2013
Book
Outliving Cancer
The Better, Smarter Way to Treat Your Cancer
PublisherBasic Health Publications, Inc.
Pub Year2013
Page Count260
ISBN9781591203063
Amazon
Description
Overview and Purpose
Outliving Cancer: The Better, Smarter Way to Treat Your Cancer by Dr. Robert A. Nagourney, MD, presents a comprehensive and pioneering approach to cancer treatment that challenges traditional paradigms. The book advocates for personalized, laboratory-directed therapy based on functional profiling of tumor cells, emphasizing the measurement of programmed cell death (apoptosis) rather than relying solely on tumor proliferation or genetic profiling. Dr. Nagourney draws on decades of clinical experience, scientific research, and patient case studies to argue for smarter, more effective cancer care that integrates conventional chemotherapy, targeted therapies, lifestyle interventions, and complementary medicine.
The book is intended primarily for cancer patients, oncologists, and healthcare providers seeking a deeper understanding of cancer biology and personalized treatment strategies. It also serves as a resource for patient advocates and integrative oncology practitioners interested in combining laboratory science with holistic care.
Introduction and Foundational Concepts
Dr. Nagourney opens with a critique of conventional chemotherapy, which historically focused on targeting rapidly dividing cells but often failed to improve long-term survival. His oncology fellowship in the 1980s exposed him to the limitations and frustrations of standard treatments, motivating him to explore alternative approaches. He introduces the metaphor of the tortoise and the hare to illustrate that steady, informed, and individualized treatment can enable patients to outlive cancer, as opposed to aggressive but ineffective therapies.
The author redefines cancer biology by emphasizing the importance of tumor microenvironment and cellular metabolism rather than viewing cancer solely as a disease of uncontrolled proliferation. He highlights apoptosis—programmed cell death—as the critical mechanism by which effective therapies work, and critiques earlier chemosensitivity assays that measured proliferation inhibition rather than cell death.
Functional Profiling and the EVA-PCD® Assay
A central innovation described in the book is the Ex Vivo Analysis of Programmed Cell Death (EVA-PCD®) assay, developed by Dr. Nagourney. This functional test preserves tumor microenvironment components such as stroma, blood vessels, and inflammatory cells, allowing for a more physiologically relevant assessment of tumor response to chemotherapy drugs. Unlike earlier assays, EVA-PCD® measures apoptosis induced by drugs, providing superior predictive value for clinical outcomes.
Clinical data cited include improved response rates and survival in lung cancer patients treated with assay-guided therapy, demonstrating the assay’s potential to personalize and optimize chemotherapy regimens. The author stresses that functional profiling can identify effective drugs and combinations, reduce toxicity, and extend survival, moving beyond the “one-size-fits-all” approach prevalent in oncology.
Historical Context and Early Research Challenges
The book traces the history of chemotherapy from its origins targeting proliferating cells with agents like nitrogen mustard and aminopterin, through the development of combination regimens (e.g., MOPP, CHOP) and bone marrow transplantation. Despite increased complexity and toxicity, these approaches often yielded limited survival benefits.
Early chemosensitivity assays, such as the clonogenic assay developed by Sidney Salmon, failed clinically because they focused on proliferating cells, which are more drug-sensitive but not representative of resistant tumor populations. Dr. Nagourney’s early laboratory work sought to overcome these limitations by measuring drug effects on tumor cells in conditions closer to in vivo biology and focusing on apoptosis.
He recounts institutional and commercial obstacles encountered while developing and attempting to commercialize functional testing, including conflicts at Oncotech, Inc., which ultimately closed. Despite these setbacks, the foundational science laid the groundwork for current personalized cancer therapy approaches.
Integration of Complementary Medicine and Lifestyle Factors
Dr. Nagourney’s interest in complementary and alternative medicine (CAM) arose from recognizing the limitations of allopathic medicine and inspired by patient experiences such as Norman Cousins’ recovery through vitamin C and laughter. The book explores the role of natural remedies, including traditional Chinese and Ayurvedic medicine, acupuncture, aromatherapy, yoga, meditation, and lifestyle factors in cancer care.
