"" Ralph Moss—Cancer Consultant

Sunday, February 18, 2018


Photo: Prof. Rolf Issels, MD, Munich, Germany

NOTE: This is a revised version of my blog/newsletter from earlier today. I have made several changes. First, the publishing journal is JAMA Oncology (not Lancet Oncology). Second, I have clarified the nature of the survival advantage by quoting the article's authors. Third, I have removed the previous photo, since it did not represent the type of hyperthermia used in this experiment.


On February 15, JAMA Oncology published a phase III randomized controlled trial (RCT) on the use of regional hyperthermia (heat therapy) with chemotherapy for soft tissue sarcomas. As this landmark paper points out, "Patients with soft tissue sarcoma are at risk for local recurrence and distant metastases despite optimal local treatment." Preoperative chemotherapy improves the outcome somewhat. But the authors' theory was that adding targeted heat therapy might improve the outcome even more.

A clinical trial to test this hypothesis began in 1998 and it has taken two full decades to finally prove that heat therapy improves both progression-free (PFS) and survival (OS). Thus, out of 341 patients treated, a total of 220 experienced disease relapse, and 188 died. But the addition of regional hyperthermia improved progression-free survival (PFS) by 35 percent. The true bottom line for patients and their loved ones is whether they live longer. The really exciting news is that survival was also prolonged vs. preoperative chemo alone. Here is how the authors phrase it:

"Patients randomized to chemotherapy plus hyperthermia had prolonged survival rates compared with those randomized to neoadjuvant chemotherapy alone...with 5-year survival of 62.7%...vs 51.3%..., respectively, and 10-year survival of 52.6%...vs 42.7%."

That could results in a great many lives saved through a relatively safe and simple procedure.

Writing in JAMA Oncology, the 21 authors concluded:
"Among patients with localized high-risk soft tissue sarcoma the addition of regional hyperthermia to neoadjuvant chemotherapy resulted in increased survival, as well as local progression-free survival. For patients who are candidates for neoadjuvant treatment, adding regional hyperthermia may be warranted."
The study was headed by Prof. Rolf Issels, MD, of University Hospital Medical Center, Großhadern, Munich. Although a mainly European multi-national effort, there were American participants at the University of Maryland Medical Center.  Nonetheless, the study has a global significance that goes far beyond its applicability to relatively rare sarcomas. 

Hyperthermia has been scorned as "alternative medicine" for decades. Mainly through the work of scientists in Rotterdam, Holland, it was eventually acknowledged as a way to help delay progression of the disease. But there remained skepticism that it actually extended human survival. Now through this meticulous multi-national study, it has now been conclusively proven to do so in a type of cancer that is notoriously difficult to treat.

JAMA Oncology is ranked #8 among the top 217 oncology journals in the world. But will this study really change anything? Skepticism towards hyperthermia still runs very deep. This is compounded by the fact that this treatment is not a mass-produced drug, but relies on a natural treatment, heat. It  requires the purchase and maintenance of expensive equipment and, more importantly, the training of highly skilled technical personnel to administer the treatment. Few hospitals have proven willing to make such an investment. Perhaps this study will change all that.

When these results were first announced at a medical conference in Hawaii in November,  it garnered a mere two articles in obscure medical publications. And, so far, this JAMA Oncology publication has not been picked up by any news service or online journal. Perhaps discussions at the forthcoming Society of Thermal Medicine (STM) meeting in Tucson, Arizona (May 7-10) will generate more well-deserved attention for this important finding.

To be clear, hyperthermia is not a stand-alone "cure," but an adjuvant treatment that must be added to other approaches. It lacks the sexiness of purported "magic bullets," of the type that appeal to Wall Street investors. But it fits in very well with the holistic approach that is favored by many private clinics in the non-English speaking world, especially in the German-language zone. This study should be a powerful stimulus to the further employment of such treatments.

To read an abstract of the JAMA Oncology paper in question:

Thursday, February 15, 2018


For the past three years, the American Society of Clinical Oncology (ASCO) has declared cancer immunotherapy to be the "breakthrough of the year." An important part of this approach comes from a class of drugs known as immune checkpoint inhibitors.

I share the general enthusiasm for this approach, but I also have caveats. One of these is the likelihood of patients experiencing serious side effects (technically known as "immune related adverse events" or irAEs) at typically recommended doses.

According to Igor Puzanov, MD, of Roswell Park Cancer Institute, Buffalo, NY:
"New immunotherapy agents are being approved at a rapid pace, and patients have new treatment options, but 'many of these agents have side effects we haven't seen before. We're seeing effects on the skin, lungs, gastrointestinal and endocrine systems, joints, heart and other organs, and some of these are only just beginning to be described'" (all emphases are added).
We must collectively resist the "gold rush" atmosphere that some drug companies have generated around their new cancer treatments. Immune checkpoint inhibitors are not magic bullets for cancer or anything else. They are, however, very useful tools that can be used as part of a safer holistic  approach to cancer. For various reasons, this type of approach is only available at clinics that are not beholden to the international medical-industrial establishment.

