the same thing that you wanted from THC or CBD in the first place.

 

So you are trying to reach the same end point from taking minor cannabinoids so I think there are other things that could be done first before we explore the minor ones, but that’s not to say that we shouldn’t at the end of this journey.

 

 

Andrew:

 

Yes, and one kind of outside point from all of this research, which is obviously very important… we recently had the Brexit vote. Has the result of this, leaving the EU in 2020, has that had any effect on your research and if not, will it have any effect moving forward? - impact of Brexit on research

 

 

Dr. Liu

 

Brexit will always have an impact on people in the UK as well as the world but for one person Brexit can be a fantastic thing and for another person it can be the worst thing in the world so all I can do is give you a perspective from my position and the work that I do is reliant upon charity money, charity donations, as well as from a company. And I don’t hold many grants from the EU and for that reason I am slightly protected, shielded from impacts that other colleagues may experience so from a personal point of view it hasn’t been a big deal. That’s not to say it won’t change in the future.

 

The work that I do is supported by funds that where there are relatively less waves in the ocean. The money still comes, allowing us to do our work. One thing I would say is despite all of the doom and gloom of the people who have said that Brexit will cause anxiety and be a catastrophe, the work still progresses at a good pace and we are still getting some good results and some good publications out there and so far it hasn’t been too bad Andrew.

 

 

Andrew:

 

Great, good to hear. You mentioned the charities that you get funding from. There’s always with these patients as well, you always get this type of conspiracy about charities not putting any money into research into these kinds of areas.

 

 

Dr. Liu:

 

Yes.

 

 

Andrew:

 

Could you just explain about what charities are funding this kind of research and how that comes about, how that happens, the research process?

 

 

Dr. Liu:

 

There’s a number of projects that I run at St. Georges and the ones that charities tend to fund are not the ones such as the cannabinoids or the LDNs because they are more to do with drug companies, so when it comes to the ‘blue sky research’ where charity money is most helpful, where charity money is prepared to take a little bit more of a punt, this is where researchers can make their great discoveries and so I’m also supported by the Ralph Bates Pancreatic Cancer Research Fund, who fund research here. We’re looking into different ways we can improve treatment for pancreatic cancer.

 

This relatively small charity, because its a small charity compared to the likes of CRUK and the like, they can be much more flexible, have much lower overheads, so money can be diverted straight into what is required and that’s what I like.

 

Where I suppose the kid gives money because they’re parent has cancer, they want that power to go to the best place possible and these small independent charities are the best ones to use I find anyway, and so other charities that support our lab, the Cancer Vaccine Institute which has recently changed its title, it has now supplied us by providing us with the funds to research cancer vaccines, new immunotherapies, the new dawn of cancer treatments and these relatively small charities allow us to do this and allows us the freedom to do what we think is right.

 

To follow science the way that the evidence takes us rather than having an agenda where you have to do this, you have to do that. Its something that really gets my goat, especially when we talk about larger charities so that’s the reason why I’m very pleased to be associated with these two charities.

 

 

Andrew:

 

You mentioned pancreatic cancer. We spoke earlier about a case study involving a patient with pancreatic cancer who ended up using cannabinoids and a number of, its important to mention combination treatments as well I guess… and she ended up living for 4 years which for pancreatic cancer is pretty phenomenal because the prognosis is so poor and its actually one of the more common cancers as well, considering it gets very little funding, next to no funding in fact.

 

 

Dr. Liu:

 

Absolutely.

 

 

Andrew:

 

Would you be able to talk again about this specific case study? - Case study patient- 4 year survival, pancreatic cancer

 

 

Dr. Liu:

 

Absolutely so this was a patient of Professor Angus Dalglish’s here at St. George’s Hospital. This patient presented to him with pancreatic cancer and who seemed to be failing other treatments.

 

She was on the standard treatment of Gemcitabine and it got to a certain stage where the treatment wasn’t working as well as it should be working, so professor Dalglish has a fantastic brain and he can absorb lots of information and he realised that by using combinations with different types of treatments there was a possibility you could improve overactivity so he used a combination of micobacterium, vitamin D and other treatments, which in the laboratory have been shown to interact positively with each other and he took this into this patient and almost immediately there were responses in certain biomarkers that suggested this novel treatment was having an effect. It was so active in fact, that this person could start working again and she lived for a further 4 years.

