In medical terminology, spontaneous remission of cancer refers to the unexplained and sudden disappearance of all signs and symptoms of
A number of theories have been proposed to try and explain the obscure mechanisms responsible for spontaneous remission. The most popular theory postulates that the immune system causes spontaneous remission. Another theory suggests that hypothyroidism slows down the growth of cancerous cells. Other researchers think DNA modulation plays a key role in cancer remission. The truth is, no one has come up with an undisputable scientific explanation for spontaneous remission of cancer.
Some people may ask why is it important to understand spontaneous remission? The main reason researchers should be interested in spontaneous remission is that it could pave the way for new and more effective therapies to treat cancers. It offers a solid basis of hope and firmly establishes nature's willingness to yield its secrets of cancer healing. Most cases of spontaneous remission are often preceded by acute febrile infections. There are many documented cases of cancer that underwent spontaneous regression after acute bacterial infections e.g. streptococcal or staphylococcal infections. A study carried out by Kleef et al for the office of Complementary and Alternative Medicine (NIH, Bethesda) concluded that the occurrence of fever in childhood protected against the later onset of malignant disease and that spontaneous remission is often preceded by febrile infections.
The incidence of spontaneous remission has been estimated to range from 1:60,000 to 1:100,000. Despite the existence of such an amazing natural phenomenon there is currently very little research focusing on spontaneous remission. The impression I get is that cancer researchers do not consider this topic serious enough to warrant a thorough and conclusive study.
Coley's Toxins:
One doctor who decided to take the phenomenon of spontaneous remission seriously was Dr. William B. Coley, an eminent New York surgeon. He spent most of his career working at Memorial Hospital (now Memorial Sloan-Keterring Center). He was convinced there was a more effective way of treating cancer after witnessing the disappointing results of surgery; the standard treatment of solid tumors at the time. He started his search by going through all the records of sarcoma patients at the hospital. To his surprise he came across the case of a German immigrant that had undergone spontaneous remission, after the doctors treating him had declared his cancer terminal. This regression had occurred after a severe attack of erysipelas. Coley searched the east side of New York for the man and found him in apparently good health more than seven years after his "miraculous" healing.
Coley was inspired by this particular case and he decided to experiment with Streptococcus pyogenes the bacterial organism that causes erysipelas. His initial aim was to induce spontaneous remission after inoculating the patient with erysipelas. However, he later decided to use non infectious by products of Streptococcus to minimize the risk of death in his patients. He also discovered that by combining the products of Streptococcus pyogenes with those of Serratia marcesens he could produce a more potent vaccine. The classic Coley's toxins, was a mixed bacterial vaccine containing both endotoxins and exotoxins. Coley's toxins administered in adequate doses caused an acute immune reaction similar to that produced by an acute bacterial infection. The clinical symptoms observed in patients injected with the vaccine were fever, chills, rigors, joint pains and general malaise.
Coley and his colleagues in Europe and America treated thousands of cancer patients.
His daughter Helen Coley-Nauts collected his records and summarized the outcome of 900 microscopically confirmed cases. The five year survival rate for this particular group of patients was found to be 50%. This proves that Coley's toxins achieved excellent clinical results that exceeded the efficacy of the current treatment modalities. Even staunch critics of the vaccine admitted that a number of hopeless cancer cases were completely cured by Coley's toxins.
However despite these achievements the use of Coley's toxins began to decline after his death in 1936. Eventually the Food and Drug Agency declared that Coley's toxins were ineffective in the treatment of cancer. As a result of the FDA's decision in 1963 it became illegal to use and produce the vaccine in America. This decision was primarily due to the fact that Coley's toxins produced very unpredictable clinical results in cancer patients. Despite the fact that hundreds of patients experienced complete remissions, the vast majority of patients with malignant disease did not respond at all to the toxins. Another factor that contributed to the demise of Coley's toxins is the lack of theoretical basis that could fully explain its selective efficacy. Since no one knew how it worked no one could improve its efficacy. The discovery of "more effective" therapies in the form of radiotherapy and chemotherapy diverted human and financial resources. These new therapies produced more consistent clinical results and were easier to understand scientifically. Last and not least economic factors also helped to push Coley's toxins out of the list of mainstream medical treatments, into the twilight zone of alternative therapy. This was mainly due to the fact that the various components required to produce Coley's toxins were readily and cheaply available. Therefore, most pharmaceutical companies decided to channel their resources into researching and manufacturing chemical compounds that could be patented. This led to the birth of the powerful multimillion dollar chemotherapy industry.
