| Introduction: The successful treatment of cancer calls for the total eradication of malignant cells from the body. The therapy set out here aims to destroy both primary and secondary (metastatic) growths in two stages; first, by bringing about extensive tumour destruction over a period of a few hours, and then by a process of attrition. In marked contrast with conventional treatments the procedure is highly selective. These are early pioneering days; not all cancers prove to be sensitive. The present advice is to be regarded as a simple prototype, in the same light as the primitive earliest cameras, motor cars or aeroplanes. Patients are asked to be realistic and not to allow hopes to rise too high. Although a great deal of experience has been incorporated into the advice, there is much room for improvement. Strict adherence is essential.
No guarantee of a successful outcome can be given. Individuals stricken with the disease understandably respond with resentment, sometimes anger, at the injustice of their dreadful predicaments. As if the initial diagnosis is not bad enough, to be told, perhaps abruptly, that a treatment is not successful is a worse experience that may be lurking in store. Cancer patients deserve respect and dignity; the intention is that the advice should provide a chance of physical healing, spare further anguish, extend survival and improve quality of life.
The question of hope is a very important one. There may be a positive response; there may not. Sincere apologies are made to patients whose malignancies may fail to respond. On several occasions, though, it has happened that improvement in terms of tumour regression has been followed by relapse. Patients should be alert to this scenario and be prepared for the worst. In these instances perhaps only a single cancer cell needs to have undergone mutation (see [6] below). The tumour consists of a mix of sensitive and insensitive cells; after the therapy has killed the sensitive cells off, the insensitive cells gain the upper hand. The only hope here would be surgery, but if resistant cells have already spread the outlook is poor.
Certain drugs acting on the central nervous system possess the additional property of causing injury to tumours; one of these has been shown to interfere with energy production. Some belong to the large group known as phenothiazines, many of which have been in use for over sixty years. Their diverse uses include the treatment of schizophrenia, nausea and pain. The active principle in this form of cancer treatment is the phenothiazine Phenergan (promethazine), currently used as an anti-histaminic, as a paediatric sedative, and to quell travel sickness. Phenergan has also been used as an anti-emetic in patients undergoing conventional chemotherapy, but, unlike chlorpromazine (Largactil), is not recommended for chronic administration. The fact that its anti-cancer potential has managed to escape detection for so long is attributed to its ineffectiveness when given on an intermittent basis. Its effects on the central nervous system are less marked than those of most other phenothiazines, which is considered an advantage.
The first doctor to administer Phenergan to cancer patients in conjunction with calcium was the late Dr Riad Mahmud, an Egyptian diabetologist. This new modification relies heavily on his inspiration. Cancer is a serious disease, and its treatment needs to be taken seriously. The apparently innocuous nature of the agents used is fortuitous, and should not encourage a superficial attitude to the therapy. In order to produce its anti-cancer action Phenergan is required to maintain destructive pressure against malignant growths by keeping to a specific schedule. The treatment is the result of a long investigation standing fully in the tradition of applied medical research.
Last but by no means least, the selectivity of the procedure allows a patient to go about his or her business almost entirely as normal while sustaining the full force of the therapy. Almost; patients need to adapt to the new situation. Strain and over-exertion should be avoided. This approach marks a revolution in cancer treatment. There are no sudden ugly costs. If a return to normal life does come about, patients are requested, please, to give a thought to those enduring the condition which, it is earnestly hoped, is no longer a problem, try to interest in the advice others who find themselves with cancer, and, if at all possible, to generate publicity.
Logically the next step is to put the therapy to the test in the form of a clinical trial. Informed research could be expected to bring about rapid improvements, such as shortening the period of treatment and extending the range of sensitive tumours. Despite the impressive weight of supportive scientific evidence (eg, see Notes on the Treatment of Cancer with Low-Dose Phenothiazines with Special Reference to Promethazine on the website of the Cancer Support Association of Western Australia, (research section: www.cancersupportwa.org.au/research2.php Username; robert: password; australia), numerous appeals over a number of years and the urgency of the situation, no cancer charity, research council or pharmaceutical company has agreed to act. Patent cover for Phenergan has long since run out; in consequence the costs of development are too great and the returns too small to attract commercial interest. As a general point, although this treatment is not advanced as a substitute for surgical debulking, Phenergan does seem to be able to reach those parts that the scalpel cannot.