 

The interesting thing Andrew is that as soon as this medicine was altered to return back to the standard of care, all the blood markers and the blood work would start to go in the opposite direction, and the only way to maintain this disease free state was to have these drugs in unison in a chronic kind of administration and unfortunately the lady passed and the reason had nothing to do with the principle or primary cancer.

 

She died from another reason and when she was studied in depth it was discovered there was no cancer in her body at all. So this opened up the idea that what Professor Dalglish and I believe and that is the possibility that cancer patients will die with cancer rather than by dying of cancer and that’s something we’re pretty excited about and we’ve been able to, by using some science performed in the laboratory to predict best treatments for a particular patient.

 

So in the case of this cancer patient who had pancreatic cancer, and as you rightly said the prognosis is dreadful, we could extend life to 4 years, which is quite staggering and its something we’re very keen to explore further and its all to do with combinations of the right drugs at the right time.

 

 

Andrew:

 

Yes, that is the important message I guess. You mentioned low dose naltrexone. Could you just describe what that is and what effects it has? - Low Dose Naltrexone (LDN) and cancer

 

 

Dr. Liu:

 

Yes. Low dose naltrexone is just a way of using a drug known as naltrexone, and naltrexone has been used for a while to fight certain types of addiction. It can antagonise certain opiates and through some work that was done a few years ago it was shown that if you were to use this naltrexone at slightly lower doses than conventionaly given, certain would respond favourably, or respond differently to the drug.

 

It seemed to clinicians that naltrexone, if you were to use it at different doses, be it a high dose- the conventionally used dose-, vs a low dose which is not typically used, you can get a completely different drug. A completely different profile, different effects altogether, which was incredibly startling and the LDN was shown to have an effect on certain autoimmune disease. So diseases effecting the autoimmune system would be altered slightly.

 

Cancer could also be ever so slightly changed as well depending on whether or not you used high doses or low dose naltrexone, so a whole series of work was initiated by myself with Proffessor Dalglish as well about 3 years ago and we wanted to understand what was happening to cancer cells when they were given different doses of naltrexone, and we showed that at lower doses a completely different set of genes were altered in cancer cells if you were to use LDN.

 

What does that mean? It means that this drug when used this way can be anti-cancerous rather than the more common accepted anti-opiate effects. So we embarked on a whole series of research that showed you could actually cause the death of certain cancer cells in certain situations if you were to use LDN and its something that really excited us and its something that we’re trying really hard to prove and to get into patients. That’s something we envisage is going to happen over the next year or two.

 

 

Andrew:

 

Might this be a universal effect or are there some cancers that would respond much better than others and why might that be?

 

 

Dr. Liu:

 

Yes, I should point out that the cancers we tested are known as cancer cell lines, which are isolated cells from a cancer patient from many years ago and they are used as a model of drug activity and as a possible representation of a particular cancer type and there are two or three types that we have investigated involve those of the lung, the breast, and of the colon, and in those three cancer cell types, the drug seemed to be having an effect at lower doses, which is particularly promising.

 

The work we have performed also showed that the way you use LDN can also impact upon its anti-cancer action so if you were to use it one way you would get a much better response than if you were to use it another way and so I suppose it opens the door to the idea that certain drugs out there which are effective could be made more effective if you were to use them much more elegantly and so yes, you are right in saying that it may not be universal purely because I haven’t tested it on all cancer types, but on the ones we have tested I would say that a good proportion of them would respond in some form or another.

 

Again, the caveat must be that these are all in laboratory based studies and we haven’t really tested it in humans yet and I don’t know whether or not at the moment that it would transpire that it is useful in patients but there is lots of anecdotal evidence, lots of patients who have self prescribed and who swear by it, but again, whether its due to LDN or not I don’t know.

 

Same story as the cannabinoids, but there is something in it. If there was nothing in it these stories would slowly die away by the side but people talk about it because people sense that they are getting a response that is good for them and I’m never going to deny people that.

 

 

Andrew:

 

Something that lots of people ask about after finding out all of this information is about clinical trials. Have there been any real clinical trials on either cannabinoids for specific cancers or LDN or even a combination of different drugs, as in the case study that you mentioned. - clinical trials. Combination approaches, Guardian article link

 

 

Dr. Liu:

 

Yes, so there are always clinical trials coming to the fore. As soon as they are funded they are taken to go in quite quickly.

 

If we talk about cannabinoids first of all, there are a number of trials that are ongoing throughout the world which are looking at the activity of cannabinoids in patients with different forms of cancer. A number of those involve safety testing rather than activity testing but nevertheless there are clinical trials out there and they are slowly increasing in number but they are few and far between.