However despite the fact that the use of Coley's toxins in cancer treatment is no longer considered to be an effective option, a small number of researchers are still fascinated by the dramatic results achieved in some patients. However one scientific fact not disputable regarding the positive clinical benefits observed in some patients, is the presence of fever; i.e. the patients who had high fever had significantly higher rates of remission than those who had mild fever or no fever at all.
Current Research
Research regarding Coley's toxins focused mainly on the immune system. Immunologists began with the assumption that one of the chemicals produced by the cells of the immune system during an acute immune reaction was responsible for the vaccines efficacy. The race to identify the "active" factor produced in response to Coley's toxins was on. Chemicals produced by the immune system cells to modulate its activity are known as cytokines. Numerous cytokines have been discovered since the 1950s. These include Interleukin-1[IL-1], IL-2, IL-6, IL-8, IL-12, Interferon gamma, macrophage colony stimulating factor and tumor necrosis factor. Some of these cytokines have marked anti-tumor activity, which has been clearly demonstrated in in-vitro studies as well as in laboratory animals. However clinical trials in humans using specific cytokines in combination with chemotherapy or as a monotherapy have produced disappointing results. These poor results have been obtained despite the fact that very high doses of cytokines have been used in these clinical trials when compared to the levels usually produced by the body's natural response. In recent years immunologists have redirected their efforts towards identifying specific antigens produced by malignant cells only. Some of these antigens, which provoke a limited immune response have been well characterized. However despite these promising laboratory studies a crucial clinical breakthrough in cancer vaccination is still missing. In other words the various immuno-therapeutic modalities in use today have not made a significant impact in the lives of cancer patients. This has not surprised most immunologists since the primary function of the immune system is to protect the body from invasion by foreign organisms; i.e. infectious agents. It is therefore rather obvious that although Coley's toxins cause an immune reaction it is not the immune system that is responsible for the tumor regression. This has convinced another group of researchers to concentrate their efforts on the fever produced by the mixed bacterial vaccine. Scientists have discovered that high temperatures may help shrink tumors. The National Cancer Institute is currently undertaking studies to determine the efficacy of local, regional and whole body hyperthermia in cancer treatment. Local hyperthermia refers to heat application to a small area. This can be done using an implanted microwave antennae or externally using high frequency waves. Regional hyperthermia uses radio frequency waves to heat deeper tissues or limbs. Typically the area to be heated is surrounded by rings of radiating elements. Whole body hyperthermia required the use of warm water blankets, inductive coils or thermal chambers. This method delivers the thermal energy to the entire body and is frequently used with other systemic therapies e.g. chemotherapy.
It seems as though researchers have completely forgotten the fact that Coley treated his patients with a simple mixed bacteria vaccine. I think that these two groups of researchers should take some time out and review Dr. Coley's seminal work.
New Hypothesis on Spontaneous Remission
Since fever has been clearly identified through epidemiological studies as an important factor in cancer remission, any theory regarding this phenomenon must take it into account. Fever is the oldest and most universally known hallmark of disease. It occurs not only in mammals but also in birds, reptiles, amphibians and fish. In acute infections fever, is induced by the toxins produced by bacteria. Endotoxins act on macrophages, monocytes and kupffer cells to produce interleukin-1. IL-1 enters the brain to act on the pre-optic area of the hypothalamus. Activation of this area causes the body to raise its temperature set point and the temperature raising mechanisms are activated. The benefits of fever to the organism have not been fully determined. However since fever has persisted as a response to infections and other diseases during the course of evolution, it is presumed to be beneficial.
