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TNBC / testing strategies in a NED situation

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(@chris48)
Joined: 2 years ago
Posts: 42
Topic starter  

Hello everyone,

Since I find it very interesting and useful to read about strategies and progress updates from others, I also want to keep posting our experiences and progress here.  

My wife was diagnosed with TNBC last year. After her chemos, surgery and radiation she is now in a NED situation. To keep it that way, we are tracking her CTCs (circulating tumor cells) and try to keep them as low as possible by using different strategies. The first one we are currently trying is about shutting down the power house ( https://www.cancertreatmentsresearch.com/shutting-down-the-power-house-of-cancer-a-strategy-to-fight-cancer/ ).

Here is what she currently takes on a daily basis (her bodyweight is 55kg):

  • 450mg Berberine (1 capsule "MCS Berberine Pure"; we will switch to 250mg "MCS Berberine Pro Liposomal" next week)
  • 2400mg EGCG (6 capsules "MCS EGCG 80%")
  • 4,5g Omega 3 (6 capsules "MCS Omega 3 Pure")
  • 90mg Sulforaphane (6 capsules "MCS Broccoli Ultra")
  • 1g Metformin

She started this protocol a week ago (no side effects so far) and we are planning to go for another 2 weeks and top it off with a IV Vitamin C treatment. Afterwards we will check again for CTCs and see if they went down.

 

Background information:

  • Feb 2021: diagnosed with TNBC
  • Mar-Jun 2021: neoadjuvant chemo (carboplatin + nab-paclitaxel)
  • Jul 2021: breast conserving surgery (non-pcr / T2N1miM0)
  • Aug-Oct 2021: adjuvant chemo (epirubcin + cyclophosphamide)
  • Nov-Dec 2021: Radiation

CTCs levels (measured via Maintrac epCAM by a German lab called Pachmann):

  • Jul 2021: 250 (after surgery)
  • Oct 2021: 200 (after adjuvant chemo)
  • Jan 2022: 0 (after radiation)
  • Jul 2022: 450 (this one really worried us)
  • Jul 2022: 200 (this was only 2 weeks later and this significant drop, according to Dr. Pachmann, was very unusual because the CTCs are usually very stable; also her leukocytes were extremely high, which could indicate that the immune system reacted to a tumor)

If you have any questions, I am happy to answer them. And I highly appreciate any comments, thoughts and opinions on my posts.

 

All the best,

Christian


   
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(@daniel)
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Joined: 8 years ago
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Hi Chris,

Thank you so much for sharing the information here.

For ethical- and regulation-related reasons, I cannot discuss the application of MCS Formulas products.

I woudl only like to add, that in this context, if you agree I woudl like to send you a few other supplements as a gift, that woudl be great to use them as a support during this time, prior to the measurement of CTCs.

Have a very nice weekend!

Kind regards,
Daniel 


   
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(@chris48)
Joined: 2 years ago
Posts: 42
Topic starter  

@daniel Hi Daniel, yes, of course, that would be amazing! Although I already feel that I owe you so much, since I already learned so many important things from your articles, comments and research. So please do not hesitate to ask me in case there is anything I can do to support your website, your company or you personally. Unfortunately I am not a medical expert, just an engineer and business economist with experience in product development, product management, marketing and sales. Anyway, I would be more than happy to give something back!

Have a great weekend too!

Kind regards,
Christian


   
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johan
(@j)
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@chris48 thanks for sharing Christian, great results so far!

All the best to you and your wife,

Johan


   
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johan
(@j)
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Zoledronate and Molecular Iodine Cause Synergistic Cell Death in Triple Negative Breast Cancer through Endoplasmic Reticulum Stress

https://pubmed.ncbi.nlm.nih.gov/27116040/


   
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(@chris48)
Joined: 2 years ago
Posts: 42
Topic starter  

@j thank you so much for the wishes and the link!

I was aware of Zoledronate, but did not know about the synergistic effects with Molecular Iodine. I will look into that more deeply.

Thank you also for your great effort in this forum!!!

All the best,
Christian


   
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(@chris48)
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Topic starter  

Hello everybody,

here comes a brief update: My wife took these supplements for 3 weeks:

- 1g Metformin
- 1g Omega 3
- 0,25g Liposomal Berberine
- 2g EGCG
- 1,5g Broccoli extract (containing 75mg sulforaphane)

At the end of those 3 weeks, she received one IV Vitamin C treatment.

