Killing Cancer Cells Instead of Managing Them - Why Cytotoxic Therapies Matter

Most drugs slow tumors down. That makes them called cytostatic, meaning they don't actually kill the cancer, they slow it down. But slowing it is not the same thing as killing it. And our goal should be to eliminate the cancer. Especially when we're dealing with late stage disease. It should be cytotoxic at the core of the therapy, meaning killing the cancer cells. So we want real immune driven destruction of the cancer cells and durable remissions. That's the goal. According to the oncology literature. Cytostatic, meaning just slowing things down, are mainly cancer growth. And the cytotoxic approaches that trigger cancer cell death are not what most pharmaceutical companies are producing right now. In the conventional oncology philosophy, it starts with managing patients get cancer management. If it starts with kill safely and precisely, we then can design plans that actually aim for remission instead of just manage. I'm Dr. Dino Prado, founder of Envita Medical centers. For the last 25 years we've helped patients with late stage cancers. We've developed precision combinations to help our patients outper. And in this episode we're going to discuss that killing cancer isn't often the treatment plan. It's managing it. And we need to go beyond that. And if it's not happening for you, we need to find out why. And I will go over why we see some of these problems in standard oncology. First thing is I want to explain this Cytostatic versus cytotoxic. What does it mean? Cytostatic means slowing down the cancer growth, proliferation, cell cycle arrest signaling blockades where cytotoxic means increasing the cancer cell death and tumor shrinkage and cancer research and NCI linked reviews. Targeted agents are often act cytostatically meaning those that are most targeted. While classic chemo or immune mediated works for cytotoxic kill according to the AACR journals. So there's a difference. So I'll give you an example. Patient has a cancer and a marker for herceptin. Like breast cancer, they're HERK2 positive. Herceptin mainly signals cytostatic effects, slowing it down. It does have some ability to kill, but not a lot. It may help recruit the immune system, but it slows it down. So this is the time and where you'd want to enact the immune system to go to work. If a patient has a receptor for a particular marker and they keep taking that medicine every month or every whenever the dosage is the treatment works, as soon as you stop, it stops working. Now I Just want you to think about this for a minute. If you're the head of a CEO or pharmaceutical company, what is your goal to design drugs that are cytotoxic or cytostatic drugs that manage cancer or that potentially kill and cure cancer. And the answer, unfortunately, for the majority of drugs on the market, it's to manage because because they get their monthly revenues, the patient has to stay on the drug, and it's in a way, a form of bondage. Oncologists, when they're building the regimen in its complete design, needs to be focused on actually eliminating the cancer, not just managing it. Many precision drugs are mainly cytostatic, the drugs that are sold commercially. And when you do deep algorithm of DNA, RNA and immune profiling, unless you think of it from a perspective of killing the cancer cell, you will just block things and you won't eventually kill the cancer cell. So it's important to combine your algorithm with the ultimate goal of killing. This isn't being done, and it's actually not even a common thought. This is why these algorithms in precision oncology need to be cytotoxic. And it's usually immune centric, because the immune system critical part to patient outcomes. When we use them, think of microdosing. So if we're going to use these targets that are just slowing things down, we're going to microdose them, slow things down, only with the benefit that at the same time, we're going to kill the cancer using the immune system. Most of the big pharma design medications are to manage cancer, not kill it. So it takes the physician and the algorithm of precision to go after killing the cancer. Most modern approvals for these drugs are not direct killers. They are smart drugs that manage. They don't kill. They're targeted on like hormonal agents. And they're predominantly cytostatic, slowing things down. And for durable tumor killing, we need the immune system to be engaged. We need cytotoxic, we need to kill the cancer cell. And here's some of the clearest way to see this. What's getting approved from 2000 to 2022, about 573 oncology drug approvals. Nine percent of those were actually chemotherapy. That cancer cytotoxic. That means the overwhelming majority were cytostatic. While only 48% were targeted drugs, the other 43 were biological therapies. And they all did what they managed the cancer. So it's important that when you're building the treatment algorithms that we're Looking at killing the cancer, not simply managing it. And this is what we do with the work that we do. Design these algorithms to be cytotoxic because our goal is remission. It should always be remission and long term remission. That's the goal. That's what we want for our cancer patients. And we'll see that most of the drugs that are in the market are not designed to do that. So we have the new term used in oncology, managing the patient. Because oncologists, often with late stage cancer patients, don't see long term remissions, but they manage them trying to live longer, maybe better quality of life if they can. But these agents often have a lot of side effects and they're not targeted correctly. How dominant are targeted drugs now? Analysis of more than 80% of new oncology drugs are molecularly molecular targeting, because that's where the money is. These drugs are very expensive, they're very targeted. And instead of looking at deep mapping of all the pathways, it's one targeting target, and then you need to combine it with another drug so you have these combinations that are not looking at deep mapping. I want you to think of cancer, and I always like to use this analogy, Think of it as if you're looking down on a city and you see all these roads and some are moving right and left and