The main effect of fever on the body cells is an increase in their metabolic rates. It therefore seems logical to think of Coley's toxins as a metabolic therapy rather than an immuno-therapy. However, since fever alone did not result in 100% remission after administration of the toxins it seems reasonable to consider the possibility of another factor [or factors] playing a role in the remissions produced by Coley's toxins. Since fever is a metabolic factor, the search for other factors should start by focusing on any other peculiarities that affected the metabolism of the patients who responded well to the toxins. One factor that comes up again and again when reading the narratives of the cancer patients who responded dramatically to Coley's toxins is starvation. In my view the incidence of undernourishment appears to be remarkably high in the anecdotal cases that are frequently touted as proof of the toxins. Indeed Coley's first patient had a sarcoma affecting his neck and tonsils. In fact it is said that the patient was in danger of dying from starvation. After several attempts, Coley succeeded in infecting him with a virulent strain of Streptococcus. He developed severe anorexia, vomiting and a high fever and his tumor began to shrink almost immediately. He went into remission for eight years after just one attack of erysipelas.
Another interesting case was that of a woman from Kentville, Nova Scotia. She was suffering from renal cell carcinoma with peritoneal metastases. The surgeon who operated on her felt that her case was utterly hopeless and he thought that she would not survive the trip back home. In Kentville, her doctor gave her what he thought was a lethal dose of the toxins to end her suffering. That dose caused an almost instant remission of her cancer. The patient was traced forty years later still free from cancer.
I have formulated a theory on spontaneous remission based on the facts mentioned above: the patients who have undergone spontaneous remission of cancer as well as the patients that underwent remission after administration of Coley's toxins did so as a direct result of inadvertently combining starvation with high fever.
Since the main physiological effect of starvation is the mobilization of fatty acids and the formation of ketone bodies by the liver, it is very likely that reduced consumption of glucose and increased utilization of fatty acids derivatives makes malignant cells very susceptible to the increased metabolic rate that occurs during fever.
Cancer researchers have long suspected that cancer cells are susceptible to certain chemical or physical conditions due to their genetic abnormalities. I propose that cancer cells can be killed selectively probably by stimulating apoptosis i.e. programmed cell death. This can be done by reducing glucose as a metabolic substrate and increasing the consumption of ketone bodies. This must then be followed by a sudden increase in metabolic rate using fever or external thermal sources.
Thyroid hormones increase the oxygen consumption of most metabolically active tissues in the body. The only exceptions are brain cells, the testes, uterus and lymphatic tissue. The magnitude depends on the metabolic rate prior to giving the hormone. The higher the metabolic rate before the hormone is given the lower the rise in metabolism. Similar changes occur in the rate of metabolism as a result of fever.
It would also be of interest to mention the fact that thyroid hormone is known to cause apoptosis of tadpole tail cells. Zoologists have also noted that tadpoles tend to starve themselves during this particular phase of their development when they transform into frogs.
Clinical and epidemiological studies
The next course of action will involve scientific studies to validate my theory regarding spontaneous remission. This will involve large scale and comprehensive clinical epidemiological studies.
Epidemiological studies will focus on the metabolic factors and their relationship with the spontaneous remission. These retrospective studies will investigate the positive relationship between spontaneous remission of cancer on one hand and the presence of both fever and starvation on the other hand. To avoid any controversies the remission cases to be studied should only be of microscopically confirmed cancer. The metabolic factors to be studied will be the presence of fever at least on one occasion as well as starvation prior to or during the febrile reaction. With regard to these metabolic factors both objective and subjective reporting should be accepted as valid.
Clinical factors of starvation include:
- Severe anorexia. especially in bed-ridden patients or those with high tumor loads.
- Recurrent bouts of vomiting e.g. tumors causing gastric or intestinal obstruction.
- The inability to ingest food e.g. in tumors of the palate, pharynx or esophagus.
- Severely debilitated or comatose patients.
