Pancreatic cancer: Towards increasing treatment effectivness

Dear Visitors, below is a list of drugs recently shared with me by a reader of this website. It contains relevant information and consequently I decided to publish it as a specific article. I hope this will help:

Currently the two most effective regimens in advanced pancreatic cancer are FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin) and GnP (gemcitabine plus nab-paclitaxel). Statistically, FOLFIRINOX appears to be the best, but has higher toxicity. Also, when coupled with radical resection of primary tumor and metastases, may even lead to long term survival. In case the tumor or metastases are not removable by conventional surgery, an ablation technique like radiofrequency, cryo, laser or high intensity focused ultrasound can be used instead. However, the cancer cells that survive the ablation, either in distant micrometastases or in peritumoral tissue, are going to increase their stemness and chemoresistance. In the following I’ll try to present options that may increase the effectiveness of the GnP regimen, based on published research.

TL-118 anti-angiogenic regimen, added to Gemcitabine, is a combination of 4 drugs that target nonoverlapping aspects of the angiogenic process. The 4 drugs are cimetidine, metronomic cyclophosphamide, diclofenac and sulfasalazine. TL-118—anti-angiogenic treatment in pancreatic cancer: a case report http://www.ncbi.nlm.nih.gov/pubmed/23609193 The regimen resulted in near complete response, but was poorly tolerated and interrupted. For a comprehensive list of cimetidine applications on cancer, Repurposing drugs in oncology (ReDO) – cimetidine as an anti-cancer agent. http://www.ncbi.nlm.nih.gov/pubmed/25525463

The paper includes a reference to Targeting Mitochondrial STAT3 with the Novel Phospho-Valproic Acid (MDC-1112) Inhibits Pancreatic Cancer Growth in Mice http://www.ncbi.nlm.nih.gov/pubmed/23650499

Sulfasalazine has been previously proposed as gemcitabine adjuvant, Potential use of the anti-inflammatory drug, sulfasalazine, for targeted therapy of pancreatic cancer http://www.ncbi.nlm.nih.gov/pubmed/20567622

Diclofenac, and old anti-inflammatory drug,  inhibits both VEGF and glycolysis. Diclofenac Inhibits Tumor Growth in a Murine Model of Pancreatic Cancer by Modulation of VEGF Levels and Arginase Activity http://www.ncbi.nlm.nih.gov/pubmed/20856806

New Aspects of an Old Drug – Diclofenac Targets MYC and Glucose Metabolism in Tumor Cells http://www.ncbi.nlm.nih.gov/pubmed/23874405

Curcumin has proven helpful in various cancers, but is hampered by low bioavailability. It synergizes with many chemotherapy drugs, including gemcitabine and paclitaxel. Systemic Administration of Polymeric Nanoparticle-Encapsulated Curcumin (NanoCurc) Blocks Tumor Growth and Metastases in Preclinical Models of Pancreatic Cancer. http://www.ncbi.nlm.nih.gov/pubmed/20647339 However, there are newer formulations of curcumin with better bioavailability, like Meriva (formulated with phosphatidylcholine), that proved useful in colorectal cancer. Curcumin ameliorates oxaliplatin-induced chemoresistance in HCT116 colorectal cancer cells in vitro and in vivo. http://www.ncbi.nlm.nih.gov/pubmed/20839263 Other new formulations of curcumin are Theracurmin and NovaSOL.

