#68 Dr. Robert Nagourney on Outliving Cancer

Join us as we dive deep with Dr. Robert Nagourney, the esteemed Founder and Medical Director of the Nagourney Cancer Institute. With a distinguished career spanning decades, Dr. Nagourney has penned hundreds of manuscripts, book chapters, and abstracts for prestigious journals. He's not only a pioneer in the realm of personalized cancer treatment but also serves as the Clinical Professor at the University of California, Irvine School of Medicine.

In this enlightening episode, we delve into:

• The urgent need for a paradigm shift in cancer treatment approaches.
• The essence and significance of personalized cancer care.
• The power of being an active participant in your treatment journey.
• Exploring options to ensure patients receive the most effective treatments.
• The pivotal role of lifestyle in cancer treatment and recovery.
• Navigating life with metastatic disease.
• The potency of a particular medicine that bolsters health.

Dr. Nagourney marries profound expertise with genuine compassion, advocating for treatments that not only increase survival rates but also minimize the fallout from unnecessary, toxic interventions. His insights, combined with his captivating voice, make this episode a must-listen.

Resources:

TEDx "The future of Cancer Research Lies Behind Us" 

WSJ Article: "Every Cancer Patient is One in a Billion"

USA Today Article On Triple Negative Breast Cancer Survivor

The Nagourney Cancer Institute

Read the transcript:

0:01
This is Laura Lummer, the breast cancer recovery coach. I'm a healthy lifestyle coach, a clinical Ayurveda specialist, a personal trainer, and I'm also a breast cancer survivor. In this podcast, we talk about healthy thinking and mindfulness practices, eating well, moving your body for health and longevity. And we'll also hear from other breast cancer survivors who have reengaged with life and have incredible stories to share. This podcast is your go to resource for getting back to life after breast cancer.

0:38
Well, hello, and welcome to another episode of the breast cancer recovery coach podcast. I'm your host Laura Lummer. And I am thrilled to be able to share this show with you today we have a very special guest on the breast cancer recovery coach podcast today. Dr. Robert Nagorny, and I'm going to tell you more about him in just a moment. But I want you to check out this entire episode. It's a little bit longer than I normally post. But we have such great conversation. And we touch on everything from new, more effective ways to treat cancer, to the importance of exercise in both treatment and recovering from treatment. We talk about nutrition we talk about living with metastatic disease, so much good stuff in this episode. And Dr. Nagorny is just a brilliant physician, so talented, so experienced and so passionate about his work. So let me tell you a little bit more about him. Dr. Robert Nagorny is the founder and medical director of the Nagorny Cancer Institute. He has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He received his medical degree from McGill University in Montreal, and after internal medicine residency at the University of California, Irvine, he completed a fellowship in medical oncology at Georgetown University and a second fellowship in hematology at the Scripps Institute. Dr. Nagorny is the author of numerous abstracts peer reviewed articles and books. He's authored more than 100 manuscripts, book chapters and abstracts, including publications in the Journal of Clinical Oncology, gynecological oncology, the Journal of National Cancer Institute, and the British Journal of Cancer. He's also the author of out living cancer, a fantastic book, which I'll post the links to in the show notes for this episode, Dr. Nagorny appeared in the highly acclaimed TEDx talk, and was featured in the July 23 2019, Wall Street Journal with an article that you'll hear us talking about in the show and I'll post the links to again in the show notes. He is a pioneer in human tumor functional profiling. And basically what that means is taking the tumor and analyzing it to see what drugs would be most effective at fighting that tumor. Rather than just using a out of the box or a canned type of chemotherapy to treat cancer patients. He's used his trademark analysis to develop novel drug combinations including this cisplatin gemcitabine doublet that is today used around the world for recurrent breast and ovarian cancer treatment. His international collaborations have led to important advances in our understanding of the metabolic basis of breast carcinogenesis. And as impressive as all of that sounds, and as impressive as all of that is, one of the things I love and respect the most about Dr. Nagorny is that with all of his experience, all of his accomplishments, he truly understands that each cancer patient is an individual. He respects and appreciates the uniqueness of each person's body as well as their cancer. And he understands how difficult cancer treatment is on the physical body. So his research and his discoveries are not only spectacular because of their effectiveness, but because he's looking for and bringing awareness to better ways to defeat cancer without exposing cancer patients to unnecessary toxic treatments. So I first heard about Dr. Nagorny from a dear friend of mine, who is the mind body oncology coach and knew him through his work as the director of the Todd cancer Pavilion at Long Beach Memorial Hospital. Erin Somerville, who is actually one of my first interviews on this podcast back in episode number three, and she had a tremendous respect for Dr. Nagorny because of his approach to treating cancer and his open mindedness and holistic views of health. So she initially recommended his book out living cancer to me, and I absolutely loved it. I loved his perspective and his respect of the patient in the treatment. So I was

5:00
thrilled when his people reached out and asked me if I would have him as a guest on this podcast. So without making you wait any longer, I cannot wait to share this interview with Dr. Robert Nagorny. Enjoy.

5:15
Dr. niccone, thank you so much for joining us today on the breast cancer recovery coach. I'm happy to be here. I told our audience about your background, and also about your book outliving cancer. And one of the things that grabbed my attention right away in your book was something that you wrote in the preface. And I'd love to get us started off with that, quote, sure. You wrote to some my work has seemed disruptive. But in an era where oncologic advances are measured with micrometers, I accept the moniker of disrupter as a badge of honor. And I loved that because having been a cancer patient myself, I think a little disruption is, is a good thing in that field. And but I'd like to hear from you now on how your perspective of and your treatment of cancer is really what has earned that vouch for you.