- History of rapid weight loss
- Major depression e.g. pancreatic tumors
A similar retrospective study of patients who responded to Coley's toxins needs to be carried out. The main aim of such a study will be to prove that the patients who responded to the treatment did so as a result of the fever induced in patients who were deprived of adequate nutrition. It will also show that those who had only one of these metabolic factors i.e. starvation or fever, did not respond as well as those with both fever and starvation occurring concurrently.
Clinical studies should also be carried out concurrently due to the fact that many cancer patients have already run out of options. Many of these patients who are currently receiving only palliative treatment will make good candidates for the clinical trials. The first step will involve a period of starvation ranging from 7 to 10 days. This period will allow for adequate mobilization of fatty acids and formation of ketone bodies. By the end of this period most non-neural tissues including cancer cells will be utilizing fatty acids and ketone bodies as their major sources of energy. Alternatively a ketogenic diet can be given to those patients who are unable to tolerate starvation or in those who are already undernourished. It may also be interesting to note at this point that some people have advocated for the use of insulin coma therapy as a treatment for cancer. I believe that the few cases of cancer remission that have been recorded as a result of insulin therapy have occurred as a result of starvation combined with low-grade fevers. Insulin only augments the natural effect of starvation of lowering the blood sugar.
The second step in the clinical studies will involve suddenly increasing the metabolic rate of the malignant cells. Since most cancers are systemic diseases this will involve increasing the metabolic rate of the whole body. The three basic methods of causing a rapid and sustained increase in the metabolic rate include:
- Intravenous infusion of a mixed bacterial vaccine
- Whole body hyperthermia using external devices.
- Intravenous thyroid hormone [Tri-iodothyronine]
The first choice will involve the intravenous administration of a relatively high dose of a standardized mixed bacterial vaccine like Coley's toxins. The sole purpose of this infusion will be to stimulate the immune system cells to produce fever-inducing cytokines to enable the formation of an acute febrile response. High fevers lasting at least ten hours will probably be sufficient to achieve a measurable clinical response. Body temperature, blood pressure, and pulse rate should be closely monitored to enable clinicians to act rapidly in case of adverse reactions. The blood levels of glucose, fatty acids, and ketones should also be measured to assess their overall and individual contribution to the efficacy of the treatment. Patients should be given appropriate information regarding the expected side effects. They should be informed that they will have to tolerate the side effects of fever since the analgesics commonly used to treat the generalized body pains tend to lower the fever which is required for its direct therapeutic effect on cancer cells. Immediately after the treatment the patients should be assessed to determine the efficacy of the treatment. The final clinical protocol that will be formulated will make room for adjustments to cater for individual treatment. The patient's age, weight, sex, general health, tumor type, tumor size, tumor site and state of the immune system will have to be taken into account.
The second method of increasing the metabolic rate of previously starved cancer patients will involve the use of external heating devices. Since the devices and machines necessary for artificially increasing body temperature are already available in many leading research centres, this method can be quickly evaluated. This method of treatment will be particularly useful in cancers limited to specific organs or limbs.
The third method of increasing the metabolic rate will involve the use of thyroid hormones. The dose to be used should be as high as those used in the treatment of severe hypothyroidism. The only limitation will be the fact that some malignant cells may not respond to treatment because they may lack receptors for thyroid hormone.
Experiments to confirm the role of fever in boosting the immune response should also be carried out. I believe that some of the puzzling behavior observed in sick animals can now be understood. I believe that the reduced food appetite, lethargy and sleepiness observed in animals with acute infections, is a deliberate effort geared towards causing nutritional starvation. The main aim of this starvation is to reduce the glucose consumption of immune cell precursors and increase their use of fatty acid metabolites. This effect is then combined with the hypercatabolic state induced by the fever to stimulate the maturation of the immune cell precursors. Therefore it appears as though fever and anorexia were invented by evolutionary forces to act primarily on immature immune cells. This activity is probably not confined to immature immune cells, since spontaneous remission proves it also acts on other immature cells including undifferentiated malignant cells.
