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goddess forever
Posts: 255
Reply with quote  #1 
I started the regime but am wondering if  should take the Cam supplements at different time than the Femara?  Thanks Shelagh

Chief of Research
Posts: 1,129
Reply with quote  #2 

Mrsb / Shelagh:


The Facts

The  two factors central to the issue of potentially adverse effects of concurrent CAM interventions and oncotherapy  are:


  1. Adverse interaction across the hepatic p450 Cytochrome enzyme system;
  2. Adverse exertion of anti-oxidant activity with concurrent chemotherapy.


As to the first, there is no issue: although letrozole (Femara) strongly inhibits CYP2D6, moderately inhibits CYP2C19, and has a low affinity for CYP3A4, the low affinity for CYP3A4 suggests minimal potential for adverse interactions across this enzyme, and in any case no  component of the edge-CAM regimen exhibits a potentially adverse hepatic enzyme interaction, a rigorous inclusion criterion for any agent in the regimen, as I extensively document in my Drug Interactions  in Oncology review (now 33+ pages).


And as to the second, it is  irrelevant as it pertains to antioxidant-mediated chemotherapy (not all oncotherapy), and letrozole (Femara) exerts no significant antioxidant activity as part of its  anti-estrogen endocrine capabilities.


Against a Blind Prohibition

And as I have  already demonstrated there are numerous antioxidants widely deployed in oncology such as amifostine (Ethyol), used as a radio-protective and cytoprotective, mesna (Mesnex) a bladder-cytoprotective, dexrazoxane (Zinecard) a cardioprotective against oncotherapy cardiotoxicity, and pentoxifylline (Trental), a radioprotective used to treat RIF, radiation-induced fibrosis, all antioxidants, all without evidence of adverse interaction and FDA-approved as such, but they happen to  be traditional medicine antioxidants  as opposed to natural / CAM antioxidants, but if an injunction applies or not against one class  then out of consistency it must apply to the other (see my Pleas for Consistency in my review).


However, despite there being no significant potential for adverse interaction as the above indicates, scheduling of administration, before, after or concurrent  with oncotherapy is not stipulated by the regimen or my guidance associated with it: the decision is the patient's in consultation with her/his oncologist.   As to my  own perspective, I have discussed it here and at length in my above-cited oncology interactions review, and a blanket prohibition against concurrent CAM-oncotherapy is to date against the evidence, with numerous systematic reviews and meta-analyses failing to discover  significant adverse potential despite widespread concerns expressed and disjunctions issued, against  the data.  


Not So Fast: The Need for Context-Dependent  Assessment

But - and this is critical - although there is no plausible case for a broad disjunction against CAM-oncotherapy concurrency in general, this does not mean that each individual agent, whether CAM or traditional, does not in specific cases  harbor a potentially adverse interaction.  I cite and document the cases of interference with  SJW (St. John's Wort) among many other CAM against (none of which  however are part of the Edge-CAM regimen), as well as traditional medicine agents like statins among many others which can lead to  problems of compromised efficacy or increased toxicity or both. 


My approach is a context-dependent protocol.  So for example I was recently consulted on a case of bupropion (Wellbutrin) being coadministered with tamoxifen, and I strongly caution against concurrent  use.  The oncologist saw no problem, thinking incorrectly the interactions problems with tamoxifen stemmed only from SSRI-type antidepressants, and furthermore the manufacturer itself denied any adverse potential.  They were both mistaken, and demonstrably so, and were unaware of decisive evidence, which I presented to the contrary, and most disturbing Wellbutrin bears a clear  FDA-required  warning to the same effect which even the manufacturer seemed ignorant to, and the oncologist failed to uncover.  But I would have no objection to tamoxifen and venlafaxine (Effexor) based on robust evidence.  Thus my approach of context-dependent protocol views the broad claims of (1) that concurrent CAM-oncotherapy  supplementation is to  be avoided as problematic, and (2) that such supplementation is  not problematic, as both invalid: instead, interaction safety is according to context, on a case by case basis depending on the agents used (this was how  the component of my regimen were scrupiously vetted).


Constantine Kaniklidis

Breast Cancer Watch


goddess forever
Posts: 255
Reply with quote  #3 
Constantine Thanks for clarifying this. I must admit since the brain surgery i do have more trouble reading and understanding medical information but  I did myself and my Natropath check each of my prescribed medications against your previous list of possible interactions. This is a new experience for me as here in Canada we get dumped out of the Oncologist care very quickly and we are at best left to advocate and educate ourself. not a perfect system Thanks for your guidance.Shelagh
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