A NEW FORM OF CHEMOTHERAPY FROM JAPAN
From The Cancer Chronicles #12
© Autumn 1992 by Ralph W. Moss, Ph.D.
THIS IS PRACTICALLY THE ONLY ARTICLE IN FAVOR
OF CHEMOTHERPY EVER PUBLISHED IN THE CANCER
CHRONICLES. MANY MONTHS LATER, A WOMAN
CORNERED ME AT AN ALTERNATIVE HEALTH
CONVENTION. "SO," SHE DEMANDED, ANGRILY, "ARE
YOU STILL PUBLISHING THAT PRO-CHEMOTHERAPY
Cancers of the liver or the lung, whether a primary growth or
metastases, are among the most ominous types of malignancy.
There are very few good treatment options, and patients often
lose hope when they learn they have this condition. There is
however a new and innovative Japanese treatment which is
offering hope to some people with these conditions.
The treatment is a new form of chemotherapy with the rather
inelegant name of SMANCS-Lipiodol. Let's break this down.
First of all, NCS stands for "neocarzinostatin," an antitumor
antibiotic derived from the 'strep' microbe and discovered in
Japan in 1965. Its nature was characterized by H. Maeda in 1966,
currently chairman of the Microbiology Department at the
University of Kumamoto. Over 500 scientific papers have been
written about NCS, one of a class of anticancer compounds known
as Enediynes (Science 5/22/92).
The SMA in SMANCS stands for a mixture of two other
chemicals that increase the activity of the primary drug. (Drugs
other than SMANCS are also being tried in this approach.)
Lipiodol is thick, viscous stuff produced by mixing iodine, about
40 percent by volume, with vegetable oil. It is routinely used as a
contrast medium for X rays. In other words, when x-ray pictures
are taken, lipiodol makes internal organs show up better.
It also turns out--and this is the real innovation--that this oily
contrast agent enhances the activity of chemotherapy, including
SMANCS, in key internal organs. The oil is sticky and
particularly so in cancer. It exploits the helter-skelter blood
vessels the tumor has patched together for its own growth and
survival. At the same time, doctors temporarily raise the
patient's blood pressure to drive the oily mixture deep into the
In 1986, Dr. T. Nonno wrote in a Japanese medical journal: "We
discovered that when the lipid contrast medium, Lipiodol, was
administered arterially, it remained selectively in the solid
tumor for a long time. Using this characteristic nature of
lipiodol... remarkable anticancer effects against various
malignant solid tumors were observed...."
The word "chemotherapy" usually conjures up serious side effect
damage to the immune system. For example, a standard
treatment for liver cancer, 5-fluorouracil (5-FU), can be
extremely toxic. SMANCS/Lipiodol, while certainly
chemotherapy, appears remarkably non-toxic . However, there is
a big "but," that must modify this statement. For if it is
administered incorrectly, it can also be highly toxic, even fatal.
In the Maki Hospital in Kumamoto, Japan, Dr. S. Maki infuses a
solution of SMANCS-Lipiodol into the affected organ (generally,
the liver or lung) by means of a catheter. This is introduced into
a major blood vessel that runs past the groin, the femoral artery.
This catheter is carefully threaded up the blood stream toward
the target organ. Needless to say, this has to be done by a very
skilled surgeon, such as Dr. Maki.
If by chance the drug is fed into the wrong artery, it could do
heavy damage. In the case of the liver, it can accidentally infuse
the sensitive tissues of the stomach or gastrointestinal tract and
result in instant ulcers. In the case of the lung, mistakenly
introducing SMANCS/Lipiodol into the arterial feed of the spinal
column could result in instant paralysis.
Nevertheless, some brave doctors and very much braver patients
have started to employ this therapy in Japan. A smattering of
Occidentals are also going to Japan to receive it. A man named
Harlan Smith has posted the fascinating account of his and his
wife, Betty's, Japanese odyssey to the "Cancer Forum" of
Compuserve. At this writing, the Smiths are on their second trip
to the Maki Hospital in Kumamoto, an island in Western Japan.
Harlan is a 61 year old electrical engineer and Betty , 59, a
retired S&L branch manager. They have five children and five
In August 1990, Betty had surgery for colon cancer. A year later
the cancer had spread and Dallas surgeons removed half her liver
to stop metastases. However, Betty's cancer progressed to both
liver and lung. The Smiths rejected the conventional therapy for
this condition (5-FU/leukovorin) because they were "not very
impressed with its performance." They instead decided to explore
all options they could discover. The Smiths eventually uncovered
this new treatment, SMANCS-Lipiodol.
From Harlan's account, one can draw the following conclusions:
- The treatment seems helpful, if not a miracle cure. After several
weeks of treatment, Betty's liver tumors have stabilized, if they have
not yet completely disappeared.
- The Japanese people have been extremely friendly, which makes up
for some of the formidable language and dietary differences.
- The doctors and staff at the Maki Hospital, including Dr. Maki himself,
seem skillful and compassionate, although there are communications difficulties.
- The cost of the treatment is around $15,000. This is no higher than
many treatments in the US. The main problem is that third party insurance
companies balk at paying for anything experimental.
- In general, Harlan has found the FDA, which has not approved the
therapy, to be uncooperative in helping him get SMANCS for Betty in
the United States, whereas NCI officials have been somewhat more helpful.
SMANCS is clearly not for everyone. But for those who have
sufficient time, energy and money, it is definitely something to
know about in the treatment of cancers that are not easily
benefited by any approach. In addition to the Maki Hospital, other
doctors using similar methods include N. Nakoa, Department of
Radiology, Hyogo College of Medicine, Nishinomiya,who has
increased 5-year survival of advanced liver cancer from 18 to 27
percent, and T. Kanematsu, Department of Surgery II, Faculty of
Medicine, Kyushu University, Fukuoka, who calls this is "an
effective treatment for [liver] carcinoma" when the tumor cannot
be surgically removed.
IN CANCER CHRONICLES #13 (December, 1992)
HOWEVER WE ISSUED THE FOLLOWING:
UPDATE ON JAPANESE CHEMO
In the last issue, we discussed a relatively new form of
chemotherapy, SMANCS/Lipiodol, used experimentally in Japan.
Harlan Smith, who investigated this method first hand, now feels
his description may have been too optimistic. When U.S. doctors
examined his wife Betty's MRI scans they concluded that no real
progress had been made in regressing her tumors. Betty is now
undergoing the Burzynski treatment in Houston.... Harlan also
wants it known that not just NCI, but also FDA, co-operated with
him in obtaining the Japanese chemotherapy for his wife in the
articles on war on cancer
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