6:09
Well, to start off on, we have had a slow but progressive improvement in outcomes, particularly in breast cancer, breast cancer being a principal cause of cancer in women in American women, one out of eight, one of them one of nine. So this is a disease that afflicts 268,000 women in the United States alone every year and between one and 2 million women around the world. So this is a major public health issue. We have slowly improved our thinking about this disease and other cancers moving from I think, a rather crude model, where we thought we would cut it all out and the original radical mastectomy was so disfiguring and so unsuccessful, and then the modified radical mastectomy and then lumpectomy and finally finally began to look at this disease as a systemic disorder. And when we did that, we began to weave into the work the hormonal milieu, and the use of less toxic, more effective smart bombs. And we're now finally getting to the point where we can manage if not cure patients and prolong survival is common. The problem I think we have is that we've tended to be kind of reductionist are thinking about cancer medicine has been, I think, sometimes too simplistic. And one of the problems for me was that we tended to lump everybody together. I mean, it was only a scan few decades ago, before, we didn't even understand that there were estrogen receptor and estrogen receptor negative and positive tumors. I mean, imagine how fundamental that was, or the fact that we didn't know about her too, or we didn't understand about the BRCA ideas. So these concepts have enabled us to slowly drill down onto patients individually, but I don't think we're there yet. I don't think we've done enough. So what I'm what I guess if I'm disruptive, my tendency is to believe that every patient is unique, and that their tissue their biology will instruct us on what to do. Some people may do very well, with simple treatments, some patients may need very intensive treatments. And the problem today is we tend to lump everybody together. So I guess if I'm disrupting anything, it's business as usual medicine. And that's a good thing. In my opinion, that's a good thing. Yes. And now your perspective of cancer is something I mean, there's kind of a controversy over it. Right? You say that cancer is a metabolic disease where a lot of physicians and a lot of the view is that it's a genetic disease. Can you talk a little bit about what the differences and why it's important to understand that difference?

8:45
Well, I don't think they're necessarily mutually exclusive. I don't think you have to say there's a genetic or non genetic disease, I think what, what it really is, is that it's more fundamental than just the genes, the genes are the informatics of the cell, they're the kind of blueprint of the cell. And for anyone who's ever had a home designed, if you take a very good blueprint, and you build it on a on a earthquake fault, or you build it on a on a sandy lot that gives way or there's a sinkhole, then the best design turns out to be a very bad place to live. And, and in a way, cancer genetics is like the blueprint you're given. It's what your contractor your construction team does with it, that makes you the cell with a tumor or the person you are. So we became interested in not what you had to work with, but what you did with it, and that that fundamental difference is the difference between genotype which is genetics, and fino type, which is biology, which is physical reality. So my interests became interested in phenotype and I'd like to study cells and how cells behave. And not long after I began to do that, I began to realize that cancer cells live and die by their ability to make and use energy and that

10:00
that's, that's really the field of metabolism. So as you go from DNA and information into function, a lot of function is metabolic activity cells must make and use energy to exist. So our most recent effort in the last few years, has moved us away even from genes and RNA, even from cellular behavior into cellular biochemistry, What? What? sources of protein, nutrients, glucose lipids? What are the materials that your cells use to make the energy that keeps them alive? And after all, since cancer is a disease of cells that want to live too long, they seem to be able to make energy better than the rest of the cells? Are we able to target that? Is it going to be possible to undermine the metabolic basis of cancer and really change this, this outliving or this long living cancer into a cell that dies quickly? Okay, and that is something that was really interesting to me in your book as well, because I think it is a very common belief that cancer just grows exponentially. Whereas you talk about in the book, that it's not so much that it's growing so fast, is that it won't die. Is that correct? Right? Oh, yes, yes. And I think that's another fundamental change in our thinking. Most breast cancers that arise in the breast and are found at a mammogram had been present in the breast for years, sometimes a decade or longer. And the reason it takes so long for us to find them is that cells don't grow very quickly. What they do is accumulate into the masses that we find on mammograms or ultrasounds or MRIs. But it takes one cell several months to become two and another several months to become four and another several months filled to become eight. So it takes many, many, many divisions to get to the point where you can even find them. And And yes, I think that the drugs and the treatments and the approaches that we've taken, and that, you know, the chemo therapies we use are largely designed to stop cells from growing, when they were when drugs work, when the when the chemo therapies and things that we use are effective. It's really because they induce the state of cell death, one form, which is called apoptosis, but there are many forms of programmed cell death. So so that's what we measure in the laboratory. How do drugs cause cells to die not stop growing, but die? That's really interesting. And so that's really at the new Gorny Cancer Institute. That's what you focus on. And my understanding is it's a very customized approach right as you as you already said, each cancer is different but also each body that it's growing in is different. So can you talk a little bit about how you customize that approach to treating someone who has cancer?

