Improved Survival and Quality of Life Through an Integrative, Multidisciplinary Oncological Approach: Pathophysiological Analysis of Four Clinical Cancer Cases and Review of the Literature

Our plain-English summary of Improved Survival and Quality of Life Through an Integrative, Multidisciplinary Oncological Approach: Pathophysiological Analysis of Four Clinical Cancer Cases and Review of the Literature, by M. Berretta, A. Morra, R. Taibi, et al (Frontiers in Pharmacology, 2022).

The study

• Authors: M. Berretta, A. Morra, R. Taibi, F. Monari, N. Maurea, M. Ippolito, U. Tirelli, F. Fiorica, L. Montella, G. Facchini, V. Quagliariello, M. Montopoli
• Journal: Frontiers in Pharmacology
• Published: 2022;13:867907
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: According to the National Cancer Institute, the integrative medicine (IM) approach to medical care combines standard medicine with complementary and alternative medicine practices that have proved safe and effective. Methods: We describe the clinical cases of four patients with malignant pleural mesothelioma (MPM), diffuse malignant peritoneal mesothelioma (DMPM), intrahepatic cholangiocarcinoma, and breast cancer (BC) who received supportive treatment (ST) according to an IM approach after the failure of standard cancer treatments or the appearance of serious adverse events caused by antiblastic chemotherapy. The critical role of complementary drugs in reducing the side effects of cancer treatments and normalizing the white cell count is especially apparent in the case of the patient with metastatic BC, who experienced prolonged neutropenia. Results: The IM approach was well-tolerated and had no adverse side effects. It improved the quality of life (QoL) of all patients and in two cases extended overall survival. Conclusion: The extended clinical and instrumental response to IM of the patients with malignant mesothelioma and the improved health-related QoL and good tolerance of the ST demonstrated in all cases support the value of this approach in patients whose cancer therapies have failed but who show a good performance status. Our data require confirmation in a well-designed prospective clinical trial.

Copyright © 2022 Berretta, Morra, Taibi, Monari, Maurea, Ippolito, Tirelli, Fiorica, Montella, Facchini, Quagliariello and Montopoli.

In plain English

This article described four cancer patients, two with mesothelioma, who received what the authors called an integrative medicine supportive treatment after standard treatment failed or caused serious side effects. It consisted mainly of vitamins C and D, probiotics and a medicinal mushroom blend. A 64-year-old man with malignant pleural mesothelioma stopped chemotherapy and began the treatment. The authors reported no new infections, improved quality of life, a time to progression of 22 months (13 on chemotherapy, 9 on the supportive treatment), and that he was alive 32 months after diagnosis. A 56-year-old man with diffuse malignant peritoneal mesothelioma began it after his disease progressed with acute kidney failure. The authors reported an overall survival of 24 months and a time to progression of 14 months from the start of supportive treatment. The other patients had intrahepatic cholangiocarcinoma and breast cancer. The article did not report any patient's asbestos exposure and had no comparison group. The authors concluded the results support this approach in patients with good performance status, and said their data need confirmation in a prospective clinical trial.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series (four clinical case reports) with a narrative discussion of the literature
• Who was studied: Four cancer patients:
• a 64-year-old man with metastatic malignant pleural mesothelioma;
• a 56-year-old man with diffuse malignant peritoneal mesothelioma;
• a 76-year-old woman with intrahepatic cholangiocarcinoma;
• a woman with metastatic HER2-positive breast cancer.

The cases ran from 2017 to 2022. The article does not say where the patients were treated, beyond the authors' Italian affiliations.

• Exposure: The exposure studied was a supportive treatment, not asbestos. It consisted mainly of:
• vitamins C and D;
• probiotics (Lactobacillus rhamnosus LRH11, Lactobacillus acidophilus LA5, Bifidobacterium bifidum BB12);
• a medicinal mushroom blend (Micotherapy U-care).

The peritoneal mesothelioma and cholangiocarcinoma patients also received N-acetyl-cysteine. The article does not describe any patient's asbestos exposure.

• Main results:
  • Pleural mesothelioma patient (case 1): after supportive treatment began, there were no new infections and quality of life improved. Time to progression was 22 months: 13 months while on chemotherapy and 9 months while on supportive treatment. He was alive 32 months from diagnosis.
  • Pleural mesothelioma patient (case 1): a scan in May 2021 showed minimal progression in one lumbar aortic lymph node. This was treated with radiotherapy, and the most recent scan showed complete remission.
  • Peritoneal mesothelioma patient (case 2): kidney function improved, with eGFR rising from 13 to 23 ml/min. Abdominal pain disappeared and he began eating again.
  • Peritoneal mesothelioma patient (case 2): overall survival was 24 months and time to progression was 14 months from the start of supportive treatment. He died of disease progression in July 2021.
  • Cholangiocarcinoma patient (case 3): quality of life improved and fatigue decreased on supportive treatment. Her liver disease progressed, and she died in January 2022.
  • Breast cancer patient (case 4): she developed prolonged grade-2 neutropenia after the second dose of the Comirnaty COVID-19 vaccine. She recovered in May 2021 after 15 days of the mushroom blend.
• The authors' conclusion: The authors concluded that two findings support giving integrative medicine to patients whose cancer therapies have failed but who have a good performance status: the extended response in the two mesothelioma patients, and the improved quality of life and good tolerance seen in all four cases.
• Limitations the authors state:
  • The authors stated that their data need confirmation in a well-designed prospective clinical trial.
  • The authors stated that the breast cancer case is not comparable to the first three, either in prognosis or in available treatment options.

Topics

Medical terms in this study, explained in our Lexicon: Quality of Life, Pleural Mesothelioma, Peritoneal Mesothelioma, Chemotherapy, Neutropenia, Overall Survival, Mesothelioma, Performance Status.

Related studies

• Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach — L.V. Klotz, H. Hoffmann, et al. (2022)
• The Importance of Multidisciplinary Approach in Early Detection of BAP1 Tumor Predisposition Syndrome: Clinical Management and Risk Assessment — A. Battaglia (2014)
• Primary Malignant Pericardial Mesothelioma: A Clinical Case Series Illustrating the Necessity of a Multidisciplinary Approach — A.N. Rosenbaum, M.C. Bois, et al. (2019)
• Surgical management of malignant pleural mesothelioma: impact of surgery on survival and quality of life-relation to chemotherapy, radiotherapy, and alternative therapies — S. Papaspyros, S. Papaspyros (2014)
• Pseudoprogression Associated with Clinical Deterioration and Worsening Quality of Life in Malignant Pleural Mesothelioma — M.B. Barnet, R.R. Zielinski, et al. (2018)
• Lymphohistiocytoid mesothelioma: a clinical, immunohistochemical and ultrastructural study of four cases and literature review — D.X. Yao, J. Shia, et al. (2004)

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