Scientific Basis: Novel and unconventional, the therapy has several unusual features. Phenothiazines active against cancer trigger a cytotoxic mechanism (necrosis) within the cancer cell itself. The continual state of partial disablement of the power-houses (mitochondria) that supply the malignant cell with much of its requirement for chemical energy marks the organelles out as the Achilles heel of malignant growth, and enables a new chemotherapeutic target to be selected. In other words, rather than imposing an artificial form of death upon the cell, a procedure which is commonly unsuccessful, a natural phenomenon is invoked.
The presence within malignant cells of sensitivity of energy metabolism to Phenergan should weaken cellular defences sufficiently to allow calcium to enter the cells and wreak serious damage. Phenergan selectively causes disruption of energy metabolism in the mitochondria of cancerous cells. Mitochondria are subcellular particles which in normal cells produce some 95% of the energy required for cellular maintenance. Calcium has the same overall effect as Phenergan, but with these differences; the disruptive action is both more direct and more effective. On the first day the major burden of tumour destruction falls on calcium. Glucose facilitates cellular recovery; in prolonging exposure to calcium a useful secondary aim is to deplete the sugar in the tumour mass, thereby further endangering viability. Much of the theory can be found in Notes on the Treatment..., above.
One of the difficulties of making revisions to a venerable text such as this (the first version was put on the web in 1996) is whether or not the altered advice becomes more effective thereby. Thus it is with calcium. What is known in addition to the findings of Dr Mahmud is (a) that an inoperable and obstructive cancer of the oesophagus regressed after a single dose of 50mg Phenergan and a high oral dose (1.6g) calcium over a period of 80 minutes, (b) the progression of breast disease in a patient who had been taking calcium daily for a number of months was very slow, and that a scan indicated heterogeneity and extensive calcification, and (c) that a regime of doxorubicin and zoledronic acid was beneficial in the treatment of the same condition.
In these circumstances the combination of calcium with Phenergan would be expected to bestow benefit. In theory the administration of calcium during chronic treatment with Phenergan might usefully augment tumour destruction, but the safety of the measure has yet to be tested. The author would be most grateful to hear of the experiences of any patient brave enough to be adventurous.
Contra-Indications: Cancer patients are unlikely to benefit if:
- Steroids are being administered in high doses. Interference with anti-cancer activity is unstable, and therapy with Phenergan can be commenced three days after cessation of steroids.
- There has been brief or intermittent exposure after the onset of disease to phenothiazines or to certain chemically-related drugs possessing similar anti-cancer properties.
- Analgesics classified as non-steroid anti-inflammatory drugs (aspirin, ibuprofen, diclofenac, etc) are being taken. Here the advice is to wait for a week before commencing. Serious pain calls for professional attention. Paracetamol, temporarily and in moderation, is suitable; so are opiates (for example, morphine given on prescription). Provided the pain is not too severe, a TENS (transcutaneous electrical nerve stimulation) device can provide limited measures of relief.
- The patient is deficient in essential fatty acids. This is an uncommon condition of which scaly skin, especially on the backs of the hands, can be an indicator. Polyunsaturated fatty acids are micro-nutrients and are required for normal health. Acids participating in the process of tumour destruction still await identification.
- There is dietary supplementation with vitamin E. The question of vitamin E calls for special mention. Most diets already contain amounts adequate for a healthy life style. For individuals free from cancer dietary supplementation (50-100iu daily) is beneficial, offering protection against coronary heart disease. Unfortunately the same beneficial properties are exploited by cancerous growths, which accumulate vitamin E as a protection against pharmacological attack. Many dietary schedules drawn up expressly for cancer patients include substantial amounts of vitamin E. The wisdom of these recommendations is questioned. While it is known that vitamin E protects against the development of cancer, there is nothing to suggest any benefit is to be gained once malignant disease is established. Indeed, several patients on vitamin E supplements (400-1200iu daily) failed to respond to Phenergan. Current advice is therefore to stop supplementation immediately and to wait 7-10 days. Likewise, selenium supplementation above the RDA is not recommended.