Finally many alternative cancer therapies in use today may have been inspired by actual cases of spontaneous remission caused by the combination of starvation and fever. The doctors who observed them may have considered other more obvious factors leading them to formulate erroneous theories on spontaneous regression. This may include the following:
1. Dr. Josef Issels; whole-body comprehensive immunotherapy.
2. Dr. M. Gerson; combined dietary regime.
3. Dr. Sam Chachoua; induced remission therapy.
4. Dr. Subgis Korolijow; insulin hypoglycemic therapy.
Social and Economic impact
The news of a real breakthrough in cancer treatment is going to be greeted with great joy and relief. Cancer is one of the most dreaded diseases in the world today. It is responsible for the deaths of millions of people worldwide . In the United States alone it kills 350,000 people annually. However once the general population realizes that the phenomenon of spontaneous remission of cancer has been occurring for hundreds of years, they will be shocked by the fact that most cancer researchers had not given it the attention it deserves. The general public will also be informed of the incredible work of William Coley and how it was generally ignored despite some promising results. Most people will soon realize that this breakthrough should have occurred decades ago. Their jubilation will then be replaced by anger. Anger due to the unnecessary pain and suffering endured by cancer patients as a result of the disease or the toxic treatments administered.
Most people will find it hard to believe that a treatment so simple could have eluded thousands of brilliant scientists working in the numerous cancer research institutes. But the fact of the matter is very few of these organizations are interested in researching spontaneous remission. Most of these organizations [especially those privately funded] have become like the pharmaceutical companies they depend on for financial support. They have become obsessed with the idea of discovering a new molecule that can treat various malignancies. This is mainly due to the perception that only novel molecules can be patented. Therefore, most research being carried out today as far as new cancer treatments are concerned is geared towards potentially profitable new molecules. However publicly funded research institutes are supposed to approach cancer with a broader view. Such public institutes should seriously investigate alternative views of cancer treatment as well as apparently strange phenomenon as spontaneous regression. For example, does the National Cancer Institute have any theory regarding spontaneous remission? Does the NCI keep any statistics regarding spontaneous remission? These are the kind of questions that the NCI director might be asked, by a special congressional committee that will be investigating this issue in the near future.
The economic impact will be much more dramatic. The pharmaceutical companies specializing in cancer chemotherapies will be greatly affected by the losses that they will definitely incur, as their products will certainly be declared obsolete. Drug regulatory agencies like the FDA will have no choice but to ban the use of most chemicals used in cancer therapy today.
Oncologists and cancer researchers will not be spared. Many researchers will find themselves jobless since most of their funding is obtained from pharmaceutical companies. Most individual donations will probably cease once the general public gets the perception that the war on cancer is finally over. Doctors involved in the diagnosis and treatment of cancer will notice a marked reduction in the demand for their services.
Summary
In conclusion, I believe that the metabolic therapies outlined above will form the basis of a new modality of cancer treatment. A new type of treatment that is exactly what health care providers and consumers had been hoping for, an effective and cheap method of eliminating cancer forever.
In future, the failure by cancer researchers to seriously study spontaneous remission will be regarded as the biggest error in the history of modern medicine. A mistake that caused a lot of unnecessary suffering and loss of life.
Joseph Thuo-Medical Officer working for the Ministry of Health [Kenya]
References
1. Majid Ali
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3. Chang WY. Complete spontaneous regression of cancer; four case reports, review of literature, and discussion of possible mechanisms. Hawaii Med J. 2000 Oct;59(10):379-87
4. Hall, Stephen S. A commotion in the blood: life death and the immune system. New York, Henry Hold, 1997.
5. Kluger MJ, Kozak W, Conn CA, et al. Role of fever in disease. Ann N Y Acad Sci 1998;856: 224-33
6. Hercbergs A, Leith JT. Spontaneous remission of metastatic lung cancer following myxedema coma. Journal of the National Cancer Institute. Vol 85(16)(pp 1342-1343), 1993
7. Hercbergs A. Spontaneous remission of cancer-a thyroid hormone phenomenon? Anticancer Res 1999 Nov-Dec; (6A):4839-44.