12:45
Sure, well, the drugs that we use the the chemotherapy drugs and for patients who are might be listening to this, the names will be familiar their drugs like cyclophosphamide, Cytoxan doxorubicin or Adria Meissen are taxable or tax a tear. These are drugs that are used every day in the clinical setting. And you know, they work in many patients, they work well, in some patients not so well. But the thing is that they work by causing cell injury, they do something to the cell that it doesn't like, and whether that injury is to stop it from undergoing mitosis, which is the actual process of cell division, or whether it's damage to the machinery of the cell DNA, and that's like alkylating agents, all of the drugs have their own mode of action. Now, if the cancer cell is really good at defending itself against one form of injury, let's say for example, Cytoxan. Well, if Cytoxan injury is not going to be read by the cell as being damaging as the cell laughs it off, then all of Cytoxan you give these patients with causes hair loss, nausea and vomiting and lowered blood counts. All that Cytoxan is doing nothing for that patient. On the flip side of the coin, Adria Meissen, which works by a different mechanism might be ideal for this patient. And they won't get enough of it, because you're giving them too much of the other drug that isn't working. He says so. So what we've gotten interested in is the idea that cancer patients aren't just some generic, uniform population, they're actually discrete individuals who have their own very personal profiles of response to drug and if you can get a portion of their tumor into the laboratory, and expose it to these drugs of interest in the Adrienne meistens and the cytotoxins. Well, then you can say, Well, gee, this drug is good, this drug is bad, let's not use this one. And let's make sure to use lots of this one. And that's that's kind of the premise of of our work is to individualize at a cellular level, what drugs to use and what drugs to avoid. And in the traditional setting, is that because I know many cancer breast cancer survivors who were diagnosed through maybe through imaging typically and biopsy and is that biopsy then not treated to see what chemotherapy agents it would be sensitive to is that not

15:00
The traditional way of going about it.

15:03
You know, I'm awfully sorry to tell you that it isn't it is not what most physicians do. And they were there were reasons why they didn't in the years past, everybody thought cancers are growing so quickly, they decided that they were going to study them and select drugs based on what they studied, they would stop them from growing. And so there was a generation of doctors who did cancer growth curves and get cancer proliferation models, none of which really worked. So everybody sort of abandoned the field. We came along in the 90s and onward, and recognize this whole idea that cancer had to be killed that cancer was a cell survival signal. And when we flipped over to that a lot of people said, Well, we've already done that, and it doesn't really work. And in point of fact, they really hadn't ever done that. But they were kind of wedded to their own way of thinking. So we've been a little bit out there in the woods trying to explain to people that the new field of cancer medicine will be cellular biology measured on an individual basis, using cell death measures using these, these these correct measures of drug effect. So yeah, I mean, I guess, unfortunately, many people will go through biopsies, and then go on to treatments get these generic treatments. And I can tell you, for anyone who's listening who's had chemotherapy, they're going to know the word Cytoxan, Adriamycin and taxall very well.

16:16
Because everybody gets it, everybody gets it, everybody gets it. Now, I have a I have a personal story, current story, one of our longtime friends developed breast cancer. And we recently did a biopsy, and she has a form of cancer that may not respond quite as well. And lo and behold, she's not sensitive to that combination. And we had to weigh in and get the biopsy done ourselves, because no one was going to take the time to figure this out. So luckily, I was able to get this patient biopsied my colleagues here at Memorial Medical Center, were kind enough to do the biopsy for us, and we are going to change the treatment that she's going to get. Because she was not sensitive to that standard, off the shelf treatment, she needs something different. And that will be reported out this week, we just finished the study. And either I or one of my colleagues will assume her care and make sure that she gets the right thing. I wish I could tell you that everybody gets the luxury of that approach. Most people don't and I wish more did I do too? And is that a result of just kind of the best practices of oncology? Or is that because of our insurance companies? Or what has an influence over that that prevents everyone from getting that kind of care?

17:28
Well, I mean, I think there are a lot of reasons. But I guess if you think about medicine, medicine was once a very artful undertaking, the patient, Doctor relationship was sacrosanct. And there was a great deal of personal interaction, and doctors and patients became friends and kind of comrades in arms. Today, medicine has become corporatized. And so corporations like certainty, they want to know exactly who's going to get what, when. So if they if you say to them, Well, gee, we're going to be individualizing the therapies and we're going to be crafting our therapies, well, they say, Well, you know, we're not, we're not a high end venue, here, we're us, we're just General Motors, we just turn out the same car every time exactly the same. And so I think that there is a real collision about to occur, the collision is between corporate medicine, which is this increasingly standardized approach so that you can predict all the drug uses and all that sort of stuff and, and do tenure out projections. And, and and the more individualized medicine, which is what patients are clamoring for, I mean, people really don't want to be treated like something off a conveyor belt, they want to be treated individually, but it gets in the way of this kind of corporate model. So So yeah, I think there's going to be a bit of a bit of a crash, where the people that wants what's right for them, and the medical systems and the insurers who want everybody to get the same thing are going to have it out. I'm not sure who's going to win. Hopefully, the Customize wins. That's what I'm hopeful of, I hope.

19:02
Well, in Ethan saying that if you take a customized approach to treating breast cancer, I'd say it's not necessarily less toxic, because we're still using toxic agents, but it's more effective or has a higher cure rate. Would that be correct?