- Multi-drug resistance (mdr) can arise during radiotherapy or treatment with certain cytotoxic drugs. It is not generally recognised that a mutation in a cancerous cell may result in partial or complete disablement of the cytotoxic mechanism. Clones of these mutant cells may grow rapidly and are generally insensitive to therapy. Preliminary data suggest that patients who have not been exposed to radiotherapy have a better chance both of responding positively and also of avoiding relapse.
- The disease is prostatic cancer, melanoma or mesothelioma. At the present time it is not known whether these early findings reflect the presence of an intrinsic mechanism of resistance in these particular tumours or whether some other cause was responsible for failure. The idea that a high glucose content might offer tumours a measure of protection is feasible. Patients with certain brain tumours (astrocytomas) have enjoyed prolonged survival, but the chances of full recovery would appear to be remote. Anafranil (clomipramine) is a more suitable drug in such instances, but requires medical supervision. Patients are advised to search the web (Google: enter the words cancer brain clomipramine).
Practical Steps - the Self-Medication Schedule:
(a) Pre-Treatment
- First, polyunsaturated fatty acids (the so-called omega-3 fatty acids) of fish origin are needed. Flax oil may also be taken. The purpose of the polyunsaturated fatty acid supplement is to provide cancerous cells with the means to assist in bringing about their self-destruction. Patients should aim at a minimum of a gram daily; more is advisable, but the intake can be cut back if bowel looseness is experienced. Should it be noticed that bleeding, say, from a cut or injury, lasts for longer than usual, the supplement needs to be stopped for a few days and the amount halved on resumption. Medical supervision may be necessary.
- Second, patients are advised to take 250mg each of inositol and choline daily. These naturally-occurring substances are available from health stores. Some authorities recommend inositol hexaphosphate (IP6), which contains only 23% inositol and has the disadvantage of forming insoluble precipitates with calcium within the bowel. It may also be more expensive than inositol itself.
- Third, certain micro-nutrients are recommended with the intention of protecting the white cells of the blood against rare side-effects (blood dyscrasias). A multi-vitamin/mineral preparation containing the recommended dietary allowance (RDA) of copper (2.5mg), manganese (4mg), zinc (15mg) and selenium (50mcg, or 0.05mg) is advised. Minor deviations from these amounts, which should be taken daily, are unimportant. Vitamin supplements in excess of RDA values, especially vitamin C (RDA 60mg) and vitamin E (RDA 10-15 international units [iu]; see later), must be avoided as far as possible. Because the intention is selectively to induce peroxidation within cancerous cells, anti-oxidant preparations, especially those of Chinese origin, should also be carefully avoided. All recommended supplements should be continued for the entire duration of the therapy.
(b) Procedure: Patients need to consume at least 3g of omega-3 polyunsaturated fatty acids together with the recommended supplements daily for three days before commencing. If the patient has been on supplementary vitamin E, intake should be terminated immediately and treatment delayed for ten days. The day of therapy should be set aside for complete relaxation. Most of the side effects will be experienced on the first day; two further days of rest should be allowed.
Patients cannot be expected to undergo the strain of following the instructions by themselves. It is essential to have a partner or close friend present at all times on the first day to ensure the procedure is followed through. On the first day breakfast and lunch should be light and carbohydrate-free. Omelettes, vegetables, bran preparations and sugar-free fruit such as grapefruit are all suitable. Apart from alcohol there are no fluid restrictions; drinking is to be encouraged. Tea, coffee and fruit juices should contain no sugar.
For convenience the therapy may be commenced at 9am. The schedule is as follows:
0hr: 50mg Phenergan.
1hr: 800-1200mg soluble calcium in 100-150ml (4-6fl.oz.) water.
2hr: 400-600mg soluble calcium in 100-150ml water.
4hr, 7hr and 10hr: as for 2hr.
12-14hr (the exact time is not important): 25mg Phenergan.
The total amount of calcium is 2.4-3.6g over a period of 9hr. The precise amounts are not critical.
It is necessary to continue eight hours later on the following day with 25mg, with 25mg every eight hours thereafter (7am, 3pm, 11pm are suitable times) until an adequate period of time has elapsed after the last traces of disease have disappeared. At present this period is arbitrarily put at six months, but should be extended if any doubt exists over the elimination of disease. The reason is discussed below (Duration and Outcome). Efforts should be made to keep to the timing. An hour or so either way is not critical, but if a dose has been missed, it should be taken immediately.