Tocotrienols, delta and gamma (from Annatto) also synergize with gemcitabine. Vitamin E delta-tocotrienol prolongs survival in the LSL-KrasG12D/+;LSL-Trp53R172H/+;Pdx-1-Cre (KPC) transgenic mouse model of pancreatic cancer. http://www.ncbi.nlm.nih.gov/pubmed/23963802 A Phase I Safety, Pharmacokinetic, and Pharmacodynamic Presurgical Trial of Vitamin E delta-tocotrienol in Patients with Pancreatic Ductal Neoplasia. http://www.ncbi.nlm.nih.gov/pubmed/26844278

Evodiamine, an extract from Evodia plants. Enhanced Antitumor Efficacy of Gemcitabine by Evodiamine on Pancreatic Cancer via Regulating PI3K/Akt Pathway http://www.ncbi.nlm.nih.gov/pubmed/22211100

Disulfiram, synergizes in vitro with both gemcitabine and paclitaxel. However, disulfiram metabolites are less potent and less studied. Gemcitabine response in pancreatic adenocarcinoma cells is synergistically enhanced by dithiocarbamate derivatives http://www.ncbi.nlm.nih.gov/pubmed/21236335 Reversing the Intractable Nature of Pancreatic Cancer by Selectively Targeting ALDH-High, Therapy-Resistant Cancer Cells http://www.ncbi.nlm.nih.gov/pubmed/24194908 Disulfiram targets cancer stem-like cells and reverses resistance and cross-resistance in acquired paclitaxel-resistant triple-negative breast cancer cells http://www.ncbi.nlm.nih.gov/pubmed/24008666 There is a new liposomal formulation, Liposome encapsulated Disulfiram inhibits NF-kB pathway and targets breast cancer stem cells in vitro and in vivo http://www.ncbi.nlm.nih.gov/pubmed/25277186

A combination of dietary agents show promise against pancreatic cancer, Sulforaphane, quercetin and catechins complement each other in elimination of advanced pancreatic cancer by miR-let-7 induction and K-ras inhibition http://www.ncbi.nlm.nih.gov/pubmed/25017900

Most of the above focused on gemcitabine synergy, but to get most of nab-paclitaxel, it is possible to use lansoprazole, Lansoprazole induces sensitivity to suboptimal doses of paclitaxel in human melanoma http://www.ncbi.nlm.nih.gov/pubmed/25449440 High dose lansoprazole combined with metronomic chemotherapy: a phase I/II study in companion animals with spontaneously occurring tumors. http://www.ncbi.nlm.nih.gov/pubmed/25143012

Other potentially useful drugs or supplements: apricoxib, 3BP, clobenpropit, oseltamivir, omeprazole, but some at massive (unrealistic) doses.

Apricoxib, a novel inhibitor of COX-2, markedly improves standard therapy response in molecularly defined models of pancreatic cancer. http://www.ncbi.nlm.nih.gov/pubmed/22829202

Inhibition of glucose turnover by 3-bromopyruvate counteracts pancreatic cancer stem cell features and sensitizes cells to gemcitabine http://www.ncbi.nlm.nih.gov/pubmed/25015789 Systemic delivery of microencapsulated 3-bromopyruvate for the therapy of pancreatic  cancer. http://www.ncbi.nlm.nih.gov/pubmed/25326230

Clobenpropit enhances anti-tumor effect of gemcitabine in pancreatic cancer http://www.ncbi.nlm.nih.gov/pubmed/25024609

Therapeutic targeting of Neu1 sialidase with oseltamivir phosphate (Tamiflu) disables cancer cell survival in human pancreatic cancer with acquired chemoresistance http://www.ncbi.nlm.nih.gov/pubmed/24470763

Omeprazole Inhibits Proliferation and Modulates Autophagy in Pancreatic Cancer Cells http://www.ncbi.nlm.nih.gov/pubmed/21629657

An interesting new treatment, if it will be approved, radioactive Listeria.

The injection of 188Re-labeled antibodies bound to L. monocytogenes resulted in reduction of the primary tumor by more than 60%, and remarkably, the number of detectable metastases was reduced by more than 90%. Single-agent combinatorial cancer therapy http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666690/

Most of the above can be applied to other cancers, and there is one more, deuterium depleted water, which is non-toxic and can synergize with chemotherapy.

Deuterium depletion results in several fold increases in the median survival time of cancer patients during oncotherapy.