19:19
Well, I think that basically what you do is you take bad drugs and give them better. And so to be honest, I don't love the current collection of chemo therapies. I don't I don't love the fact that they're so toxic. I don't love the fact that they cause a lot of bone marrow suppression and side effects, but I do use them when they work. The problem is almost half, maybe half of the people that get drugs or at least amongst the drugs are getting getting the wrong thing. And if a patient is getting the wrong drug, they're not only not getting better, they're getting worse. They're getting side effects and toxicity and they're not getting the right thing while they're getting the wrong thing. So on a lot of levels.

20:00
The prospect of getting the wrong treatment to me is very unappealing. It's it's, it's toxic, it's it's punishing to the body, and it's prolonging the disease process while the right the right drug is still waiting to be used. So on a lot of levels, I don't like the idea of generic therapies. Yeah, definitely. Well, on my on your side with that one. So we let's talk a little bit about how treatment is handled at the Nagorny Cancer Institute. And if someone was in treatment, would they come there? Is this a place where people receive chemotherapy? Or is this a place where more you're focused on analyzing someone's the type of cancer they have, and offering guidance or input on the most effective treatment for them?

20:46
Well, we do treat patients I do see patients, but there's only so many patients that I can see so far, our laboratory capabilities extend well beyond my clinical activities, the laboratory enables the individual patient to take charge of their cancer if you submit a tissue to us. And the sample reveals activity for

21:07
Taxotere instead of tanks or, or cisplatin, instead of Cytoxan, then I think that based on literature and experience, one can then go back to their treating physician and say, let's use this instead of that. And, and so we do a lot of that kind of consultative work, where we grant patients the opportunity to actually engage in their own treatment selection than their own treatment choices, particularly because much of what we're testing is within the literature. I mean, we're not we're not making up new treatments, we're just taking the five or seven or 10 different combinations that a patient might receive, and recommending the one that most closely fits their biology. We usually recommend that patients who come to us are off active treatments, so they're either newly diagnosed, and there are some uncertainties for example, one of the areas we've done a lot of work in is called triple negative breast cancer. Some years ago, triple negative breast cancer was considered this kind of rare and difficult to treat entity and no one knew what to do with it. And we realize that many of these triple negative breast cancer patients were candidates for different classes of drugs. In fact, I wrote rather extensively some years ago, on the idea that we should be introducing the platinum carbo platinum cisplatin into this population, I wrote my first paper almost 20 years ago on that topic. And we then went on to pioneer combinations that have proven uniquely effective in that disease. So in the patients who present with an unusual diagnostic subtype, something where they're not quite sure what to do with triple negative, for example, as I mentioned, or other variants, that's one group that we step up to and say, you know, let's let's get the right thing up front. The second group that we see quite a lot of our people who've been through conventional or standard treatments and have recurred. So they have sort of biologically declared themselves not to fit the the normal and customary expectation, and those people need something different. And we will step up to the plate and look at other drugs and combinations for them. And then then the final group of the people have sort of failed everything. And at that point, they're exploring, you know, truly experimental approaches, and we keep dozens of small molecules in our laboratory, we can test you know, fossil nostril kinase inhibitors and mTOR inhibitors and and all manner of these targeted agents. So we can really explore what a patient who is looking toward quote unquote, experimental therapies, but as we can explore where they should go to get that so there are a lot of different levels, the ones that were in upfront in need of unusual treatment, those who are failed conventional therapies, and then those who are really looking for for anything that might possibly work.

23:38
And do you find so because you were saying you do use drugs that are have been studied and other psychologists are familiar with? Are they receptive to the information you get if someone has their cancer analyzed by your institute,

23:52
their treating doctor?

23:55
Again, again, for the for the circumstance where the doctor is confronting a fairly straight forward treatment, for example, there are there's there are combinations today one combination is Cytoxan Adrienne license widely used. Another combination is Cytoxan. And Taxotere also widely used them and tested head to head, they're comparable. So for example, I've had physicians who were patients comes to me and we test them and we find that Cytoxan Adriamycin is not as good as Cytoxan then tax it's here. Now there's no reason why the doctor would be so wedded to giving Adriamycin which is kind of toxic, that they couldn't just flip over to another standard of treatment. So yeah, and those circumstances usually the physicians I would hope and believe will be responsive on when we get into the more complicated patients where we're finding treatments that the doctors may not be familiar with. Sometimes we actually send the doctor our protocols because we've done so many studies over the years we've actually developed treatment regimens and we will send to the doctor the dosing and the schedules that we use. We have a

25:00
I just got a lovely Christmas card from a patient with a recurrent ovarian cancer. And she's on a slightly unusual combination. But she wrote this delightful card and said how well she feels within the first couple of cycles. So yeah, I think the doctors that are receptive to the idea of crafting their therapies to the individual can get great outcomes. And we use in many circumstances standard conventional, off the shelf therapies. We're not We're not inventing new drugs, we're just using the same drugs better. Okay, that's great. And so if someone was in treatment, now you my audience is breast cancer survivors, and a lot of them are still in treatment. Are there specific questions that you would suggest that would be good to ask their oncologist?