Success depends on maintaining destructive pharmacological pressure against the cancer throughout the entire period. Even if the treatment fails to halt the progress of disease, Phenergan can enhance quality of life and extend survival. For patients prepared to take a risk with the intention of accelerating the effects of the treatment, 200-250mg calcium taken routinely in the morning with Phenergan are suggested. If no untoward effects are experienced, the time of administration could be switched to the evening. In other words, the therapy places the patient in a no-lose situation.
During the first day it is anticipated that products of tumour destruction will be excreted in the urine. Patients with close hospital connections might be able to commission measurements of metabolite excretion, especially uric acid and urea.
In most countries Phenergan can be freely purchased in the form of 10mg and 25mg tablets; other phenothiazines are available only on prescription. Formulations in which the drug is provided in conjunction with other drugs are not recommended.
Warning: The availability of Phenergan varies from country to country; for example, in Canada the product has been withdrawn, and in the US is available only on prescription. Patients should be extremely cautious and make absolutely sure they are receiving promethazine. Adulterated or counterfeit products sold on the internet should be scrupulously avoided.
In view of the serious consequences of premature discontinuation, if a marked improvement is maintained after a few weeks patients would be well advised to purchase sufficient Phenergan to last for two or three months in case procurement becomes difficult.
Soluble calcium is widely available as tablets in a variety of preparations; for example, 250mg, 400mg (UK; Sandocal), 600mg (Caltrate), 1000mg (Sandocal) or 1200mg (Calsource). Tablets of 1000-1200mg require to be snapped in two. To ensure solution, water should be added 15-20 minutes beforehand.
Side Effects: On the first day patients tend to feel very drowsy after an hour or so and may need to be woken up to take the calcium. Sensations of nausea are uncommon, and can be suppressed by drinking. Restlessness of arms and legs, described by one patient as `twitching', on the first day and fatigue and soreness on the next are likely to be experienced. The latter may persist for a day or two more, depending on the magnitude of the tumour burden. These manifestations are interpreted as a response to destruction of malignant tissue. In sharp contrast someone who was free of cancer noticed only a slight drowsiness at 8-10hr. For those with experience of the fiercer forms of chemotherapy and radiotherapy the difference will be welcome. No instances of pain resulting from the therapy have been reported, but paracetamol would be suitable. Morphine can also be taken when recommended by a doctor.
On the whole patients do not find the experience unpleasant. Sedation after commencing Phenergan normally lasts no more than a week, but may persist in a few cases. In these instances the dosage can be halved, with a 10mg tablet every 8 hours and an extra 10mg at night, making a total of 40mg. Driving a car and using machinery or sharp tools are not recommended, at least for a fortnight.
Few patients experience difficulty with Phenergan therapy. Chronic treatment is generally well tolerated. One patient maintained herself on the full schedule for over four years; another, who has kept on since 1998, experienced a modest gain in weight. The only patient who found the therapy insupportable responded to every medication in the same manner. There is a very small chance that jaundice may develop within a few days, or that the white cell count may fall (leucopenia or agranulocytosis) after 4-6 weeks. The former can be recognised by a yellowing of the features, the latter by sore throat. Thrombocytopenia (fall in platelet count) is again highly unlikely, and may be indicated by unexplained bruising or cuts bleeding for longer than usual. Alternatively the condition may be caused by an excessive intake of polyunsaturated fatty acids; medical assistance should be sought.
Caution: To date the question of safety has not been an issue, but calcium treatment can cause slight tumour enlargement which may initially cause problems, especially at an advanced stage. For example, in a patient with obstructive carcinoma of the oesophagus swallowing became more difficult on the following day, but gradually returned to normal during the following weeks. In instances where growths obstruct natural functions difficulty may be encountered. If in doubt the advice for the first day can be omitted, and the treatment commenced with 50mg Phenergan in the late evening. The assistance of doctors may prove necessary.
Response to Therapy: A general improvement in terms of weight gain, improved sleep, restored appetite and general well-being should be perceptible at least by the end of the first week. Lessening of pain is an encouraging sign, but where there is involvement of bone several weeks may pass before relief is noticed. A record of body weight should be kept. The advice on offer is gentle and humane; for those with experience of the fiercer forms of chemotherapy and radiotherapy the difference will come as a welcome surprise.