Deuterium depleted water effects on survival of lung cancer patients and expression of Kras, Bcl2, and Myc genes in mouse lung. http://www.ncbi.nlm.nih.gov/pubmed/23441611

DDW at 25 ppm is marketed under Qlarivia brand, costs about 7 euros / liter.

By Ovidiu Herlea

Disclaimer:

This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, I provide general information for educational purposes only. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. I am not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. This is just my own personal opinion regarding what we have learned on this road.

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Wondering
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Wondering

its crazy how effective LDN + ALA + HCA was in 3 serious cases:
https://www.ncbi.nlm.nih.gov/pubmed/20042414
most people with pancreatic do not hear about this treatment. they NEVER get the chance to try it. Sad. Incredibly sad.

Helga
Member

Hi Daniel,

Yes, you should definitely write a post on LDN (at least I strongly support the idea :-)). What is fascinating to me about it is the fact the low-dose somehow works better than high-dose. It happens rarely for a drug. At least I am not aware of any other that is used this way.

I found an interesting article on LDN used for rheumatologic purposes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/
There is some interesting info on microglia information:

“Naltrexone, however, exerts its effects on humans via at least two distinct receptor mechanisms. In addition to the antagonist effect on mu-opioid and other opioid receptors, naltrexone simultaneously has an antagonist effect on non-opioid receptors (Toll-like receptor 4 or TLR4) that are found on macrophages such as microglia [17]. It is via the non-opioid antagonist path that LDN is thought to exert its anti-inflammatory effects. Microglia are central nervous system immune cells that are activated by a wide range of triggers [18]. Once activated, microglia produce inflammatory and excitatory factors that can cause sickness behaviors such as pain sensitivity, fatigue, cognitive disruption, sleep disorders, mood disorders, and general malaise [19]. When chronically activated, the resulting proinflammatory cascade may become neurotoxic, causing several deleterious effects [20]. Given the wide variety of inflammatory factors produced by activated microglia (e.g., proinflammatory cytokines, substance P, nitric oxide, and excitatory amino acids) [21], a range of symptoms and medical outcomes could share the pathophysiological mechanism of central inflammation.”

ovidiu
Member

After more than 2 years, I’ll try to provide an update on Chemo regimens and possible ways to augment efficacy.
In 2018 the most effective regimen is still FOLFIRINOX, but it has the highest hematological toxicity and only patients with good performance status get it. GnP is less toxic, but is the most expensive, because of the high cost of Abraxane. A new nano-liposomal formulation of Irinotecan has recently been tried, with good results. Something that should be kept in mind, for patients with locally advanced and unresectable PDAC, but without metastases, is that effective chemo may temporarily shrink the tumor, in which case it could be resected or ablated. As for ablation techniques, recently good results have been achieved with irreversible electroporation, and very recently a new technique, nano-pulse stimulation, similar to IRE but with much shorter pulses, has shown even better results in a mouse model.

Looking for confirmation of the adjuvants I listed in the original article, there was nothing new on TL-118.
About phospho-VA, there is a new formulation, but wasn’t tested in combination with Cimetidine. Phospho-valproic acid inhibits pancreatic cancer growth in mice: enhanced efficacy by its formulation in poly-(L)-lactic acid-poly(ethylene glycol) nanoparticles. PMID: 28849098
About Curcumin, most research is focused on analogues or nano-formulations, but there is one article, with a small improvement over Gemcitabine alone. Phytosome complex of curcumin as complementary therapy of advanced pancreatic cancer improves safety and efficacy of gemcitabine: Results of a prospective phase II trial. PMID: 29614381
About Tocotrienols, the variable bioavailability seems to have hampered application, but there is research on Gemcitabine – Tocotrienol conjugates.
About DDW, unfortunately most pancreatic cancers are able to adapt to metabolic changes due to DDW (unlike breast cancer), so it’s not useful here.