25:45
Well, clearly, I think patients want to be engaged in their management. So for example, particularly, you know, the upcoming lectures that I will be giving on metastatic disease, that is to patients with metastatic disease have to have to stay on top of their disease, because if the disease progresses, if it isn't responding well, you need to be making decisions in real time. So the patients I think, should try to engage in some of the parameters of their disease so that they can know if they're getting better or worse, so that they can begin to prepare, if necessary for the next line of treatment. So I like personally in the setting, to use tumor markers, you know, I if a patient has a has an advanced breast cancer, and they have an elevated ca 15.3 or an elevated ca 2729 or an elevated CEA, whatever they're measuring blood test, we think it's a good idea for the patients to inquire you know, how how are my markers is getting better or worse, not so much that you change treatment immediately because of a marker change, but so that you get that early warning, you know, like like the storm clouds are brewing so that you know, oh, in the next weeks or month or two, we need to be looking at something else. Patients need to kind of get getting engaged in their in their treatments. On another thing I think patients should realize is that cancer is a whole body illness. It's not it's not just a disease of the breast or disease of the sum site of metastasis. Cancer is a disease that thrives in an environment of, of of, shall we say metabolic, unhealth. So patients are increasingly interested in how their lifestyle and diet and things can impact their cancers. And in point of fact, it does it This isn't idle speculation, this is reality. So patients should should examine their activity levels. Exercise is therapeutic on smart dietary regimes, not abstemious not restrictive diets, you don't have to become ketogenic, you can be low glycemic, calorie restricted, you can maintain regular physical activity, you can examine things like sleep patterns, I mean, there's a lot that goes into health. And I think that doctors have not been adequately trained to ask about or consider the contributions of these lifestyle changes. So yeah, I mean, patients should get engaged in their own health. And that's great open for my next question, because you wrote a talk called garlic, wine and chocolate. I hope I have that correct. And in that you talk about lifestyle and complementary or alternative medicine. So what what are your thoughts on that? And as not just someone in treatment, but as a survivor? What are some of the main tips you would say on incorporating these kinds of healthy lifestyles? Or any maybe kind of alternative treatments or complementary treatments into their life?

28:37
Well, yeah, I did. I have given a lecture on garlic, wine and chocolate, largely because it's so popular. And everybody likes to eat well and drink wine and have chocolate. But it turns out that foodstuffs we as a species, have have succeeded and thrived by learning and consuming things that are good for us. So when I wrote a major treatise, some years ago, on garlic as a medicinal I'm actually an editor of the Journal of medicinal food. And, and when I wrote a treatise for this for the inaugural issue, I pointed out that we don't like garlic. Because it tastes good. We like garlic, because it's good for us. And we've learned to like the flavor. That's, that's actually true of many herbs and spices and things that we eat, we've learned to eat and enjoy them because our body told us generations ago that those members of our society that ate them did better. And that turns out to be a kind of biological lesson in real time, human species evolved with their food supply. So when we talk about lifestyle and food supply and things like that, yeah, I mean, it is profoundly important for our well being that we return to the biology that we were given as a species and that biology needs a certain amount of sleep, and that sleep should be in dark, and the sleep should be

30:00
have tried to get to interestingly, to try to keep it with diurnal rhythms you've probably heard you probably know that women who worked night shifts have higher incidence of cancer, it's it's a frightening reality, that when you disrupt fundamental biological realities, there are night shift worker issues that can induce a state of diminished health. And cancer was one of the side effects of that. So, so yeah, and there are other like, for example, we know that obesity, particularly post menopausal obesity, and again, it's not entirely well understood. But we know that women who are a little heavier when they're younger, may do okay. But if they remain heavier, as they get older, and they're postmenopausal, they have a much higher incidence of breast cancer. So so these are lifestyle changes that we we can adapt on. Another, another one, you know, we were talking about exercise and activity, it turns out that many people don't realize that exercise is really virtually a drug, when one exercises, they induce a change in the metabolism, that is very healthy. And for any of the patients who may be undergoing treatment for metastatic disease, they will know a drug called Afinitor or everolimus. Afinitor is a chemotherapy drug, it's a pill. And that pill works at the level of a metabolic pathway that is directly connected to exercise. So so in a way we've we've become a funny society where we'd rather take a pill and then walk around the block where we're looking for an exercise, though. So yeah, I mean, these are really fundamental issues that I don't think have been addressed enough in the in the medical literature or in medical school, that these lifestyle changes and behavior patterns can have a very big and long term effect on our health. Yes, you are preaching to the choir, I love it. And you know, I'm sure you're probably familiar with the exercises medicine movement that's through ACSM, and Kaiser Permanente. And, you know, just really trying to focus on how critical exercise is. And I love what you said about you know, we need to exercise a pill that I've seen presentations, where they show all the benefits of exercise and say, you know, if someone introduced a pill that did all these things, the billions of people would be flocking to this pill. And yet, we know we can do it every day, and we just don't. Yeah, I think, yeah, you're right. I mean, I think that people are more in charge of their health than they realize and, and exercise is a big part of it. And it doesn't have to be strenuous exercise, you can do regular I mean, walking is actually a very good exercise. And and you don't have to be a big, you know, marathon runner. In fact, I'm not even sure that's so good for you. But But I think that that walking, swimming, I'm a rower. I mean, if you if you maintain a even keel heartbreak on a regular basis, that's what it does biochemically is to alter the, the central metabolism, mitochondrial metabolism and and change actually reconfigure how your body makes and uses energy. It's profound. That's awesome. I love it. So you are actually going to be the keynote speaker at the Susan G. Komen metastatic breast cancer meeting coming up in January and January 4. And could you tell us a little bit about what what will your topic be? And what do you hope people learn from from your talk at this event?