Patients suffering from radiation-induced injury may find that Phenergan provides some measure of relief. In a case of breast cancer peripheral neuritis induced by post-mastectomy radiation cleared up after several months.
Duration of Treatment and Outcome: Very reasonably, most patients ask whether their particular form of disease is likely to respond to the self-medication procedure described here. The therapy takes advantage of a metabolic weakness common to all malignant tissues so far examined. For this reason then, all cancers should be amenable to treatment, but not all are so. As mentioned above, a high glucose content may provide protection. Forms of the disease which have displayed sensitivity to the earlier oral procedure include non-Hodgkin lymphoma, lung cancer and a chordoma; instances of breast cancer, colorectal cancer, and cancer of the oesophagus, all with secondary spread, also responded. Malignancies found to be insensitive are listed above in [7].
Whether a favourable outcome ensues or not depends on the circumstances and medical history of the patient. The earlier the presentation, the better. Other factors which might affect the outcome have been discussed above. On the basis of current experience with a total of about fifty patients, the chances of remission are under half; of improvement in the quality of life and extension of survival, about two-thirds. What is certain is that unless the therapy is started, it has absolutely no chance of succeeding.
No matter how hopeless the situation may appear, some positive outcome from Phenergan is not necessarily out of the question. Under no circumstances should Phenergan treatment be discontinued prematurely; if treatment is interrupted before the growth is wholly eradicated, residual tumour cells acquire resistance and Phenergan will be found to have no anti-tumour effect second time round. No reason is known for this peculiar behaviour, and no means of resensitisation is known at the present time. The maxim is: if in doubt, don't drop out.
The effects on the disease should be monitored by any means available. Even a dressmaker's tape measure and a little native wit can provide useful information. The results from marker levels and scans should be interpreted with care. If therapy is commenced between measurements, it should be borne in mind that shrinkage due to Phenergan may be offset by tumour growth prior to commencement of therapy. A similar argument applies to tumour markers, where a decrease may be partly cancelled out by a previous increase. The temptation to delay in order to make comparisons between the effects of different treatments may appear attractive but should be resisted.
Of those who decided to abandon the therapy prematurely, none survived. The therapy works slowly; just how long it will be necessary to keep taking Phenergan will depend, among other factors, on tumour type, the extent of disease at the commencement of treatment and on the state of nutrition. It may be necessary to stay with Phenergan for two years or more, especially where there are secondary deposits in the bone.
It might be added that it is not considered likely that there will ever be a "cure" for cancer in a journalistic sense. What is sure is that until the principle of destroying cancer by disrupting energy metabolism within malignant cells is accepted by the scientific establishment, which at the time of writing appears unlikely, the merciless toll will continue. Without properly directed research the problems recognised here will not be overcome.
Precautions: A leaflet is provided with the Phenergan packet; the advice given should be read and, apart from discontinuation, adhered to. Alcohol does not interfere with the anti-cancer action, but abstinence is advised by the manufacturer. Exposure to ultraviolet light and sunlight, especially sunbathing, are to be avoided as far as possible. The group of drugs known as monoamine oxidase inhibitors must not be taken in conjunction with Phenergan.
There appears to be danger from viral infection. At the time of commencing therapy with Phenergan the thirteen `hotspots' found in the bones of a patient with metastatic breast cancer were no longer active two years later. An attack of influenza was then followed by drug-resistant resurgence at new sites; she survived for seventeen months. This single case would suggest that contact with acute viral infection should be avoided.
Relationship of the Patient with the Doctor and Cancer Specialist: The help and support of medical advisers is valuable and must at all costs be enlisted and retained. Being secretive is discourteous; keeping your oncologist fully informed is essential, and may stimulate genuine interest and additional sympathy. Accurate reports of progress need to be requested. Tumour regression is always welcome, but even if the news is not good the therapy should not be abandoned.
Facing up to cancer calls for an unusual measure of bravery. The patient who manages best is sufficiently courageous to face the future with equanimity. Doctors are sometimes reluctant to spell out the gravity of a prognosis. Patients may be left with a false sense of optimism, and for that reason prefer an option that disguises a poorer chance of survival. The prognosis with conventional treatment should nonetheless be requested.