While searching for new treatments against PDAC, I found several new and potent ones, but most are still experimental. I will detail some of them in later posts.

ovidiu
Member

Regarding ablation techniques, I’ll quote from the articles on Irreversible Electroporation and then Nano-pulse stimulation:

The application of thermal ablative techniques to LAPC has been previously associated to high rates of morbidity, as a result of a heat sink effect. In LAPC the beneficial effects of ablation is limited by the close proximity of critical vascular structures to the targeted tumor lesions. In fact, the primary mechanism of cell death induced by thermal ablative techniques is represented by a coagulative necrosis that involves also often surrounding structures. Electroporation (IRE) has proved to be a new method of tumor ablation that activates energy-dependent biochemical mechanisms that promote apoptosis. In contrast with other thermal ablative options, IRE has been shown to produce larger perivascular tumor death while sparing tissue scaffolds. The use of IRE in the treatment of LAPC has apparently shown promising results, with relatively acceptable morbidity rates and improvement of survival.

Irreversible electroporation for locally advanced pancreatic cancer through a minimally invasive surgery supported by laparoscopic ultrasound. PMID: 29335228

In this study, we assessed nanopulse stimulation (NPS) as a local treatment for pancreatic cancer in a syngeneic mouse Pan02 pancreatic cancer model and characterized corresponding changes in the immune profile. A single NPS treatment either achieved complete tumor regression or prolonged overall survival in animals with partial tumor regression. While this is very encouraging, we also explored if this local ablation effect could also result in immune stimulation, as was observed when NPS led to the
induction of immune-mediated protection from a second tumor challenge in orthotopic mouse breast and rat liver cancer models. In the Pan02 model, there were insufficient abscopal effects (1/10) and vaccine-like protective effects (1/15) suggesting that NPS-induced immune mechanisms in this model were limited.
Recently, another electrical engineering technology, which can generate electric pulses with pulse durations in the nanosecond ranges, has been developed by Schoenbach et al. and other groups. Nanosecond pulsed electric fields or electric pulses (nsPEFs or nsEPs), here named Nano-Pulse Stimulation (NPS), have been studied largely for local tumor ablation. Similar to IRE, NPS is delivered with a specialized electrode and is usually considered non-thermal if appropriate parameters are adopted. NPS successfully ablates local tumors with no reoccurrence in several animal models. Beyond the local tumor regression, the protection of no tumor growth from a second tumor challenge was reported from two research groups.

Nano-Pulse Stimulation for the Treatment of Pancreatic Cancer and the Changes in Immune Profile. PMID: 29954062

ovidiu
Member

IRE efficacy (in a mouse model, more or less equivalent to LAPC) can be improved by moderate heating of the tumor, quoting:
Moderate heating (MH) at 43 °C for 1-2 minutes significantly enhanced ex vivo IRE tumor ablation of Pan02 cells by 5.67-fold at 750 V/cm and by 1.67-fold at 1500 V/cm. This amount of heating alone did not cause cell death. An integrated IRE system with controllable laser heating and tumor impedance monitoring was developed to treat mouse ectopic pancreatic cancer. With this novel IRE system, we were able to heat and maintain the temperature of a targeted tumor area at 42 °C during IRE treatment.
Pre-heating the tumor greatly reduced the impedance of tumor and its fluctuation. Most importantly, MHIRE has been demonstrated to significantly extend median survival and achieve a high rate of complete tumor regression. Median survival was 43, 46 and 84 days, for control, IRE with 100 μs, 1 Hz, 90 pulses and electric fields 2000–2500 V/cm and MHIRE treatment respectively. 55.6% of tumor-bearing mice treated with MHIRE were tumor-free, whereas complete tumor regression was not observed in the control and IRE treatment groups.
Controllable Moderate Heating Enhances the Therapeutic Efficacy of Irreversible Electroporation for Pancreatic Cancer. PMID: 28924200

