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Review
. 2015 Dec;35 Suppl(Suppl):S276-S304.
doi: 10.1016/j.semcancer.2015.09.007.

Designing a broad-spectrum integrative approach for cancer prevention and treatment

Keith I Block  1 Charlotte Gyllenhaal  2 Leroy Lowe  3 Amedeo Amedei  4 A R M Ruhul Amin  5 Amr Amin  6 Katia Aquilano  7 Jack Arbiser  8 Alexandra Arreola  9 Alla Arzumanyan  10 S Salman Ashraf  11 Asfar S Azmi  12 Fabian Benencia  13 Dipita Bhakta  14 Alan Bilsland  15 Anupam Bishayee  16 Stacy W Blain  17 Penny B Block  2 Chandra S Boosani  18 Thomas E Carey  19 Amancio Carnero  20 Marianeve Carotenuto  21 Stephanie C Casey  22 Mrinmay Chakrabarti  23 Rupesh Chaturvedi  24 Georgia Zhuo Chen  5 Helen Chen  25 Sophie Chen  26 Yi Charlie Chen  27 Beom K Choi  28 Maria Rosa Ciriolo  7 Helen M Coley  29 Andrew R Collins  30 Marisa Connell  25 Sarah Crawford  31 Colleen S Curran  32 Charlotta Dabrosin  33 Giovanna Damia  34 Santanu Dasgupta  35 Ralph J DeBerardinis  36 William K Decker  37 Punita Dhawan  38 Anna Mae E Diehl  39 Jin-Tang Dong  5 Q Ping Dou  12 Janice E Drew  40 Eyad Elkord  41 Bassel El-Rayes  42 Mark A Feitelson  10 Dean W Felsher  22 Lynnette R Ferguson  43 Carmela Fimognari  44 Gary L Firestone  45 Christian Frezza  46 Hiromasa Fujii  47 Mark M Fuster  48 Daniele Generali  49 Alexandros G Georgakilas  50 Frank Gieseler  51 Michael Gilbertson  52 Michelle F Green  53 Brendan Grue  54 Gunjan Guha  14 Dorota Halicka  55 William G Helferich  56 Petr Heneberg  57 Patricia Hentosh  58 Matthew D Hirschey  59 Lorne J Hofseth  60 Randall F Holcombe  61 Kanya Honoki  47 Hsue-Yin Hsu  62 Gloria S Huang  63 Lasse D Jensen  64 Wen G Jiang  65 Lee W Jones  66 Phillip A Karpowicz  67 W Nicol Keith  15 Sid P Kerkar  68 Gazala N Khan  69 Mahin Khatami  70 Young H Ko  71 Omer Kucuk  5 Rob J Kulathinal  10 Nagi B Kumar  72 Byoung S Kwon  73 Anne Le  74 Michael A Lea  75 Ho-Young Lee  76 Terry Lichtor  77 Liang-Tzung Lin  78 Jason W Locasale  79 Bal L Lokeshwar  80 Valter D Longo  81 Costas A Lyssiotis  82 Karen L MacKenzie  83 Meenakshi Malhotra  84 Maria Marino  85 Maria L Martinez-Chantar  86 Ander Matheu  87 Christopher Maxwell  25 Eoin McDonnell  53 Alan K Meeker  88 Mahya Mehrmohamadi  89 Kapil Mehta  90 Gregory A Michelotti  39 Ramzi M Mohammad  12 Sulma I Mohammed  91 D James Morre  92 Vinayak Muralidhar  93 Irfana Muqbil  12 Michael P Murphy  94 Ganji Purnachandra Nagaraju  42 Rita Nahta  5 Elena Niccolai  95 Somaira Nowsheen  96 Carolina Panis  97 Francesco Pantano  98 Virginia R Parslow  43 Graham Pawelec  99 Peter L Pedersen  100 Brad Poore  74 Deepak Poudyal  60 Satya Prakash  84 Mark Prince  101 Lizzia Raffaghello  102 Jeffrey C Rathmell  53 W Kimryn Rathmell  9 Swapan K Ray  23 Jörg Reichrath  103 Sarallah Rezazadeh  104 Domenico Ribatti  105 Luigi Ricciardiello  106 R Brooks Robey  107 Francis Rodier  108 H P Vasantha Rupasinghe  109 Gian Luigi Russo  110 Elizabeth P Ryan  111 Abbas K Samadi  112 Isidro Sanchez-Garcia  113 Andrew J Sanders  65 Daniele Santini  98 Malancha Sarkar  114 Tetsuro Sasada  115 Neeraj K Saxena  116 Rodney E Shackelford  117 H M C Shantha Kumara  118 Dipali Sharma  119 Dong M Shin  5 David Sidransky  120 Markus David Siegelin  121 Emanuela Signori  122 Neetu Singh  123 Sharanya Sivanand  124 Daniel Sliva  125 Carl Smythe  126 Carmela Spagnuolo  110 Diana M Stafforini  127 John Stagg  128 Pochi R Subbarayan  129 Tabetha Sundin  130 Wamidh H Talib  131 Sarah K Thompson  132 Phuoc T Tran  133 Hendrik Ungefroren  51 Matthew G Vander Heiden  134 Vasundara Venkateswaran  135 Dass S Vinay  136 Panagiotis J Vlachostergios  137 Zongwei Wang  138 Kathryn E Wellen  124 Richard L Whelan  118 Eddy S Yang  139 Huanjie Yang  140 Xujuan Yang  56 Paul Yaswen  141 Clement Yedjou  142 Xin Yin  48 Jiyue Zhu  143 Massimo Zollo  21
Affiliations
Review

