91色情片

Your work was partly inspired by the death of your son, George. What happened?

George鈥檚 mum died of cancer when he was 14 months old, and with his first cancer shortly after. He was successfully treated and was in remission for many years, then when he was 14 he was diagnosed with a basal cell carcinoma behind his ear 鈥� which was also removed. The last cancer he had was an osteosarcoma of the jaw, which was discovered when he was 15. Shortly afterwards George was diagnosed with Li-Fraumeni syndrome 鈥� a rare genetic condition that predisposes people to cancer.

What got you into repurposing everyday drugs to fight cancer?

When the standard treatments for the osteosarcoma failed, I looked for anything at all that might have an effect. I used PubMed, the search engine for biomedical literature, and found researchers in different parts of the world working on repurposed drugs. I contacted them and was surprised by how much time they gave me: they wanted to help.

Why are some non-cancer drugs useful for treating cancer?

At the moment, the most popular way of developing drugs is to start with a molecular target and develop something to hit it specifically. But basic evolutionary biology tells us that cancer is a complex adaptive system that evolves resistance to targeted agents. Clinicians and scientists often characterise older drugs like aspirin as 鈥渄irty鈥� drugs because they hit multiple targets. We see this as an advantage. For example, the painkiller diclofenac helps to stop tumours growing their own blood vessels. Research suggests it also primes the body to respond better to chemotherapy and radiotherapy. It does multiple jobs in one tablet.

When you contacted the researchers, what did they suggest your son try?

One suggestion was an anti-diabetic drug called pioglitazone taken in combination with celecoxib, which is used to treat rheumatism. The idea was to take these alongside metronomic chemotherapy, where you give standard chemotherapy drugs at very low doses every day with no treatment breaks, instead of less frequent, bigger doses.

What did your son think about all this?

He knew and he was very keen that we make these efforts. He wanted to live.

How did your son鈥檚 oncologists respond?

They said: 鈥淲e don鈥檛 have any experience of these drugs鈥�. In the end they came back with a treatment protocol which somebody at the hospital had used before. It didn鈥檛 work.

What happened to George?

He died on 25 April 2011, aged 17. Looking back, it is unlikely that repurposed drugs would have made a huge difference because by that point the disease was very advanced.

Why was their potential as a cancer treatment missed in the first instance?

When these drugs were originally developed cancer was viewed as a disease of deranged cells; all the focus was on finding ways of killing them. Now when we talk about cancer we do it in a much more holistic way: there are cancer cells, but there鈥檚 also a whole microenvironment around the tumour. A lot of repurposed drugs change aspects of that environment, removing the support systems that cancer depends on.

Can you give some examples?

There鈥檚 evidence to show that aspirin is beneficial for colorectal cancer after diagnosis, and that it can reduce the recurrence of adenomas 鈥� benign tumours that are often a first step towards colorectal cancer 鈥� after they are surgically removed. Another example is the beta blocker propranolol, which has shown a positive effect when used before surgery in a number of cancers, including ovarian cancer. Cancer is aided by bodily systems that increase the proliferation of cells while also lowering immunity, but propranolol reverses these pro-tumour effects.

Can doctors prescribe these drugs for cancer?

They can, but there are problems. For the patient, it is incredibly hit-and-miss: it depends on whether your doctor is willing to prescribe off-label. And for the doctor, they risk getting into trouble or looking odd in front of their colleagues.

What are the main challenges you face getting repurposed drugs approved to treat cancer?

The patents have expired on the majority of the drugs, so any drug company that invests in a clinical trial is not guaranteed to recoup that money because some other manufacturer could swoop in and sell the same drug at a lower price. Also, if the trial is successful, getting the drug licensed costs money.

Secondly, very few of these drugs are going to be effective on their own: we are looking at using them in combination with standard therapies or other repurposed drugs. In that situation multiple companies are involved, which raises issues around cooperation.

If you are doing a trial without a pharmaceutical company, there are logistical issues: you have to buy the drugs yourself and even cheap drugs aren鈥檛 that cheap. You also have to package up the placebo and the drug 鈥� so you have highly paid consultants shoving aspirin into unmarked containers.

What solutions are you coming up with?

We supported a UK crowdfunding project to repurpose a malaria drug called artesunate as a colorectal cancer drug. The response was great and we exceeded the target of 拢50,000. But it鈥檚 not a sustainable model because it takes a huge amount of work, and while the public wants to be involved, compassion fatigue will kick in as the number of appeals grows. That鈥檚 particularly true for rare cancers, as there鈥檚 not a huge constituency of patients we can mobilise. So we have to look at other options. Besides identifying promising drugs, we are looking at public policy. We hope to find a process whereby when sufficient evidence of a positive clinical effect is found, new licences could be granted.

鈥淲hen it鈥檚 someone鈥檚 life at stake, people do extraordinary things鈥�

Some might accuse you of encouraging cancer patients to turn away from conventional therapies that could save their lives.

All cancer patients and their families have the right to seek alternative opinions. But I work for a foundation called the , which funds some research into repurposed drugs, and we spend a lot of time exposing fake cancer cures. We don鈥檛 recommend that people stop their current treatment; for any faults it may have, it鈥檚 better than no treatment. Instead we supply information for people to take to their oncologist and discuss with them. We don鈥檛 encourage people to self-medicate, although we know some people do. When it鈥檚 someone鈥檚 life at stake, people do extraordinary things 鈥� and for good reason.

This article appeared in print under the headline 鈥淓veryday drugs can fight cancer鈥