ovidiu
Member

Abraxane (nab-Paclitaxel) is believed to strongly deplete the PDAC stroma, which dense stroma impedes the delivery of chemo to the tumor. However, Abraxane continues to be expensive, and in some countries the high price may prohibit its use. There are some drugs, with anti-fibrotic activity, which could be used for the same purpose, to deplete the PDAC stroma, namely Pirfenidone, Tranilast, and possibly Telmisartan. However, since they are Tgf-beta inhibitors, and Tgf-beta plays a dual role (inhibition or promotion of growth and metastasis), the use of anti-fibrotics listed above should be evaluated on a per patient basis.

Pirfenidone inhibits pancreatic cancer desmoplasia by regulating stellate cells. PMID: 23348422
Tranilast-induced stress alleviation in solid tumors improves the efficacy of chemo- and nanotherapeutics in a size-independent manner. PMID: 28393881
Tumor stromal disrupting agent enhances the anticancer efficacy of docetaxel loaded PEGylated liposomes in lung cancer. PMID: 27171485

About 80% of the PDAC patients have the Kras mutation, which is associated with resistance to apoptosis (but sensitivity to ferroptosis) and poor response to chemo, but other possible mutations are EGFR (native, about 40% of patients) and Her2 (induced by Gemcitabine). In case of EGFR mutation, addition of Erlotinib to Gemcitabine improves response, especially in patients who develop rash. It may be possible to take advantage of the Her2 upregulation by Gemcitabine, Up-regulation of Her2 by gemcitabine enhances the antitumor effect of combined gemcitabine and trastuzumab emtansine treatment on pancreatic ductal adenocarcinoma cells. PMID: 26475267

Shikonin appears to be synergetic with Gemcitabine against PDAC, but purified Shikonin is very expensive, and there is no recent trial with the cheap Lithospermum erythrorhizon extract. Shikonin induces apoptosis and necroptosis in pancreatic cancer via regulating the expression of RIP1/RIP3 and synergizes the activity of gemcitabine. PMID: 29312502

There are a couple of new drugs, that achieve promising results against PDAC, but it’s hard to tell when they will become available to patients. Quoting from articles on Zt/g4-MMAE (RON antibody conjugated to monomethyl auristatin E) and Avasimibe (cholesterol acyltransferase inhibitor):

In vitro, Zt/g4-MMAE rapidly induced RON internalization, resulting in cell cycle arrest followed by massive cell death. The maximal effect was seen in pancreatic cancer cells with more than 10 000 receptor molecules per cell. Zt/g4-MMAE also synergized in vitro with chemotherapeutics including gemcitabine, 5-fluorouracil, and oxaliplatin to further reduce PDAC cell viability. In vivo, Zt/g4-MMAE exerts a long-lasting activity, which not only inhibited but also eradicated pancreatic xenograft tumors.
Preclinical Efficacy of Anti-RON Antibody-Drug Conjugate Zt/g4-MMAE for Targeted Therapy of Pancreatic Cancer Overexpressing RON Receptor Tyrosine Kinase. PMID: 29944378

Single treatment with avasimibe or gemcitabine shows effectiveness in reducing tumor growth rate and induces slight tumor remission after a period of treatment. Tumors grew up again after 20-days gemcitabine treatment, indicating the appearance of gemcitabine-resistance. Avasimibe treatment alone maintains tumor size at a constant level over the treatment period. In contrast, combinational therapy reverses tumor growth by substantially reducing tumor size with no sign of tumor recovery even after 34-days treatment, indicating a nearly complete tumor remission was achieved by the combination therapy.
Cholesterol esterification inhibition and gemcitabine synergistically suppress pancreatic ductal adenocarcinoma proliferation. PMID: 29489864