2 days after that we sent a blood sample to the lab for testing CTC. They slightly decreased from 200 to 150 CTC/ml (see attached image).

Of course we are glad that they decreased, but we would like to get them down to zero again.

We are thinking about the following protocol for the coming 3 weeks:

- 0,5g Omega 3
- 0,25g Liposomal Berberine
- 1g EGCG
- 0,9g Broccoli extract (containing 45mg sulforaphane)
- 3g Curcumin (with piperin)
- 100mg Aspirin
- 65mg Thymoquinone
- 1,5g Olive Leaf Extract

We are unsure about the dosages. Since she has problems taking more than 15-20 capsules/day, we decreased some of the dosages. But if there is a big benefit in taking more, I think she would do it.

If you were in her situation, would you do anything differently?

We already have Boswellia, Milk Thistle, Astragalus extract and Glutamine Inhibifour at home. Would you add those to the list? Do you see any synergies or counterindications with them?

I highly appreciate any shared thoughts and comments.

Kind regards,
Christian


   
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johan
(@j)
Joined: 5 years ago
Posts: 2115
 

@chris48

Hi Chris,

The drop from 450 to 200 on July 17, from the timeline you posted I'm not clear if she was on any supplements or treatment in and right before that 2-week time frame. Or was she on the supplements you posted (berb,sulf,egcg, and metf) at that time?

 

 

 

 

 


   
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(@chris48)
Joined: 2 years ago
Posts: 42
Topic starter  

Hi Johan,

she did not take any meds/supplements between the 450-200 drop (she just exercised more often). There were only 2 weeks between these measurements. According to Dr. Pachmann (head of the lab), it was very unusual because the CTCs are usually very stable. Her leukocytes were extremely high at the 200 measurement, which could indicate that the immune system reacted to a tumor (according to Dr. Pachmann).


   
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johan
(@j)
Joined: 5 years ago
Posts: 2115
 
Posted by: @chris48

Hello everybody,

here comes a brief update: My wife took these supplements for 3 weeks:

- 1g Metformin
- 1g Omega 3
- 0,25g Liposomal Berberine
- 2g EGCG
- 1,5g Broccoli extract (containing 75mg sulforaphane)

At the end of those 3 weeks, she received one IV Vitamin C treatment.

2 days after that we sent a blood sample to the lab for testing CTC. They slightly decreased from 200 to 150 CTC/ml (see attached image).

Of course we are glad that they decreased, but we would like to get them down to zero again.

We are thinking about the following protocol for the coming 3 weeks:

- 0,5g Omega 3
- 0,25g Liposomal Berberine
- 1g EGCG
- 0,9g Broccoli extract (containing 45mg sulforaphane)
- 3g Curcumin (with piperin)
- 100mg Aspirin
- 65mg Thymoquinone
- 1,5g Olive Leaf Extract

We are unsure about the dosages. Since she has problems taking more than 15-20 capsules/day, we decreased some of the dosages. But if there is a big benefit in taking more, I think she would do it.

If you were in her situation, would you do anything differently?

We already have Boswellia, Milk Thistle, Astragalus extract and Glutamine Inhibifour at home. Would you add those to the list? Do you see any synergies or counterindications with them?

I highly appreciate any shared thoughts and comments.

Kind regards,
Christian

Chris, why does she have problems taking more than say 20 capsules? Does she have gastrointestinal issues from the supplements (and if so do you know which), or difficulties swallowing?

The subsequent drops in CTC are encouraging but it's hard to define the recent drops to 150 as a downward trend, it would have to be confirmed in the future. 

If I'm right you are implementing the "Shutting Down the Power House of Cancer"-strategy proposed by @daniel. Daniel
has always highlighted the importance of an adequate dose, and looking at his article your dosage for most of the supplements you mention falls short of what he recommends.

Reducing inflammation (Curcumin, baby Aspirin and Olive Leaf Extract) is good but in cancer, it's unlikely to be curative.

