Bridging the gap in veterinary oncology

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Bridging the gap in veterinary oncology

Integrative Oncology leverages the advances of Western biomedicine by downsizing the cancer burden while simultaneously utilizing the tools we have available to us from other traditions of medicine. The goal is to make the body a less hospitable environment for cancer and support its natural healing processes.  

Research is accumulating on how diet, exercise, lifestyle, stress, herbal medicine and acupuncture impact the development of and recovery from cancer in humans. Recent studies also show that the health of the gut microbiome may impact individual responses to conventional cancer therapies like chemotherapy and immunotherapy. By combining the strengths of the Western biomedicine paradigm with those of traditional medicine paradigms, which have a long history of supportive lifestyle and natural medicine therapies, we open the door to improving outcomes for our animal cancer patients.

My clinical experience shows that when lifestyle and nutritional interventions, including diet, exercise, emotional wellness, select supplements, acupuncture and herbal medicines, are appropriately implemented alongside thoughtfully-applied patient-specific biomedicine therapies, patient well-being improves — and often, so do patient outcomes. When patient well-being improves, client satisfaction improves, and the experience of the whole veterinary team becomes more rewarding.

When clients are presented with broader options and supported in taking an active role in their pets’ healing, the experience of cancer treatment can become one of empowerment and hope rather than despair and hopelessness.

Toward a paradigm of integrative cancer care

At its root, cancer is a chronic disease characterized by the dysregulation of multiple body processes, including chronic unmitigated inflammation, the failure of appropriate immune responses, and aberrant molecular signaling resulting in an alteration of the body’s “ecosystem”. These shifts in the body’s internal environment lead to epigenetic changes, which ultimately result in altered gene expression, abnormal tissue growth, and the creation of a tumor microenvironment that supports the survival, growth and metastasis of dysregulated cells. In many veterinary patients, cancer does not manifest appreciable signs until it is in advanced stages or has become a life-threatening medical emergency.

Given that cancer is a multifactorial manifestation of disease, an effective approach to healing also needs to be multifactorial. Systemic Inflammation, angiogenesis and immune dysfunction are all recognized factors contributing to cancer development, growth, persistence and metastasis. When I discuss the role of herbs in cancer management with clients, I explain that many herbs have been shown to mitigate inflammation in the body, inhibit angiogenesis, and bolster anti-cancer immune responses. These actions are in addition to their uses in alleviating the side effects of conventional cancer therapies or the clinical signs resulting from the cancer itself.

Evidence-informed Chinese herbal medicine in cancer care

As my specialized training lies in oncology and Chinese Herbal Medicine, I will focus on the role the latter can play in an evidence-informed integrative approach to cancer patient care.

Within the Traditional Chinese Herbal Medicine (TCHM) paradigm are plant-based treatments containing compounds that are currently being researched and exploited for their anti-cancer actions. Many of these actions parallel the mechanisms of metronomic chemotherapy, immunotherapy and targeted cancer treatments, while offering more balanced, or broader-acting and adaptogenic actions in the body as a whole.  A number of herbs exhibit the potential to prevent or reverse multiple drug resistance (MDR), the main cause for chemotherapy resistance, and are under heavy investigation for development as pharmacological agents. For these reasons, they present an attractive option for maintenance therapy after the completion of conventional treatments, and also hold the potential for effective additions to our combination therapy protocols.

Integrative therapy utilizing TCHM has been associated with prolonged survival in a number of human cancer types, such as metastatic mammary carcinoma, lung cancer, pancreatic cancer and gastric cancer. Conversely, evidence also indicates that careful patient-specific considerations are warranted. For instance, some herbal therapies might promote the growth of certain types of cancer, such as hormone responsive breast cancer; and other specific herb-chemotherapy combinations could potentially interfere with the efficacy of certain chemotherapy drugs. It is, therefore, important to respect the importance of patient-specific prescribing.

An extensive review of herb pharmacokinetics and drug-herb interactions is beyond the scope of this article. However, we need to acknowledge that the importance of appropriate patient-oriented TCHM diagnosis and prescribing cannot be overemphasized. And in an evidence-informed approach to Integrative Oncology, efforts to stay up to date with the current literature on this topic, especially when combining herbal medicines with conventional treatments, are vital to safe, effective and informed integrative treatment.

A substantial amount of research can be found on individual herbs and herb-derived compounds in cancer care. Following are a few select examples of TCHM formulas that may be helpful in cancer patient care and in vivo research supporting their use.

Supporting immune function 

1. Dang Gui Bu Xue Tang: Oral administration modulated immune activity in tumor-bearing mice through:

  • increased cytotoxic T lymphocytes and NK cell numbers
  • down-regulated activated T helper cell (CD4+/CD25+).