going all the way through. And if you just blocked one road, cancer will learn to grow down a different road. This is the deep mapping of DNA, RNA and immune profiling. And unless you affect all of those, you won't get the result that you're looking for long term. And when you understand that, when you look at drugs that are actually approved, There are not many drugs approved for all these targets. So if we run, for example, DNA and rna, we have thousands of markers. We may only have a few drugs that actually are actionable targets for those markers. That means we have a whole number of non actionable targets. So what do we do with precision oncology? We go on and off label and integrative agents to hit all the targets. This makes a difference in the treatment because it allows us to be comprehensive with the goal of being cytotoxic, with the goal of killing the cancer. That should always be the goal. And so this is an important component to cancer treatment. Now, the immune system is one of the most important parts. I've said this over and over again, because the immune system ultimately does the killing, Immune mediated kill. We've seen now things like checkpoint inhibitors, PD1s, PD L1s it has brought immunotherapy to the forefront. The problem is they do not often work long term on their own. In fact, long, durable remissions, maybe 19% according to Frontiers. That's not a lot. But the reason for that is because if we looked at the tumor and the neighborhood of cells outside the tumor, what we call the spatial biology, there are gangs that are blocking the police of your immune system from getting the tumor. And so these gangs need to be removed or adjusted so that these parts of your natural killer cells can get to the tumors. And so that goes beyond PD1 therapy. That's just one piece of the puzzle. It can be variations and changes. So we can help a patient's tumor go from being cold to hot, which hot means now the tumor is being killed by the immune system. So this is the key piece. So when you're using cytostatic drugs, slowing things down, which most patients are, if you're doing chemotherapy is probably what you're doing, you need to incorporate cytotoxic so that now you have the to kill the cancer while it's in the slowdown mode. So that while that division is slowed down and the progression is slowed down, you have the therapies that are going in to kill the cancer. Very important. So these majority of targeted drugs, they can be biologics or they can be medications. But at the end of the day, are they killing the cancer? They're buying time. They're slowing things down. But we shouldn't end there. That should just be the beginning. Now it's time to bring the immune system in and go after a complete total tumor kill and removal of cancer. This is such a simple thing, but such an important concept actually up all your medications. You'll see most of them are cytostatic. They might have a little something that says it kills cancer, but it's not its main action. The main action is to slow down the cancer growth, because that's how these markers work. Unless you enact an immune modulated approach. And when you look at most cancers, they don't have immunotherapies. They're using them only in late stage. And if there's mutation, you need to enact immunotherapy, in my clinical experience, immediately, because this is the key to durable remissions. That's the goal. Because the immune system is cytotoxic. It's what it does over 10,000 times a day. A healthy immune system goes, goes after cancer cells and pre cancer cells and removes them. So we need to get that pipeline of healthy immunity back into play. And that becomes a critical piece to care. Immunotherapy has shown that it can kill cancer. We've seen that in checkpoint in hemorrhage, we've seen it in T cell therapy. But we also have other things that help us to know that. We can do testing to see what effects your immune system needs, what changes need to take place so that your immune system can get back in control and get rid of or eliminate or reduce the cancer. Because the immune system is key. According to the lancet oncology and subseque updated studies, we know from all the published papers that immunotherapies have great effect. But the ones we're seeing today are not enough because of this 19% long term response with PD1s, we need to go beyond that. So we need to build custom immunotherapies that stimulate the body's ability to teach your immune system to fight the cancer and remove the blockades so that it helps your body go into the longer term remission. Move the tumors from cold to hot. And if you have cancers that are already naturally hot, like the melanomas, the renal cell, lung, bladder cancers that already respond well to immunotherapy, that immunotherapy needs to be very front and center at the core. And not just PD1s, but designing custom therapies to help your immune system fight the cancer, this is critical and this makes all the difference in the world. When you do deep mapping, multiomics, DNA, RNA, spatial biology, immunity, you can see whether the agents are cytotoxic or they're just cytostatic. And you can find out what pathways are being blocked and you can see the parts of the immune system and the tumor microenvironment that needs to be improved. And when you design all of that and customize that now you're on track. We see this, that as soon as you implement these targets with studies like I predict Winter and our paper we published in 2024, our response rates were 35 times not percent, 35 times higher than conventional or late stage cancers because of targeting and 43 times better quality of life because we don't need to use high doses. We can be precise and reduce the side effects. These critical aspects change cancer. And this is why it's so important that we look at it from the perspective of killing the cancer without harming the patient, improving quality of life and targeting the So I hope this was helpful and this gave you a better idea that not all chemotherapy is equal. And each bit of chemotherapy needs to be customized for the patient. And that's what we recommend where precision oncology can help open doors that were closed before. May the Lord bless you on your journey to healing, Sam.