You might want to get in touch with Dr. Nagourney. He recently wrote a blog on TNBC:
https://www.cancertreatmentsresearch.com/community/breast-cancer/stage-4-triple-negative-breast-cancer-the-right-treatment-may-be-at-hand/#post-5767

As for synergies and possible antagonistic interactions between supplements and repurposed drugs please check my
blog, I've posted on the supplements I find most relevant in cancer treatment with a particular interest in
synergies. https://synergiesforcancertreatments.blogspot.com

Best,

 


   
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(@daniel)
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Joined: 8 years ago
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@chris48 Hi Chris,

Thank you for the update. Reduction is always good, no matter what the reason is.

Of those you mentioned, as a next step, my focus would be on:

- High dose Curcumin (several tablets per day)
- Boswellia (several capsules per day)
- Thimoquinone (a few to several as possible with some oil to increase absorption)

Kind regards,
Daniel

This post was modified 1 year ago by Daniel

   
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johan
(@j)
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Posts: 2115
 
Posted by: @j
Posted by: @chris48

Hello everybody,

here comes a brief update: My wife took these supplements for 3 weeks:

- 1g Metformin
- 1g Omega 3
- 0,25g Liposomal Berberine
- 2g EGCG
- 1,5g Broccoli extract (containing 75mg sulforaphane)

At the end of those 3 weeks, she received one IV Vitamin C treatment.

2 days after that we sent a blood sample to the lab for testing CTC. They slightly decreased from 200 to 150 CTC/ml (see attached image).

Of course we are glad that they decreased, but we would like to get them down to zero again.

We are thinking about the following protocol for the coming 3 weeks:

- 0,5g Omega 3
- 0,25g Liposomal Berberine
- 1g EGCG
- 0,9g Broccoli extract (containing 45mg sulforaphane)
- 3g Curcumin (with piperin)
- 100mg Aspirin
- 65mg Thymoquinone
- 1,5g Olive Leaf Extract

We are unsure about the dosages. Since she has problems taking more than 15-20 capsules/day, we decreased some of the dosages. But if there is a big benefit in taking more, I think she would do it.

If you were in her situation, would you do anything differently?

We already have Boswellia, Milk Thistle, Astragalus extract and Glutamine Inhibifour at home. Would you add those to the list? Do you see any synergies or counterindications with them?

I highly appreciate any shared thoughts and comments.

Kind regards,
Christian

Chris, why does she have problems taking more than say 20 capsules? Does she have gastrointestinal issues from the supplements (and if so do you know which), or difficulties swallowing?

The subsequent drops in CTC are encouraging but it's hard to define the recent drops to 150 as a downward trend, it would have to be confirmed in the future. 

If I'm right you are implementing the "Shutting Down the Power House of Cancer"-strategy proposed by @daniel. Daniel
has always highlighted the importance of an adequate dose, and looking at his article your dosage for most of the supplements you mention falls short of what he recommends.

Reducing inflammation (Curcumin, baby Aspirin and Olive Leaf Extract) is good but in cancer, it's unlikely to be curative.

You might want to get in touch with Dr. Nagourney. He recently wrote a blog on TNBC:
https://www.cancertreatmentsresearch.com/community/breast-cancer/stage-4-triple-negative-breast-cancer-the-right-treatment-may-be-at-hand/#post-5767

As for synergies and possible antagonistic interactions between supplements and repurposed drugs please check my
blog, I've posted on the supplements I find most relevant in cancer treatment with a particular interest in
synergies. https://synergiesforcancertreatments.blogspot.com

Best,

 

https://www.roswellpark.org/newsroom/201904-researchers-uncover-new-role-tamoxifen-triple-negative-breast-cancers

"Tamoxifen is approved for treatment and prevention of ER-alpha-positive breast cancers, but was previously thought not to be effective against TNBC tumors because it targets ER-alpha, one of the proteins they lack. But this new work from a team led by Gokul Das, PhD, Associate Professor of Oncology in the Department of Pharmacology and Therapeutics and Co-Director of the Breast Disease Site Research Group at Roswell Park, proposes a new role for this broadly studied and well-tolerated targeted agent: targeting ER-beta."

You might want to check for synergies with Tamoxifen:
https://synergiesforcancertreatments.blogspot.com/p/synergies.html
There are quite a few!

 


   
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johan
(@j)
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Aspirin in combination with Letrozole or Olaparib induced apoptosis in estrogen receptor-positive T-47D & triple negative MDA-MB-231 breast cancer cell lines

https://aacrjournals.org/cancerres/article/80/16_Supplement/1441/641367/Abstract-1441-Aspirin-in-combination-with


   
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(@chris48)
Joined: 2 years ago
Posts: 42
Topic starter  

@daniel @j Hi Daniel and Johan,

thank you so much for your input!