33:25
Well, thanks for the introduction. I, I was trying to think what would interest the population to my understanding this is going to be a rather diverse population. And it will also be almost, you know, almost completely a population of people who are confronting metastatic cancer metastatic breast cancer. Fortunately, of the 268,000, more or less breast cancers, we see each year, only six to 10% present with metastatic disease. So that's the good news. The bad news is up to 30% of people who present with more localized disease recur. So when you do the numbers, you know, you had 10% or 30%, you've got 40% of that 268,000 people confronting metastatic diseases they go on in their life. That's a big number. And we have not spent, we have not spent enough time worrying about metastatic breast cancer. We do a lot of a lot of outreach for mammograms. And we do a lot of outreach for screening for genetic disorders. But when a patient is confronted with metastatic cancer, they're not likely to live much longer today than they were many decades ago. We are not making headway in this most devastating of presentations. So I was I was thinking about this presentation in the audience and what would they be interested in at first I was thinking of different topics, but I sent it I decided upon a an article I wrote for The Wall Street Journal this past July, and the title was every cancer patient is one in a billion.

34:53
And the reason I did that was in my article in the Wall Street Journal, I described how we are each SP

35:00
She's very unique. And that you can go down through the mathematics of the genetic sequences that get to cancer and realize that it is about one in a million, you could actually argue that every person sitting in that audience of the several 100 will be in the audience, and however many will be on line watching it. Almost no single patient with any form of breast cancer is the same as the one next to them or across the room, they are actually uniquely different. And so our job and my message to these people is we need to get better at making individual decisions. You and I were talking a little earlier about how we have this sort of collision between the kind of corporate thinking about organized medicine and everybody's the same. And then the growing desire for patients to be taken individually. And and I guess, if I land on any side, if I'm the disrupter, I'm an individual patient, kind of guy. I think that we would get a lot further with a lot more patients, if we took them seriously. And if wherever possible, we studied each patient's biology, do you need taxall, or tests with T or platinum or were Cytoxan or Adriamycin or binaural, amener kept saying to me, there are all these different drugs yet today, when you go to the NCCN guideline, or when you go to different different recommendations. They're so standard, they just say, Well, if you've got this take that. I can't you I can't imagine that. If you go to I don't know what you'd like to shop. But if you wouldn't walk into Target and go into the men's department and buy a shirt. I mean, you wouldn't. You wouldn't let someone foist something onto you that didn't fit you. Yet, when you go to your doctor, and you're going to be confronting these poisonous therapies, they just push something at you. I'm offended by that. So yeah, I guess the message for this group is going to be to try to, to, you know, take charge of their disease where possible, use individual tissue biology to guide therapy, where possible use other tools, I'm not against genomic analysis, it doesn't offer us as many insights as we'd like to think. But it's certainly worth conducting. Make sure that you don't carry a predisposition that there isn't some broken genetic element like BRCA, or ATM, on learn about diet and lifestyle changes that might help each patient live a longer and better life, recognize that the impact of lifestyle can be very profound can be therapeutic. So yeah, I mean, the message to this crowd is that that this isn't a hopeless, a situation that they need to sort of take charge of those things they can control and and have a participatory role in their own management cancer. Cancer is a team effort. Yeah. And do you think that it's because we're putting so many resources towards screening and early detection, that we haven't had such a focus on those who are living with metastatic disease?

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Well, on early detection carries an enormous benefit. I mean, many cancers from colon and lung to breast and ovary can be more readily cured if they're detected. So I'm not against early detection at all, I'm, I'm all for finding these diseases early. I'm actually even more in favor of preventing them entirely. But but the the issue is that the reason I think people are sort of less enthusiastic in the metastatic setting is that the tools at our disposal that that the arrows in our quiver for cancer therapy, I think were not well conceived. And, and devised, I mean, the cyclophosphamide and and Adrienne meistens are 50 year old drugs. And now if they were going to cure people, by giving them differently, or in different sequences, or doses or schedules, I'm pretty sure we'd have cured cancer already. So the fact of the matter is that we've got these incredibly blunt instruments that we keep foisting on patients. And I think that the reason that metastatic disease has been less exciting, isn't we're not, we're not making the headway. I would personally if I were granted the opportunity to really study this disease differently, we would be completely focused on on the whole metabolic basis of cancer, we published a treatise on breast cancer, almost over 1000 patients study, where we looked at what constitutes the bioenergetics, the metabolism, the the the nutrient features of cancer, and we think that there are potentially targetable explanations for cancer that we're not exploring. We're so wrapped up in DNA and informatics and and Illumina platforms and all the genomics, that we're not looking at this sort of glaring, obvious fact that cancer is a disease of cells that want to make and use energy differently. And I think that metastatic disease and all levels of cancer will probably be better managed. When we get down to the nitty gritty of what makes cancer tick, and at least, you know, maybe I'm biased, but I believe that it's bioenergetics. I think that it's Cellular Physiology and cellular by

40:00
algae and mitochondrial physiology bioenergetic processes that we have not targeted adequately. And that's why we're just not getting ahead of this disease.

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And is there anything that we as patients, survivors, consumers, loved ones have cancer patients? Is there anything we can do to try to keep the power of the decision making for treatment in the hands of our physicians rather than corporations and insurance companies? Or even to put more emphasis on that kind of study on looking at the whole cellular metabolism piece of it more? Is it a matter of where we donate as senators rewrite to? Is there anything at all we can do about that?