Central to this discussion is the concept of cancer as a metabolic disease involving altered mitochondrial function and energy metabolism. The author highlights the importance of diet, exercise, and stress management in cancer prevention and treatment:
- Dietary components such as soy, garlic, turmeric, and traditional spices contain antioxidants and micronutrients that may reduce cancer risk.
- Exercise activates AMP kinase, improving cellular metabolism and immune function, with benefits extending to metabolic syndrome, diabetes, cardiovascular disease, and cancer.
- Psychoneuroimmunology links emotional stress and immune disruption, underscoring the need for psychological and social support.
Dr. Nagourney endorses an eclectic, individualized approach summarized by his guiding principle: “I give conventional treatments unconventionally and unconventional treatments conventionally.”
Case Studies Illustrating Personalized Therapy
The book includes detailed patient case studies demonstrating the clinical application and benefits of laboratory-directed therapy:
- Rick Carroll (NSCLC): Despite advanced disease and initial hospice care, serial tumor biopsies and functional testing guided sequential chemotherapy regimens, leading to prolonged remission and survival beyond expectations.
- Alan Kapuler (Non-Hodgkin B-cell lymphoma): Combined natural therapies and lab-guided chemotherapy achieved durable remission with minimal toxicity, illustrating synergy between lifestyle interventions and personalized treatment.
- Ingrid Ottesen (Breast cancer): Lab-directed chemotherapy led to durable remission in a patient with poor prognostic markers, predating targeted therapies like Herceptin.
- Steve Lockwood (Pancreatic cancer): Functional assay identified an effective three-drug regimen, resulting in clinical improvement and prolonged survival despite poor prognosis.
- Elizabeth Panke (Platinum-resistant ovarian cancer): Functional testing identified a paradoxical drug combination leading to complete remission and over a decade of disease-free survival.
- Dr. John Friedberg (Metastatic renal cell carcinoma): Functional testing guided low-dose chemotherapy resulting in dramatic tumor regression and improved quality of life, despite the cancer’s typical resistance to chemotherapy.
- Ryan Kuper (Lung adenocarcinoma): Functional assay predicted sensitivity to crizotinib despite negative genetic tests, highlighting the limitations of genomic profiling alone.
Challenges in Clinical Integration and Reimbursement
The book discusses regulatory and reimbursement challenges faced by advanced chemosensitivity assays. A notable conflict involved Oncotech’s drug resistance assay, which Medicare considered for coverage despite its inability to identify effective drugs. Dr. Nagourney opposed this, advocating for assays that identify active drugs to truly guide therapy. Patient advocates like Elizabeth Panke testified about the clinical benefits of functional testing, influencing Medicare’s decision to deny coverage for less informative assays.
These challenges illustrate the tension between scientific validity, commercial interests, and healthcare policy, which can impede adoption of superior personalized testing methods.
Genetic Versus Functional Analysis and Targeted Therapies
Dr. Nagourney critiques the oncology field’s overreliance on genomic profiling, which often fails to predict clinical response adequately. He emphasizes that gene expression is permissive rather than deterministic, and that epigenetic regulation, protein modifications, and tumor microenvironment profoundly influence cancer behavior.
Targeted therapies, such as EGFR inhibitors (gefitinib, erlotinib) and ALK inhibitors (crizotinib), are discussed in the context of “oncogene addiction,” where cancer cells depend on specific survival pathways. Functional testing can identify effective targeted agents even when genetic mutations are absent or unclear.
Case studies, such as Sue Allen’s prolonged remission with Tarceva guided by functional testing, demonstrate the clinical utility of this approach. The book also addresses mechanisms of resistance and strategies to overcome them, including combination therapies and adjunctive treatments like hydroxychloroquine.