Based on your feedback, we rethought the next protocol and Bianca agreed to increase dosages, although she has difficulties swallowing pills in general and has some minor stomach pain after taking sulforaphane. Anyway, we were thinking to do 3 weeks with slightly lower dosages, where she has to swallow only 22 pills/day and afterwards 1 week with higher doses, 2 IVC treatments and - if we find a doctor who prescribes it - Atorvastatin. For a better comparison, I attached a table.

The lower dosages we justify with mainly 3 arguments:
- Low bodyweight (55kg)
- Healthy diet with lots of Omega 3 (fe.g. flaxseeds) and sulforaphane (e.g. broccoli sprouts)
- Lot of exercise (less Metformin/Berberine needed?)

 

I still have many questions running through my head. Here are the top 5:

- What do you think about this protocol and the dosages (see attachment)?

- Since I do not find EDTA IV nearby (Cologne) to make IVC more effective, would you rather take EDTA or Baicalein capsules?

- Would you completely switch to the liposomal version of Curcumin or maybe take both forms in parallel?

- Is there any other med/supplement that you would consider for this protocol?

- Would you test the CTCs on sensitivity for meds and supplements?

Huge thanks again for all your help!

All the best,
Christian


   
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johan
(@j)
Joined: 5 years ago
Posts: 2115
 

@chris48 

Hi Chris, I think it's OK to take both curcumin formulas in parallel, and in order to make it easier to take supplements you can open the capsules that have powders in them and add them to a smoothie or juice. Also, I find it's easiest to swallow capsules, especially the bigger capsules, with liquids other than water, such as fresh juice, or chocolate milk (skimmed milk with 100% cacao, a good source of theobromine, dutch cacao has the highest %). 

Maybe add some ginger to her diet (e.g. ginger tea), dried ginger will give her the most 6-Shogaol, and it is a good combination with curcumin and egcg. 

A strong cytotoxic substance might be a good fit e.g. artemisinin. 

Best of luck!

 

 

 


   
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johan
(@j)
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Inositol hexaphosphate (IP6) enhances the anti-proliferative effects of adriamycin and tamoxifen in breast cancer
https://pubmed.ncbi.nlm.nih.gov/12846414/
Our data not only confirm that IP6 alone inhibits the growth of breast cancer cells; but it also acts synergistically with adriamycin or tamoxifen, being particularly effective against ER alpha-negative cells and adriamycin-resistant cell lines.

Tamoxifen and epigallocatechin gallate are synergistically cytotoxic to MDA-MB-231 human breast cancer cells
https://pubmed.ncbi.nlm.nih.gov/9892181/
In conclusion, low concentrations of catechins are cytotoxic to ERalpha- human breast cancer cells

Hydroxycitric acid potentiates the cytotoxic effect of tamoxifen in MCF-7 breast cancer cells through inhibition of ATP citrate lyase
https://www.sciencedirect.com/science/article/abs/pii/S0039128X20300817
Our results revealed that TAM effects on breast cancer are mediated, in part, through the regulation of key genes involved in lipid metabolism.

Synergistic inhibition of drug resistant breast cancer cells growth by the combination of luteolin and tamoxifen involves Nrf2 downregulation
https://www.jocpr.com/abstract/synergistic-inhibition-of-drug-resistant-breast-cancer-cells-growth-by-the-combination-of-luteolin-and-tamoxifen-involve-6169.html

Inhibition of breast cancer cell growth by combined treatment with vitamin D3 analogues and tamoxifen
https://pubmed.ncbi.nlm.nih.gov/7923220/

Synergistic cytotoxic effects of tamoxifen and black cohosh on MCF-7 and MDA-MB-231 human breast cancer cells: an in vitro study
https://cdnsciencepub.com/doi/abs/10.1139/Y07-111

Berberine enhances the anti‑tumor activity of tamoxifen in drug‑sensitive MCF‑7 and drug‑resistant MCF‑7/TAM cells
https://www.researchgate.net/publication/305078188_Berberine_enhances_the_anti-tumor_activity_of_tamoxifen_in_drug-sensitive_MCF-7_and_drug-resistant_MCF-7TAM_cells

Caffeine and Caffeic Acid Inhibit Growth and Modify Estrogen Receptor and Insulin-like Growth Factor I Receptor Levels in Human Breast Cancer
https://aacrjournals.org/clincancerres/article/21/8/1877/79074/Caffeine-and-Caffeic-Acid-Inhibit-Growth-and
findings demonstrate various anticancer properties of caffeine and caffeic acid against both ER+ and ER− breast cancer that may sensitize tumor cells to tamoxifen and reduce breast cancer growth.