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You know, as a field metabolism is in its nascent stage, it's still just growing, it's still just developing. So I don't know if there's a particular senator or vice presidential candidate or anyone who's specifically running on metabolism. But I would say that an organization is Augustan, as powerful as the Komen Foundation could begin to examine granting funds and resources to investigators who are getting out of the gene and into Cellular Physiology and energetics. I think that one of the problems is that the the last generation of cancer researchers were almost uniformly gene dies. So so brilliant breakthroughs, Petru at all with their discovery of the luminal, A and D and subtypes of basil oils. And, and a lot of really interesting prognostic information that is finding out what group you're in very, very, very good work really worthy work. But where we've not done enough is what to do about it. And I think I hope that as we push this along, and as we try to get the Colemans and the funding entities to do it, maybe they will smile upon investigators who are doing more biochemistry and less molecular biology lessons, less gene stuff, and more more real cell stuff. And I'm certainly interested in cellular biology and funding work that that looks at how cells behave and how these organoids and 3d models work. And that's that's coming into its own something that we started some years ago is becoming really a field in and of itself is there's actually a whole symposium now on a field that we were sort of alone in 20 years ago. Beyond that, though, I think metabolism may be a very, very important direction. And if people are interested in guiding monies, maybe you would ask that the funding entities take a closer look at these investigators, people were doing important work and mitochondrial physiology. There's a work out of Cornell and other centers at Columbia University in New York groups in Boston, other groups that are really looking at cell metabolism. I really I can't stress enough how important I think that will be interesting. Okay. And I wonder what your thoughts are on aftercare. So the space that I work in is women who are recovering from breast cancer treatment. And they're dealing with just the psychological, the emotional and the physical, short term and long term effects of having been through chemotherapy, radiation and the trauma of having been a cancer patient. What are your thoughts on or what do you know about maybe programs that are being developed for aftercare? When women are finished with their or finished, as I say, quote, unquote, finished? When we move into that space where treatment is done, were released from our physicians and they say no, come back in six months come back in a year. And they're dealing with a lot of things like neuropathy and joint pain or whatever the aromatase inhibitors might be causing. What do you think about the value of, you know, clinically supervised aftercare programs for cancer survivors?

43:53
Well, you know, it's interesting that when you look at the literature on degenerative diseases, like for example, people who have osteoarthritis, osteoarthritis is a sort of wear and tear phenomenon. And there were for many years, people would say, Well, you don't want to exercise or you don't want to be active because you've got this bad knee here. But it turns out that that there is a certain amount of restorative response to activity you can actually take people with, have some aches and pains and things get them more active, and over time they regain function. So So I guess, in in terms of cancer, cancer is is you know, obviously the the diagnosis of cancer requires incredibly toxic and punishing therapies. But at the end of it, you're a little bit damaged. I mean, you're like somebody who's got arthritis or something. And in fact, it turns out that I think it is extremely important that people regain their activity and get back into a lifestyle, a healthy lifestyle, particularly exercise. And as much as people sort of don't want like you know, so often someone

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So I'm just too tired, or I just don't have the energy to do it. And, and you've really got to push yourself because physical activity, we talked about this twice. Now, physical activity is a therapy, it is therapy, it's not just makes you feel good doesn't make you breathe deeper. It resets adenosine monophosphate kinase. I mean, this is like, serious physiology. And so people need to realize that they are they are they are taking a, a therapy when they do exercise and also and something that I think is grossly under studied asleep. Sleep patterns. We don't we have very unhealthy sleep patterns. As you probably realize there's a lot of illness, a lot of human illness, a lot of a lot of accidents, and auto accidents and all kinds of stuff that are to do with sleep deprivation, we're all sleep deprived, everybody's sleep deprived. So another thing people have to learn is sleep health, and to learn to, to the physical activity that creates the state of exhaustion that puts you into a better sleep pattern, learn to sleep in a more darkened environment turns out that nighttime light isn't very good for us. It turns out interestingly, as you probably know, that substances like melatonin, which is a natural product produced in the brain that induces a state of sleepiness. Melatonin can also be taken as a supplement, and it's relatively non toxic. I don't know if there's any toxicity to it. And it actually has an impact on particularly estrogen receptor positive breast cancer. So so there are rather simple things that may be very helpful that we that we overlook that we that we should take more seriously from the standpoint of lifestyle and diet and that sort of thing. I mean, we're very, I mean, obviously, like garlic.

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Diet is important. And we want to look at things like cruciferous vegetables. The cauliflower is in the pudding broccolis of the world, because they really are very helpful, and therapeutic indole, three carbinol diambil methane found in these foodstuffs are therapeutic. So there is a whole process of regaining health and and it's dietary and its lifestyle. And, yeah, I think it's incredibly important. People should return to their lives after they've can't have cancer, they should not be damaged goods, they should go back to their lives, right? I think was a video that I watched recently about someone a cancer patient that you had worked with, and she was on Metformin. And I've read other case studies and things where Metformin is being used oftentimes in people after their cancer treatment at long term. And so is that indicative of the importance of managing blood sugar after cancer?