2. Xiao Chai Hu Tang: Improved immune function in tumor-bearing mice.

Supporting body condition 

Xiao Chai Hu Tang: Oral administration in tumor-bearing mice at a dose of 50 and 100 mg/kg resulted in:

  • slowed tumor growth
  • prevented loss of body condition
  • lowered tumor-related elevations in serum IL‑6
  • attenuated muscle atrophy by affecting myoblast proliferation and differentiation
  • suppressed pro-cachectic inflammatory cytokine production via inhibition of nuclear factor‑κB.

Supporting appetite 

Liu Jun Zi Tang: Oral administration improved appetite through:

  • enhanced ghrelin signaling, which is involved in appetite regulation
  • improved gastric motility via hesperidin content.

Pharmacokinetic evaluation of the formula suggests that its effects on ghrelin are:

  • exerted via synergistic action of multiple ingredients rather than attributable to one ingredient alone
  • due to local direct action in the stomach.

Supporting energy 

Tao Hong Si Wu Tang: Oral administration prevented fatigue in mice.

Supporting immunotherapy 

Shi Quan Da Bu Tang: Oral administration improved in vivo tumor vaccine antigen-specific immune response over vaccination alone resulting in

  • slowed tumor growth
  • improved survival time
  • enhanced antigen presenting ability of dendritic cells (in vitro)
  • improved phagocytosis (in vitro).

Decreasing treatment-related toxicity 

  • Liu Jun Zi Tang: Used along with standard antiemetic therapy, and evaluated in a randomized phase II study in humans, this herbal formula showed additive relief of chemotherapy-related vomiting, nausea and anorexia compared to standard antiemetic therapy alone.
  • Xiao Chai Hu Tang: Treated and prevented induced gastritis and gastric ulceration in rats.
  • Long Dan Xie Gan Tang: Sorafenib (in the same class of drugs as the veterinary tyrosine kinase inhibitor Toceranib) was evaluated with co-administration of Long Dan Xie Gan Tang. When given together, there was no significant alteration in chemotherapy blood levels or metabolism, but the liver toxicity induced by Sorafenib was mitigated.

Preventing cancer development and growth 

  • Shi Quan Da Bu Tang: Oral administration prevented development of hepatic carcinoma in rats.
  • Xiao Chai Hu Tang: Oral administration inhibited hepatocellular carcinoma growth in vivo.
  • Xue Fu Zhu Yu Tang: Oral administration significantly improved survival time and demonstrated anti-tumor activity in experimentally-induced liver sarcoma in mice.

Optimizing life

After over 12 years of clinical veterinary oncology practice, the wellness benefits I’ve seen with my patients receiving an integrative approach are so consistent that it has become ethically difficult for me to practice without offering these options. It has significantly improved my job satisfaction, and my clients are grateful to have their requests for assistance in selecting effective supplements, natural medicine options, nutritional interventions and stress management supportively addressed.

Even in cases where “cure” isn’t achieved, quality of life can improve. I have seen patients live comfortably with their cancer for extended periods of time, far beyond the prognosis we typically see with conventional treatments. I have seen prolonged disease stabilization with herbal treatments. And although it doesn’t happen for every patient, I have seen tumors shrink with aggressive herbal medicine and lifestyle interventions alone when our initial intent was palliative care.

I now practice Integrative Oncology almost exclusively. I also offer Integrative Oncology Telemedicine Consultations to provide integrative assistance to veterinarians and support those managing patients with cancer. This arises from a desire to help bridge the gap between conventional and alternative medicine world-views, in the hope of bringing pet owners and the veterinary profession together on a comprehensive and effective path to wellness. When we learn to more effectively bridge this gap, these treatments will become more accessible to our profession as a whole.

As we develop a broader view of health and healing, we are empowered to take an active role in treatment and recovery. Treatment then becomes not  about a “battle against cancer” but about how we optimize life.

This focus is emotionally  healthier both for us as clinicians and for our clients as pet guardians. It allows us to focus on wellness rather than disease, while effectively supporting the human-animal bond. And in the end, whether the cancer itself is the cause of death, or whether it is eliminated, the quality of the life that is lived during the treatment journey is almost always improved.

References

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Cheng YY. “Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics”, Journal of Food and Drug Analysis, 2018. 

Fujitsuka, N. “Rikkunshito, a ghrelin potentiator, ameliorates anorexia–cachexia syndrome”, Front Pharmacol, 2014. 

Hsieh, CC. “Dang-Gui-Bu-Xai-Tang modulated the immunity of tumor bearing mice.” Immunopharmacol Immunotoxicol, 2003. 

Hung, KF. “Complementary Chinese herbal medicine therapy improves survival of patients with gastric cancer in Taiwan: A nationwide retrospective matched-cohort study”, J Ethnopharmacol, 2017. 

Kim, A, et al. “Sosiho‑tang ameliorates cachexia‑related symptoms in mice bearing colon 26 adenocarcinoma by reducing systemic inflammation and muscle loss”, Oncol Rep, 2016. 

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This article has been peer reviewed.