   
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(@chris48)
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Topic starter  

@j Thank you so much for your very helpful feedback Johan! I think we will add both artemisinin and ginger to her list. Also thank you for the synergy list of tamoxifen! Due to the side effects and her NED situation we were hesitant to use it, but maybe it would also be a good idea to pulse it together with those supplements from time to time. 


   
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Posted by: @chris48

@j Thank you so much for your very helpful feedback Johan! I think we will add both artemisinin and ginger to her list. Also thank you for the synergy list of tamoxifen! Due to the side effects and her NED situation we were hesitant to use it, but maybe it would also be a good idea to pulse it together with those supplements from time to time. 

My father in law has been on tamoxifen 20mg for about 19 years now without noticeable side effects, and since TAM could be useful even in TNBC ( https://www.roswellpark.org/newsroom/201904-researchers-uncover-new-role-tamoxifen-triple-negative-breast-cancers) it looks like a good option to consider and discuss with her oncologist.


   
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johan
(@j)
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Posted by: @j
Posted by: @chris48

@j Thank you so much for your very helpful feedback Johan! I think we will add both artemisinin and ginger to her list. Also thank you for the synergy list of tamoxifen! Due to the side effects and her NED situation we were hesitant to use it, but maybe it would also be a good idea to pulse it together with those supplements from time to time. 

My father in law has been on tamoxifen 20mg for about 19 years now without noticeable side effects, and since TAM could be useful even in TNBC ( https://www.roswellpark.org/newsroom/201904-researchers-uncover-new-role-tamoxifen-triple-negative-breast-cancers) it looks like a good option to consider and discuss with her oncologist.

btw, tamoxifen is a small pill, in the attached pic it's next to a berberine capsule. Berberine caps can easily be opened and added to food or juice as it's a powder.


   
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laika
(@laika)
Joined: 1 year ago
Posts: 11
 

Hi @chris48

Was her tumor PD-L1 positive, and is there any possibility of getting her on adjuvant Keytruda? It is now FDA-approved for high risk early stage TNBC in the USA. Even a year out from ending treatment, it may still be beneficial.

https://www.merck.com/news/pivotal-phase-3-data-for-keytruda-pembrolizumab-in-high-risk-early-stage-triple-negative-breast-cancer-tnbc-published-in-the-new-england-journal-of-medicine/

Best wishes, sorry you're in this situation,

Anna


   
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(@laika)
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This is anecdotal, but I've been on Tamoxifen 20mg (stage IV TNBC) for 6 months or so now, with no side effects.

I am also on zolodrenic acid, however, which reduces risk of bone issues due to the Tamoxifen. For an early-stage NED person I guess the risk-benefit analysis shifts. I personally would try it and take a limited course (maybe a year or so) if she didn't have side effects. Alldaychemist sells a 10mg formulation as well.


   
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(@chris48)
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Topic starter  

Hi everybody,

unfortunately we are not in a NED situation anymore. This week, a new tumor (same physiology than primary tumor) was detected via ultrasound (it was not visible on mammography or CT scan). It is only 5x8mm in size. She will have surgery already next Thursday, but we do not know what exactly will be done (removal of one or both breast? With skin and nipples or without? With axilary lymph nodes or not?).

Would you take any supplements or meds (e.g. NSAIDs) prior or after surgery?
Do you have any other comment or advise?

@j, @daniel, @laika Thank you so much for all your help and support so far! Laika, I will send another reply to your earlier message tomorrow.

All the best,
Christian


   
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johan
(@j)
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@chris48 I am very sorry to hear of this recurrence.  @daniel might have some good suggestions to consider prior to surgery. The suggestions I have posted above remain relevant post-surgery. In addition, esomeprazole seems another option worth exploring, as is mistletoe ( https://juniperpublishers.com/jcmah/pdf/JCMAH.MS.ID.555815.pdf).