ovidiu
Member

Since about 80% of PDAC cell lines have the Kras mutation, and this increases the sensitivity to ferroptosis, compared to Kras-wildtype, regimens containing ferroptosis inducing agents could help, while avoiding ferroptosis inhibitors. Ferroptosis inducers are Erastin, Lanperisone (a muscle relaxant), Sorafenib, Sulfasalazine, anti-malarials Artemisinin, Artesunate, Artemether, and various new compounds. Artesunate is able to induce ferroptosis in PDAC cell lines, but not much without iron-saturated holo-transferrin, and HTF also potentiated Erastin (which disappointed in clinical trials, probably because of low uptake by cancer cells), especially at lower concentrations. Identification of artesunate as a specific activator of ferroptosis in pancreatic cancer cells. PMID: 26097885
The sigma receptors 1 and 2 have complicated functions, that are used by ligands (agonists or antagonists) to achieve a pharmacological purpose. Examples of sigma ligands are: Citalopram, Fluoxetine, Ketamine, Noscapine, Haloperidol and Sertraline. Sigma 1 antagonists and sigma 2 agonists have anti-cancer properties. Interesting, Haloperidol (which also inhibits PDAC by inhibiting DRD2 ) is also a ferroptosis inducer, and synergizes with Erastin and Sorafenib. Haloperidol, a sigma receptor 1 antagonist, promotes ferroptosis in hepatocellular carcinoma cells. PMID: 28756230
Sigma 2 receptor was recently proposed as a promising target for pancreatic cancer therapy, by ligands conjugated to toxic payloads.
Conjugating a sigma 2 ligand with a SMAC mimetic, SW IV-134 was born, which strongly synergizes with Gemcitabine against PDAC. The Targeted SMAC Mimetic SW IV-134 is a strong enhancer of standard chemotherapy in pancreatic cancer. PMID: 28095907
Quoting: The Erastin derivative des-methyl Erastin (dm-Erastin, easier to synthesize and with similar potency) was chemically linked to sigma-2 ligand SV119 to create SW V-49. Conjugation increased the killing capacity of dm-Erastin by nearly 35-fold in vitro and
reduced the size of established tumors and doubled the median survival in syngeneic and patient-derived xenograft models when compared to non-targeted dm-Erastin. Mechanistic analyses demonstrated that cell death was associated with robust reactive oxygen species production and could be efficiently antagonized with antioxidants.
Conjugation to the sigma-2 ligand SV119 overcomes uptake blockade and converts dm-Erastin into a potent pancreatic cancer therapeutic. PMID: 27244881
I wonder if the combination of SW V-49 with Haloperidol could do even better…

ovidiu
Member

The central regions of PDAC tumors are hypoxic and necrotic, infiltrated by immunosuppressive cells. Gemcitabine and nab-Paclitaxel are much less effective under such conditions. Addition of a hypoxia-activated prodrug, Evofosfamide (TH-302), to the GnP regimen, greatly improved the response rate, with minimal extra toxicity (compared with GnP). Evofosfamide also proved synergetic with radiotherapy.
Efficacy and safety of the hypoxia-activated prodrug TH-302 in combination with gemcitabine and nab-paclitaxel in human tumor xenograft models of pancreatic cancer. PMID: 25679067
A Combination of Radiation and the Hypoxia-Activated Prodrug Evofosfamide (TH-302) is Efficacious against a Human Orthotopic Pancreatic Tumor Model. PMID: 28778024