 

LDN hasn’t been tested yet, and that is precisely what we are trying to drive forward now. We’re trying to get enough support to drive clinical trials forward and I’m hopeful that will take place very soon and also with regards to this case study where this patient seemed to do very well with this combination, the principle combinations involved gemcitabine with a drug called lenlidomide and possibly with a micobacterium product, and its the combination of these three, with other things, that support this in the periphery which we believe gave this fantastic result and a very recent clinical trial along similar lines which was performed by a series of doctors but really driven by prof Dalglish was positive and that was in the news about three weeks ago, which talked about its activity and pancreatic, metastatic cancer and I think it made the front page of The Guardian, its something he is particularly proud of.

 

There have been clinical trials and they are slowly increasing the number, but unfortunately, and I say this with deep frustration that it is incredibly slow and the wheels of change take so long to turn but they are turning nevertheless.

 

 

Andrew:

 

Yes, and that’s the thing that is important. You mentioned how this combination protocol was in The Guardian recently, which is quite interesting. How would people find out about your research, Professor Dalglish, and similar articles and research that they can read and inform themselves so that they are a bit more educated about these things before they speak to their oncologists about this because that’s very important. I wouldn’t advise anyone of course to try these things on their own, there are lots of potential risks and difficulties doing that, especially if it is something that could be illegal.

 

 

Dr. Liu:

 

I suppose if it is a case of information, I myself am more than happy to address any questions that your listeners may have, and just to drop me an email and I can respond in due. But there are lots of websites out there.

 

With regards to clinical trials, which is a good starting point, in regards to where to find new treatments for conditions, even though we talk about cancer, we only talk about it because I work in the cancer field but this website www.clinicaltrials.gov lists every single clinical trial out there. It has a search bar, all you have to do is type in some key words and you will be open to a whole series of clinical trials which you can have a look at, get some more information, and then turn around to your doctor and ask them ‘Why am I not on this one?’

 

One thing I would say to patients who have been recently diagnosed with cancer is you will always feel you are losing control and it seems like the treatment options to you are decided by others and that gives you this whole feeling of worthlessness and not knowing what you can and can’t do. One thing that I would stress to you is that you are in complete control. You and you alone have the power to decide your treatment options.

 

The doctors will offer you treatment options based upon statistics, but fundamentally you can either; A. Ignore or accept what they say. I would strongly urge you to accept what they say as they have the experiences in that field, but if you have a strong feeling about one treatment, and you’ve researched it and looked into it, like you have Andrew, you’ve been like a dog with a bone, and rightly, absolutely rightly to regain control and I absolutely applaud you Andrew, I absolutely applaud you for that and that’s what you need to do. Before you can start feeling in control again, things will seem better.

 

 

Andrew:

 

Yes, and I think its important to note as well that I’ve been in a fortunate position where I’ve had the analytical skills and the prior knowledge before looking into all these things. And I’m at a facility now whereby my oncologist is very supportive and we have these conversations where I discuss things I’ve been researching. I would encourage other patients to have those conversations with their oncologist, because even if they think they are the enemy or whatever they are the experts and the specialists in these areas. Some are perhaps a bit too specialist, but there is always opportunity to, if there oncologist isn’t right for them, they can move to a different hospital which is what I have done.

 

 

Dr. Liu:

 

Yes, which is good. And one thing that I would add to that Andrew is that you are absolutely right. These oncologists are specialists in cancer. There’s no two ways about it and I’m not poo pooing that at all, but one thing that I would add is that these oncologists are specialists in cancer, but they are not specialists in YOUR cancer. Only you are.

 

 

Andrew:

 

Yes, explore all options. And speak to people like yourselves for more information and then you can go to your oncologist with that information. This is the exact reason why I set up my website which has a number of resources. The whole idea of this is for patients to be able to look up information on what might help them and then to go to their oncologist with a printout of these peer-reviewed studies and just say, ‘What do you think?’. Having that conversation…

 

 

Dr. Liu

 

Yes, and if anyone would like further information from me I’m more than happy for them to contact you Andrew and for you to pass my email to them. I won’t worry about that all and really just to help people make informed decisions I think is important. If it means me jotting a few emails down then so be it, I’m more than happy to do this Andrew.

 

 

Andrew:

 

Fantastic. So I think we’ll end it there. Thank you very much for your time Dr. Liu and that’s all. Thank you very much.

 

 

Dr. Liu:

 

Thank you, and I’ll keep you up to date with how things go and I look forward to more of your adventures.