Designing a broad-spectrum integrative approach for cancer prevention and treatment

Keith I Block et al. Semin Cancer Biol. 2015 Dec.

Abstract

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered.

Keywords: Cancer hallmarks; Integrative medicine; Multi-targeted; Phytochemicals; Targeted therapy.

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Conflict of interest statement

Conflict of Interest Statement

Keith Block is an owner of the Block Center for Integrative Cancer Treatment and of North Shore Nutraceuticals; Charlotte Gyllenhaal is an employee of the Block Center for Integrative Cancer Treatment; Jack Arbiser is the inventor of US Patents involving derivatives of honokiol and NADPH oxidase inhibitors. He has also cofounded ABBY Therapeutics for the development of NADPH oxidase inhibitors; Penny Block is the Executive Director of the Block Center for Integrative Cancer Treatment and President of North Shore Nutraceuticals; Ralph J. DeBerardinis is a member of the scientific advisory boards for Peloton Therapeutics and Agios Pharmaceuticals; Anna Mae E. Diehl has grants from Shire-Research, Metabolon, and Gilead. She is also a consultant for Astrazeneca, Genentech, Japan Tobacco, and the NuSI Foundation; Byoung S. Kwon holds patents for methods regarding anti-CD 137 and adaptive CTL therapeutics; Valter D. Longo has an equity interest in L-Nutra, a company that develops medical food; Kapil Mehta is a scientific advisor to Lifecare Innovations, and holds India Patent 8.765.797, TG2 inhibitors and uses thereof; Michael P. Murphy holds intellectual property in mitochondrial therapies and has ownership shares in a company called Antipodean Pharmaceuticals Inc. which is trying to commercialize some of these compounds; Jeffrey C. Rathmell received indirect compensation from Novartis while working on this project; Luigi Ricciardiello received an unrestricted research grant from SLA Pharma AG, Switzerland.; John Stagg has a sponsored research agreement with Medimmune LLC and is on the scientific advisory board of Surface Oncology; Matthew G. Vander Heiden is a consultant, scientific advisory board member, and owns equity in Agios Pharmaceuticals

Figures

Figure 1
Figure 1
Diagrammatic representation of removal of susceptible cells by a targeted cancer therapy resulting in disease remission, which leaves genetically heterogeneous resistant cells to proliferate, resulting in relapse.
Figure 2
Figure 2
Hallmarks of cancer, sequenced roughly in the order in which these capabilities are acquired by most cancers, as portrayed in the graphical representation of tumor evolution.

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