   
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(@daniel)
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@chris48 Dear Chris,

I am sorry to hear that there is some progression.

Time to surgery is relatively short but here is a study indicating it makes very much sense to use HydroxyChloroquine prior to surgery https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779365/

The same study indicates that using drugs or supplements that can increase intracellular Calcium in cancer cells is a great addition to the above. Here is a list of substances that modulate intracellular Calcium: https://www.cancertreatmentsresearch.com/just-another-perspective-a-calcium-perspective/

One to two weeks after surgery, I woudl consider adding Cimetidine. It is available in Germany.

Finally, you may want to check this: https://www.cancertreatmentsresearch.com/community/surgery/nsaids-before-breast-cancer-surgery-can-dramatically-decrease-recurrence/
If you like to find European centers using this approach prior to surgery, please contact the following foundation and they are likely to help as they have a good view on who is doing this https://www.anticancerfund.org/en/partners

I hope this helps.

Kind regards,
Daniel

 

This post was modified 1 year ago by Daniel

   
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(@chris48)
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Posted by: @laika

Hi @chris48

Was her tumor PD-L1 positive, and is there any possibility of getting her on adjuvant Keytruda? It is now FDA-approved for high risk early stage TNBC in the USA. Even a year out from ending treatment, it may still be beneficial.

https://www.merck.com/news/pivotal-phase-3-data-for-keytruda-pembrolizumab-in-high-risk-early-stage-triple-negative-breast-cancer-tnbc-published-in-the-new-england-journal-of-medicine/

Best wishes, sorry you're in this situation,

Anna

@laika

Dear Anna,

thank you so much for your input and your kind words! We do not know yet, if her tumor is PD-L1 positive. We have not even really talked to her doctors yet (we just got the diagnosis and were sent to CT scan). But we have an appointment for tomorrow to discuss the surgery and all other treatment options. I will keep posting updates in this thread.

Thank you also for your comment about Tamoxifen! We have it on our list, but until now, we were hesitant to use it. Maybe we will rethink it now.

Since you are fighting a similar fight, if you are interested, I could send you an overview of all the meds, supplements and therapies that we looked into. It is mostly in German, but with lots of references to the according studies. And with deepl it is easy to translate the German parts.

And if you are willing to share your whole situation and what you are doing about it, I am of course very interested.

All the best,

Christian


   
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(@chris48)
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Topic starter  

@daniel @j Thank you so much for your input! Very interesting information that we will look into more deeply during the next days. I think we will definitely take Aspirin, but we are unsure about the dosage. And some drugs to increase intracellular Calcium. Also the others look great, but we need to find a doc who is willing to prescribe them since our current docs are sticking to the official guidelines very strictly. I will contact the anticancerfund that you shared to see if they can give us advise in that respect. The thing is that we were quiet lucky to get a surgery appointment that quickly and since her tumor is growing so fast, we do not want to postpone it.

Anyway, I can't thank you enough and I hope you have a great Sunday!

All the best,
Christian


   
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johan
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@chris48 here's a website with good information on breast cancer:

https://foodforbreastcancer.com/news.php

 

 


   
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johan
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Foods to eat & avoid for triple-negative (ER-/PR-/HER2-) breast cancer:

https://foodforbreastcancer.com/articles/foods-to-eat-%26-avoid-for-triple-negative-%28er--slash-pr--slash-her2-%29-breast-cancer


   
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johan
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"Luteolin inhibits the metastasis of triple-negative breast cancer"
https://foodforbreastcancer.com/news/luteolin-inhibits-the-metastasis-of-triple-negative-breast-cancer

"Sulforaphane inhibits HER2+ and triple-negative breast cancer"
https://foodforbreastcancer.com/news/sulforaphane-inhibits-her2%2B-and-triple-negative-breast-cancer

"Quercetin and fisetin inhibit TN cell migration"
https://foodforbreastcancer.com/news/quercetin-and-fisetin-inhibit-tn-cell-migration


   
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johan
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Posted by: @chris48

I think we will definitely take Aspirin, but we are unsure about the dosage.

I am aware of people using several grams a day (slowly up titrate starting with one regular aspirin), for advanced cancers. To minimize stomach upset dissolve the aspirin in water. 1 mg of K per 325mg of aspirin, vitamin C, and Vitamin D3.


   
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