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From the Townsend Letter
August / September 2013

Current Themes in Integrative Cancer Research and Cancer Care
An Interview with Leanna Standish, PhD, ND, MS, LAc, FABNO
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Leanna Standish, PhD, NDLeanna Standish, PhD, ND, is a neuroscientist and a naturopathic physician who is board certified in naturopathic oncology. Dr. Standish is medical director of the Bastyr Integrative Oncology Research Center (BIORC), which has been providing best-science, best-practice, integrative oncology treatment for the past four years. Her primary research over the last 16 years has focused on cancer and brain research and she is currently co-principal investigator on two major NIH sponsored grants: a prospective outcomes study on breast cancer integrative oncology at BIORC and another on medicinal mushrooms with the Bastyr/University of Washington Oncomycology Translational Research Center.

Naturopathic Oncology
Dr. Leanna Standish: Naturopathic oncology has become an emerging and vibrant field within integrative oncology, applying the basic principles of integrative medicine to cancer treatment. This discipline was formalized in 2006 and now offers national board certification. There is also a fellowship designation: a practitioner who has been board certified in naturopathic oncology is designated a Fellow of the American Board of Naturopathic Oncology, comparable to the type of credentials that a cardiologist would seek after training in primary care. The national meeting of the Society of Integrative Oncology happens every year and is producing some of the best ideas (and possibly some of the best outcomes) in cancer treatment today.

Bastyr Integrative Oncology Research Center (BIORC)
I come to complementary and alternative medicine with a PhD and a very hard-nosed background in neuroscience. That background turns out to be a good fit with my work in naturopathic oncology at Bastyr. We have been funded by the National Institutes of Health to collect outcomes data and to evaluate the safety and effectiveness of integrative oncology.

Outcomes studies from clinics that provide integrative oncology are surprisingly rare. At Bastyr University, the University of Washington, and Fred Hutchinson Cancer Research Center, researchers are trying to figure out whether full-on integrative oncology services actually make a difference – whether integrative oncology care improves the aspects of health that cancer patients and doctors care about. We don't want the cancer to come back after good primary treatment, usually by conventional medicine. We also want our patients with stage 4 not to progress in their disease. Clearly we want them to live as long as possible with very high quality of life. Those are what we're measuring in our patients. We have an NIH grant to track treatment outcomes for breast cancer. The other area of work for BIORC is to develop, study, and evaluate new integrative oncology treatments.

The Oncomycology Translational Research Center
We also have a center grant from the NIH to investigate medicinal mushrooms and cancer in a research program at the Oncomycology Research Center. Historically, the Chinese, Koreans, Japanese, Taiwanese, and Vietnamese have all known about these mushrooms for thousands of years, but it is just now in the 21st century that this knowledge is being translated from the East into natural medicine that has solid data behind it.

There has been a growing understanding of the role of the immune system in cancer, a reflection of synergy in the fields of immunology and oncology over the last 20 years. Currently, the thinking is that the development of cancer, of malignancies and tumors, is really a failure of the immune system. What my group is working on is the evaluation of immune therapies that are used by traditional Chinese medicine practitioners and naturopathic physicians who specialize in oncology.

After four years of data gathering, we are about to take a very careful look at our survival outcomes and see if they are better than standard care alone. Preliminary survival results will be presented in 2013 and early 2014 at oncology research meetings. Science is not for wimps. It takes years of gathering data, treating patients, collecting their records, and running the data. In the next five years, we will have definitive data on integrative oncology outcomes in breast cancer, compared to standard care alone. We will start looking at the data within a year.

Mycology Studies
The medicinal mushrooms, all of them, merit medical research. Currently I have a post doc who is also a naturopathic physician, Dr. Catherine Coy, working under an NIH grant to look at the immune effects of some of the major medicinal mushrooms: turkey tail, shiitake, maitake, ganoderma, chaga, and lion's mane. My research groups at the University of Washington, University of Minnesota, and Bastyr University have been working since 2004 to evaluate a very interesting immune therapy that comes from Asia, Polysaccharide krestin™, an extract from a mushroom that grows all over the world and turns out to be a very potent anti-cancer immune therapy.

Typically we don't use the mushroom as a standalone intervention, although by itself it certainly has some value. However, it can be highly effective when combined with other treatments, in particular monoclonal antibodies and certain chemotherapies, such as the taxanes, taxol and paclitaxel (Taxotere™), or used as an adjutant to cancer vaccines and cancer monoclonal antibodies. I have a team that I work with here in Seattle to elucidate the mechanism of action of this mushroom product, which is standard of care in Japan. Have you heard of it?