Metabolism, Epigenetics, and the Future of Cancer Therapy
The author revisits the concept of cancer as a metabolic disease, highlighting the Warburg effect and the role of mitochondrial dysfunction. Advances in metabolomics and understanding of epigenetic regulation (DNA methylation, histone acetylation, noncoding RNAs) add complexity to cancer biology but also offer new therapeutic targets.
Drugs targeting metabolic pathways, such as mTOR inhibitors (rapamycin analogs), represent promising avenues. Natural products with metabolic effects are also explored for their potential adjunctive roles.
Dr. Nagourney argues that future effective therapies must integrate metabolic targeting with functional assays to overcome cancer’s adaptability and resistance.
The Causes of Cancer and Broader Implications
The book explains cancer’s origins as a failure of apoptosis, often triggered by mutations or viral interference with tumor suppressor proteins (e.g., p53). Environmental factors such as free radicals, inflammation, carcinogens, and hormone-like substances contribute to carcinogenesis.
Dr. Nagourney advocates a holistic view recognizing common metabolic alterations across cancer types rather than excessive tumor subtype fragmentation. He also connects cancer research to other diseases involving dysregulated cell death, such as autoimmune disorders, neurodegeneration, and AIDS, suggesting that insights into programmed cell death have broad biomedical relevance.
Clinical Trials, Chemosensitivity Testing, and Practical Guidance
The book provides an overview of clinical trial phases and critiques the current system’s inefficiencies, noting that only a small fraction of new drugs improve survival meaningfully. Laboratory-directed therapy could improve trial success rates by selecting patients likely to respond.
Common objections to chemosensitivity testing are addressed, including concerns about artificial testing conditions and turnaround time. Dr. Nagourney emphasizes that modern assays measure fundamental cancer cell death mechanisms and fit within clinical timelines.
Practical guidance includes sample collection protocols, assay turnaround, and interpretation of results. The author stresses that personalized testing can double response rates and reduce toxicity, though reimbursement and availability remain challenges.
The book also reviews treatment options across cancer types, illustrating the complexity and variability of chemotherapy regimens and the value of functional testing to narrow choices effectively.
Glossary, References, and Author Background
An extensive glossary defines key terms in cancer biology, pharmacology, and molecular targets, supporting readers’ understanding of complex concepts. References cite foundational studies validating functional profiling, chemotherapy history, targeted therapies, and clinical trials.
Dr. Robert A. Nagourney’s biography highlights his credentials in oncology and hematology, his pioneering work in functional tumor profiling, and his clinical innovations such as the platinum/gemcitabine doublet. His career reflects a commitment to integrating laboratory science with patient-centered care.
Strengths and Limitations
Strengths:
- Comprehensive integration of scientific research, clinical experience, and patient narratives.
- Clear explanation of apoptosis and tumor biology as foundations for personalized therapy.
- Detailed case studies demonstrating real-world application and benefits of functional testing.
- Balanced discussion of complementary medicine and lifestyle factors alongside conventional treatment.
- Critical analysis of clinical trial limitations and healthcare policy challenges.
Limitations and Cautions:
- Functional assays require access to fresh tumor samples and specialized laboratories, which may limit widespread availability.
- Complementary and integrative approaches discussed need further rigorous scientific validation.
- The book reflects the author’s research and clinical perspective; it is not a substitute for individualized medical advice.
- Regulatory and reimbursement hurdles may restrict patient access to advanced testing.
Utility for Cancer-Options Reference Database
This book is a valuable resource for patients and clinicians seeking evidence-based, personalized cancer treatment strategies that go beyond standard protocols. It provides a scientific rationale for functional tumor profiling, highlights the importance of apoptosis and metabolism in cancer therapy, and offers practical insights into integrating laboratory data with clinical decision-making.
Its inclusion of complementary medicine and lifestyle factors broadens the scope of cancer care, supporting integrative oncology approaches. The detailed case studies and discussion of healthcare system challenges provide context for patient advocacy and informed treatment choices.
Overall, Outliving Cancer serves as a comprehensive guide to smarter, individualized cancer therapy, emphasizing the potential to improve outcomes and quality of life through innovative, biology-driven approaches.
