How to Teach an Old Drug New Tricks
Finding new uses for everyday medicines to ease troublesome side effects of chemotherapy and radiation therapy has the potential to save lives and dollars, says Dr Michael Jameson, Assistant Dean and Associate Professor, Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland.
Dr Jameson and a team of oncologists, molecular geneticists and researchers are setting up a clinical trial funded by Cancer Research Trust NZ, after laboratory research showed that taking a heartburn medicine could counter complications from chemotherapy.
“We’re looking at how to teach old drugs new tricks,” says Dr Jameson. “The clinical trial, led by medical oncologist Dr Navin Wewala from Palmerston North Hospital whom I’m mentoring, seeks to confirm how the cheap antacid drug, cimetidine, can reduce the side effects of a particularly toxic chemotherapy drug, cisplatin, without compromising its positive effects on tumours.”
Cisplatin plays an important part in the cure of many cancers, especially in children and younger adults, but often patients are left with partial deafness, tinnitus, abnormal sensation in hands and feet and reduced kidney function. “It’s commonly used in some of the most frequent and lethal cancers in NZ, including lung, head and neck, stomach, cervix, bladder, testis, ovary, bile duct and a number of paediatric cancers.
While cisplatin-induced nausea and vomiting is now effectively managed in most patients, damage to kidneys, nerves in hands and feet and hearing is still a very serious issue,” said Dr Jameson. “Understanding how cisplatin moves into normal tissues and finding how we can protect patients from the side effects with an over the counter drug that is an oldie but still a goodie is a huge opportunity to deliver public good health outcomes.”
Dr Jameson says it’s hard to get grants to research the possible positive impacts of cheaper drugs or finding new uses for legacy drugs, but the savings on treatments and social benefits are worth it.
“We hope that the findings from our trial, supported by this $76,000 grant from Cancer Research Trust New Zealand, will show positive effects from taking a $10 a week course of cimetidine pills to mitigate some of the debilitating side effects of cisplatin chemo without interfering with the cancer-killing effects.
“There’s a real benefit in helping children get over their cancer without being burdened by the learning difficulties and impact on their quality of life of having to cope with the after effects of hearing loss for instance,” he said. “And we are using that foundational research to make new advances.”
Dr Jameson is investigating the use of another commonly-prescribed drug, Simvastatin, used to lower cholesterol levels, to reduce the risk of relapse of rectal cancer after radiation treatment and hopefully reduce the side effects too. Earlier research found that people taking statins during radiation treatment for several cancers, including breast, prostate, bladder and rectal, had better outcomes.
He and his team have been awarded a significant research grant from the Health Research Council of NZ to fund a clinical trial that will look at the effect of patients with rectal cancer taking Simvastatin before, during and after their chemotherapy and radiation therapy.
“We’re looking at how statins, which are very cheap medicines, reduce gut toxicity from radiation. The research costs millions of dollars, the treatments thousands of dollars, but the pills to reduce significant side effects without compromising cancer-fighting therapies, a handful of dollars for a whole course.”
Dr Jameson, an advocate for collaborating on lab research and clinical trials, is a realist.
“Not all research produces the results you expect or want. It can be a real bugger, the results disappointing and confounding, but every outcome delivers the opportunity to discover and learn. The grants over the years from Cancer Research Trust New Zealand have kept our goal alive as we continue to explore new uses for old drugs that can help cancer patients achieve better outcomes and also help lower our health spend.”
Dr Jameson was awarded a total of $160,217 over three grants fromCancer Research Trust of New Zealand to conduct clinical research studies.
Dr Navin Wewala was awarded a $75,904 grant from Cancer Research Trust of New Zealand in 2017 to conduct a Phase Ib randomised, placebo-controlled, double-blinded trial of cimetidine to prevent the nephro-, neuro- and oto-toxicity of cisplatin in patients undergoing chemo-radiotherapy for head and neck cancer.
About the Cancer Research Trust New Zealand
Cancer Research Trust New Zealand is the country’s second biggest independent cancer research charity, funding over $15 million in research and professional development projects since 2002. The Trust provides grants to support New Zealand-based initiatives that will lead to improvements in the prevention, detection, diagnosis or treatment of all types of cancer, or improvements in palliative care. To learn more visit: www.cancerresearchtrustnz.org.nz/we-are-getting-cancer-on-the-run.