Nancy Faass: No, but I recently looked at the literature on chaga including the chaga that they grow in Asia using a six-month growth process compared with Canadian old-growth chaga. I wondered if the data was real, because if it is, this is important.

What did the data say?
They were just in vitro and animal studies, but they reported consistently good outcomes with all the cancer cell lines that were tested.

Nutrient and Botanical Therapies
My team is looking at chaga and a wide range of other botanicals as well. Currently, the Bastyr Integrative Oncology Research Center is evaluating the safety and outcomes of whole person care, including treatments we use in stage IV cancer therapy:

  • Intravenous curcumin, given its many effects on the cancer biological pathway
  • Intravenous silibinin, a component of milk thistle
  • IV artemisinin, commonly known as wormwood
  • Sanguinaria and chelidonium, as both topical and oral anti-cancer agents
  • Mistletoe, based on the clinical data coming out of Germany
  • Nutrient IVs, for cancer patients with nutritional deficiencies, both during and after intensive chemotherapy, and also IV nutrition for head and neck cancer patients with swallowing problems
  • Intravenous ascorbic acid
  • Intravenous alpha lipoic acid for pancreatic cancer
  • IV glutathione in certain cases of severe peripheral neuropathy

These therapies are potentially significant, and we hope they will result in good outcomes, meaning people live longer and better. My own special project is intravenous curcumin in the treatment of brain tumors. We would very much like to do a phase I trial of intravenous curcumin for malignant brain cancer, and all we're waiting for is a product that is FDA-approved to go ahead with that trial.

Clinical Interventions
BIORC serves cancer patients from the Northwest, from other states, and in some cases, even other countries. Integrative oncology at our clinic means the integration of the best of standard care with the best of alternative and CAM, and between left and right brain ways of looking at science and medicine. The primary emphasis of our current work is the prevention of cancer relapse in stage 3 patients and the development of effective, non-toxic therapies for stage 4 patients.

Would you like to give an overview of how you approach patients when they come in to see you and the work that you're most proud of at your centers?

Let's take a look at the progress of a stage 4 cancer patient in our clinic: the first step is that they see one of our attending physicians. If the patient is undergoing chemotherapy, we prescribe specific therapies that will offset and prevent side effects. Each type of chemotherapy has its own side effects and its own metabolic pathway that one must know; for example, I think every physician knows now that glutamine should be given along with Taxol and platinum-based chemotherapy agents to prevent peripheral neuropathy. In other cases, the patient may have had several courses of chemotherapy, and they have come to us because the disease is still progressing. This is when our real work begins, which involves the various anti-cancer therapies that we provide.

Every patient is evaluated for the four components of integrative oncology.
1)  Naturopathic oncology. This means being seen by someone who is board certified in naturopathic oncology and a fellow of the American Board of Naturopathic Oncology (FABNO).

2)  Full-on traditional Chinese medicine. TCM entails acupuncture, herbs, diet, and everything else that the Chinese medicine physicians know how to do so well

3)  Mind-body medicine. Everyone usually receives an individual consultation with a naturopathic physician who specializes in mind-body medicine. Do they need to learn how to meditate, and if so, what kind of meditation? Do they need silence? Would they benefit from using a mantra? What about biofeedback? Do they need cranial-sacral therapy? Our goal is to identify anything that can be done to help a person get into a mental space in which they're not afraid and angry.

To shift them into parasympathetic mode.

Yes, because then we see immediate immune benefits. We regularly monitor the immune system in fairly technical ways. We test natural killer cell functional activity on every single patient to evaluate the efficacy of our immune therapies. Because integrative oncology often focuses on improving the immune competency of cancer patients, measurement of NK cell activity is a useful biomarker in patient care.

4)  Palliative medicine. This fourth area of integrative oncology practice at Bastyr now includes MD-provided palliative medicine services. Some of our patients really need better pain management and we need a physician who's been trained as an MD who knows pain meds and symptom management, who can guide people to good palliative medicine decisions.

We work with our patients in stage 4, asking the hard questions. The conversation may go something like: Do you really want to do another course of chemotherapy at this point? Yes, I know your oncologist says he or she has one more drug to try, but is that really the goal? Is that really going to fulfill your clinical goals right now?

That kind of conversation happens with me as a naturopathic physician, but I also want an MD on the team who can provide integrative palliative medicine. This is a relatively new discipline, under the auspices of the American Academy of Hospice and Palliative Medicine.


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