Previously, attenuated Listeria was linked to Re-188 labeled antibodies, and then injected to mice bearing PDAC xenografts, resulting in reduction of the primary tumor by more than 60%, and the number of detectable metastases was reduced by more than 90%.
However, this method is difficult to reproduce at a large scale, so a simpler method was devised. Instead of coupling Re-188 to Listeria with help of anti-Listeria antibodies, they incorporated 32-Phosphorus (32P) directly into the Listeria by using 32P as a nutrient in the culture medium, without the need of antibodies. The results were impressive, most likely because of the longer half-life of 32P (14 days) compared to Re-188 (16.9 hrs). At the end of the treatments (day 28), primary tumors were undetectable by eye in 100% of the mice, and just a few metastases were detected in 20% of the mice that received Listeria-32P. 43% of the mice that received Listeria-32P were free of cancer, and the other 57% of the mice treated with Listeria-32P lived twice as long as controls.
I believe the addition of a radio-sensitizer (maybe Evofosfamide, but I don’t know how it interacts with Listeria) could further improve survival, since a large percentage of the damage to the cancer cells was done by radiation, and hypoxic (damaging to radiotherapy) conditions in the central regions of the tumors may have decreased the efficacy of 32P.
32-Phosphorus selectively delivered by listeria to pancreatic cancer demonstrates a strong therapeutic effect. PMID: 28186976

ovidiu
Member

Regarding Disulfiram, I am adding some recent information on the large discrepancy between the in vitro and in vivo efficacy. Quoting from article:

The high and selective anticancer activity of DS in the laboratory has been known for more than three decades but no promising clinic data were published. We hypothesized that the discrepancy between laboratory and clinic was introduced by the metabolism of DS in cancer patients. The anticancer activity is dependent on ROS generated from the reaction between DS and copper and the final product, Cu-DDC. When orally administered, DS is enriched in liver and promptly metabolized to S-methyl and S-glucuronide DDC. The S-methylation and glucuronidation block the chelation of DS with copper and compromise its anticancer activity although the antialcoholism function remained.
The nano-encapsulation protects the thiol groups in DS and extends its half-life in the serum from less than 2 min to over 7 h and successfully
delivers the intact DS to cancer tissues…In combination with copper, the nano-encapsulated DS has demonstrated very strong anticancer efficacy in mouse models…
Investigation of the key chemical structures involved in the anticancer activity of disulfiram in A549 non-small cell lung cancer cell line. PMID: 30031402

ovidiu
Member

I missed Honokiol in the original article, so I have to mention it now: Honokiol arrests cell cycle, induces apoptosis, and potentiates the cytotoxic effect of gemcitabine in human pancreatic cancer cells. PMID: 21720559
Also, Ciclopirox olamine, which is used against skin cancer, might be useful in pancreatic cancer: Superior efficacy of the antifungal agent ciclopirox olamine over gemcitabine in pancreatic cancer models. PMID: 29535812

ovidiu
Member

I also missed intravenous ascorbate, so I’ll post now about it. Quoting from one article below, some info that I find worth remembering:
“…Previous studies have demonstrated that activation of HIF-1α is necessary for P-AscH− sensitivity. We hypothesized that pancreatic cancer (PDAC) progression and metastasis could be be targeted by P-AscH− via H2O2-mediated inhibition of HIF-1α stabilization…”
“…Low levels of hydrogen peroxide (H2O2) stimulate HIF-1α protein accumulation while high levels inhibit HIF-1α accumulation…”
“…When ascorbate is infused intravenously the resulting pharmacologic concentration distributes rapidly into the extracellular water space, generating ascorbate radical and H2O2 [18]. P-AscH− administered intravenously is proposed to serve as a pro-drug for delivery of H2O2 preferentially to tumor cells. Recently, Tian and colleagues demonstrated that activation of HIF triggers a Warburg effect that renders cancer cells more sensitive to P-AscH−. In their study, down regulation of HIF-1α induced resistance to P-AscH−, while overexpression of constitutively active HIF subunits enhanced P-AscH− toxicity…”
Pharmacologic ascorbate (P-AscH−) suppresses hypoxia-inducible Factor-1α (HIF-1α) in pancreatic adenocarcinoma. PMID: 29396728
Tumor cells have decreased ability to metabolize H2O2: Implications for pharmacological ascorbate in cancer therapy. PMID: 27833040
Treatment of pancreatic cancer with intravenous vitamin C: a case report. PMID: 29438178