47:43
Well, Metformin is a particularly interesting drug. Yes, you I published a paper several years couple years ago on Metformin, there was some news coverage of a patient of mine from Brazil who had a uniquely good response to it. But Metformin, interestingly, works at the same level. As what I mentioned earlier exercise, you see that cascade, which is the complex one of the mitochondria and feeding through LKB, one of us TK 11, and then to ANP, kindness to mTOR. That pathway, that pathway is the metabolic pathway of exercise, the metabolic pathway of metformin. It's the metabolic pathway of everolimus. So you see, these are connected, these are fundamentally connected and, and metformin, as you know, some people think they would have put it in the water supply. I mean, it's it's it's got this salubrious effect. And and it's relatively non toxic, and it can biochemically affect the same very same metabolic pathways that that exercise does, and other things do so yes, you've probably heard of fasting, intermittent fasting, of course, same same mechanism, same mechanism, these are all directly connected to one of the mediators of metabolic health and kindness. So yeah, I mean, this more and more points us toward very basic fundamental features of the cell that I think we overlooked. I think that the by I did a TED Talk some years ago, and the title was The future of cancer research lies behind us. And the principal discussion point of the TED talk was that we have forgotten much of the brilliant biochemistry of the last century, in favor of the new shiny object genomics. And while we're all dancing around DNA, all of the biochemistry of life is going by us and we should be reinvigorating our interest in the biochemistry and the entomology and the physiology of cancer. That's where the answers will lie. So So yeah, I think that I think that these dietary issues and these lifestyle issues and exercise and and drugs like Metformin, all tie into the biochemistry

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that we forgot at our peril that we that we have to revisit. And yes, you're right I, I've written on that. And Metformin is a very interesting drug. And some people just take it, they just say, you know, it has a good effect and some people just taking Metformin as a prophylactic as a preventative. Interesting. Yeah, that's fascinating. While you're speaking my language, you know, that's the one thing that I focus on with my ladies is, you know, eating real foods, moving your body on a regular basis. And it is so important as that preventative and healing and just so many benefits. So I love hearing what you have to say, well, you know, it's interesting, the the last part of all that is emotional. And that people have to realize that that a depressed patient is less likely to get through this. We know now that our immune system is in direct connection to our emotional state. So the other thing that your patients have to realize is that they can't let this cancer overwhelm them emotionally, they've got to see that there's a light at the end of the tunnel, particularly if they've gone through therapy. Patients who are more upbeat and more positive and optimistic, can actually augment their immunity. So So there are a lot of things that that that go into sort of our our sort of old wives tales about medicine, a lot of them turned out to be true that a happier, upbeat patient is more likely to do well. And that is a truism.

51:28
And it goes back to that attitude. Is everything right? I guess like, Yeah, well, gosh, I thank you so much for making so much time to be on the show today. I really, really appreciate all of your insights. And I am going to post links to the recorded Cancer Institute, your books, I think everybody should read it. And I wonder if there's an end to your TED talks as well. Is there anything else or any other way that you would recommend people getting ahold of you or finding out more about you and your work?

51:59
Well, our website has a good sign. We were happy to to field inquiries. As I've said earlier, we like to think of every patient as an individual and where the possibility arises, if someone's having surgery, or there's going to be something that can be studied, sometimes we can point patients in the right direction, avoid toxic treatments and get the best outcome. So yeah, the patients should be aware of this, you know, whether it applies directly to them is an individual decision. But yeah, we very much happy to help patients in these circumstances and, and hope that it's been helpful to your audience. Oh, I'm sure it has. Thank you so much. It's been a pleasure talking with you.

52:35
Thank you for having me.

52:37
Wow. I hope you enjoyed listening to that as much as I enjoyed being honored to get to participate in that interview. He is such an eloquent speaker, and just so well experienced and knowledgeable in the field of cancer and so compassionate with the way that he actually is considering the experience of the cancer patient, and not only wanting to figure out the most effective way to treat them, but in caring for their well being during that time. So I will post the links to Doctrina go on his website, his TED Talk, his Wall Street Journal article and his book in the show notes, which you can find at Laura lummer.com, forward slash 68. So please check all that out, because there's even more great information in those resources. Now, if you are a regular listener, or you just enjoy hearing the breast cancer recovery coach podcast, I would appreciate it so much if you can take the time to leave an honest review for the show in iTunes or wherever you listen to podcasts. And if you haven't checked out my website, Laura lummer.com. Go there now and download my free guide care four steps to healing after breast cancer. And I actually talk about some of the things that we addressed in this episode, which is beginning the practice of reducing stress in your life, looking at nutrition and especially exercise and different ways to approach exercise so that it works for you and your lifestyle in a way that you enjoy. I love one of the things that Dr. Nagorny said about how he does rowing and you can do walking. And it doesn't have to be this crazy, intense, strenuous type of exercise that so many people think they have to do and that so many people are resistant to because it doesn't sound like fun, and exercise. Physical activity can be fun. It does not have to be boring and strenuous and traumatizing. So check out CAIR four steps to healing after breast cancers for some beginning steps. And also go to Facebook and find our free group, the breast cancer recovery group where you can join and become a part of a community of breast cancer survivors who want to thrive in their life after breast cancer treatment and share their encouragement and explore

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Marines with each other. Thank you so much again for listening and I'll talk to you again next week. Bye for now.

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voices in your head. You've heard your courage to the test laid all your doubts

55:17
your mind is clearer than before. Your heart is full and wanting more your futures

55:28
Give it all you

55:30
know has

55:33
you been waiting on yours

55:39
this is your

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this