If attempts are made to dissuade, it may be asked what the dangers of the treatment with Phenergan are perceived to be; reassurance is likely to be given that the risks are small. Uniquely for an alternative treatment, this is a procedure with a firm scientific base. Reference can be made to "Successful Cancer Therapy with Promethazine: the Rationale," published in Medical Hypotheses 46, 25-29 (1996). Further evidence can be found in Notes on the Treatment of Cancer with Low-Dose Phenothiazines... (see website above). The site includes a list of the author's publications on the theme of cancer destruction through interference with energy metabolism.
Orthodox Treatment and Self-Medication: In England doctors make great efforts to sustain hopes of remission, and are the beneficiaries of measures of deep faith from their patients. Optimism is seen as a useful adjunct to recovery. An understandable reluctance exists to tell a patient that a condition is incurable, a shattering experience for which few are prepared. Self-delusion, though, is dangerous. Patients have turned down the advice offered here because they were unaware of the gravity of their situations. Faced with the inevitable, a surprisingly common response has been to ignore the advice.
In some instances there may be less time for deceptive sympathy, and the message appears blunt and uncompromising. In Australia patients are often told there is no hope of recovery. As discussed above, a dangerous sense of false security may be encouraged by a favourable report of tumour shrinkage; difficulty is experienced in accepting subsequent relapse. It is not generally known that remissions from conventional treatment are not always permanent, nor that once secondary growths become established, the chances of recovery with orthodox treatment are poor. On the other hand, when a cancerous cell migrates and establishes itself elsewhere in the body there is no reason why its genetically-determined properties should undergo change as a consequence of the move. Certainly the available experience supports the idea that when a primary growth is sensitive to Phenergan, its secondaries can be expected to respond.
Alternative Approaches: Modern medicine is often miraculous. Antibiotics, transplants, open-heart surgery, joint replacements come to mind. Unhappily the conventional treatment of cancer has not kept pace with other advances in health care. The failure of medicine opens the door to the glib operator anxious to line his or her pockets dishonestly at the expense of the desperate. Critics of alternative treatments are right to point out that methodology is rarely divulged and that claims of success are never substantiated. In stark contrast scientific evidence in support of the use of Phenergan in cancer is in the public domain (see above).
Some patients have expressed a wish to conduct different alternative treatments in tandem with Phenergan. This has on occasion led to disaster. Because their impact on the anti-cancer action of Phenergan is speculative, uncertain and unpredictable, other treatments classed as alternative should emphatically not be run simultaneously.
There is a belief that the treatment of cancer with phenothiazines amounts to alternative medicine, fringe medicine. Nothing could be farther from the truth. Sometimes one can sympathise with the opposition of doctors to complementary practices, especially when patients and their families are sometimes charged formidable sums for worthless advice and/or nostrums. The more expensive a treatment or preparation is, the greater the need for scepticism. Some complementarists are honest enough to admit that all they can offer is palliation, but understandably patients and their families expect more and are often unwilling, unable even, to accept reality.
Here the situation is totally different. Your doctor is unlikely to have heard of the therapy; scepticism can therefore be expected. In this situation the only question one can reasonably expect to have answered is whether or not harm is likely to ensue. Phenergan was introduced into medical practice in 1947; most unusually for a drug, especially for orthodox cancer treatments, the only reported fatalities were infants, for whom the drug was never intended.
In this materialistic age there is a general feeling that everything must have its price. In stark contrast with private clinics and a majority of vendors of alternatives, no fee has ever been charged. Patients are expected to meet the modest costs (currently about £3 a week in the UK) of their treatment. Some have mistakenly concluded that advice which costs nothing must by definition be worthless. They have later found themselves to have taken an expensive stance.
Action: If, after reading the above, uncertainty persists, the question remains: what is there to lose? Now is the time to decide whether or not to go ahead, and if so, to make plans this very moment. Experience has shown that when the outcome is unfavourable, a point of no return is reached when nothing more can be done. Benefit in terms of improved quality of life and extension of survival is not necessarily out of the question.
What is certain is that the sooner the treatment begins, or, put another way, the smaller the tumour burden is, the quicker the patient may become cancer-free. Delay confers no advantage whatsoever. The big errors that cancer patients commonly make are to believe that time is on their side and to adopt a wait-and-see attitude. Nothing could be more mistaken. Time is never on the side of the cancer patient. The overriding aim must, as a matter of pressing urgency, be to begin as soon as possible to get well again.
Once more, then: what is there to lose? |