While side effects with immune checkpoint drugs are different than with most chemotherapies, they can also be extremely serious and difficult to treat. According to the same Medpage Today article:

"Serious and occasionally life-threatening immune-related adverse events have been reported in the literature, and treatment-related deaths occur in up to 2 percent of patients, varying by checkpoint inhibitor."
According to a review article on the immune checkpoint drug ipilimumab (Yervoy®):
"Single cases of unpredictable, in part astonishing, and difficult to treat, life-threatening or even fatal side-effects, have been reported including cases of nephropathy, myopathy, sarcoidosis, Guillain-Barré syndrome, uveitis, and leucopenia."
This should not come as a surprise. In June 2012, my colleagues Tibor Bakacs, MD, PhD, DSc, of the Hungarian Academy of Sciences, Jay Mehrishi, PhD, then of the University of Cambridge, UK, and I published one of the first medical journal articles warning of the potentially "catastrophic" effects of these drugs. We warned that,
"147 (38.7%) of the patients experienced severe adverse events and 6.8% suffered dose-limiting events (8.4%, in the ipilimumab-alone group). There were 14 deaths related to the study drugs and 7 of these were associated with immune-related adverse events. In contrast, the complete response rate was only 0.2%, in one patient out of 403 who received ipilimumab plus a peptide vaccine."
This is the reason that some European oncologists prefer a low-dose combined approach to immune checkpoint inhibition. By this, they mean that two such agents can be used simultaneously, in conjunction with other immune-stimulating and natural treatments. The side effects with such a low-dose approach are generally mild and infrequent. It is a sane, and humane, way to use these powerful new agents.


ASCO Advance of the year 2018: https://www.asco.org/research-progress/reports-studies/clinical-cancer-advances-2018/advance-year

Source of the Dr. Puzanov quote: https://www.medpagetoday.com/reading-room/asco/immunotherapy/71026?xid=NL_ASCORR_2018-02-15&eun=g5387475d39r&pos=1 

My coauthored article on ipilimumab: Bakacs T, Mehrishi JN, Moss RW. Ipilimumab (Yervoy) and the TGN1412 catastrophe. Immunobiology. 2012 Jun;217(6)583-9.

Friday, January 19, 2018


My colleague, Tibor Bakacs, MD, PhD, DSc, of the Hungarian Academy of Sciences, and I have just had an e-letter published in the journal Science Translational Medicine (STM). STM is an offshoot of Science, the weekly magazine of the American Association for the Advancement of Science (AAAS). STM has an impact factor of 16.789, making it the 11th most influential journal in the entire medical field. (The impact factor reflects the yearly average number of citations to recent articles published in a journal.)

STM is a kind of "Formula 1" testing ground for medical science. In other words, cutting-edge medical technology usually debuts here in an atmosphere of fierce competition for space and attention. As an example, the paper we were commenting on was written by 39 authors from top institutions. It pertains to one of the most promising breakthroughs in cancer therapy--the combination of immunotherapy with cancer-killing (oncolytic) viruses. This is the subject of intense research at Sloan-Kettering Institute, M.D. Anderson Cancer Center, and many other centers.

Our 900 word e-letter demonstrates several important point that could positively impact the worldwide discussion. We show that an un-engineered Newcastle Disease Virus (NDV) vaccine is still superior to anything coming from Big Pharma. We illustrate the "proof of principle" case of a wheelchair-bound Israeli patient, with a grade IV recurrent glioblastoma multiforme (GBM) and a Karnofsky performance score of 40, who experienced a complete and long-lasting remission through the use of an attenuated Newcastle vaccine called MTH-68. This patient is alive and well more than 20 years after his complete remission. According to the consensus of experts GBM is incurable. The median survival for grade IV GBM after tumor- directed surgery and chemoradiotherapy is 14.6 months. We found no other high grade, recurrent GBM case published in PubMed, which comprises more than 27 million citations for biomedical literature from MEDLINE, life science journals, and online books.

The fact that this remission came about through the repeated use of an attenuated non-engineered virus is a very important observation. It means that the virus can be administered safely and in a virtually non-toxic fashion almost anywhere in the world.

Dr. Bakacs and I met in the early 1990s through our mutual friendship with the brilliant late Hungarian-American general practitioner, Laszlo Csatary, MD of Alexandria, VA. Bakacs is a clinically trained scientist with over 30 years experience, author of 75 scientific papers in leading medical journals. We have remained close friends and collaborators for decades.

In 1999, Csatary and Bakacs, et al. published a letter on this exceptional case in the Journal of the American Medical Association. In the same year, I joined them, along with Josef Beuth, MD, of the University of Cologne, in a more comprehensive case series on the beneficial effects of NDV.

In 2013, the Israeli patient's physician, Arnold I. Freeman, MD, of Hadassah Hospital, Bakacs and I published a follow-up review of this exceptional GBM case in the Journal of Clinical Oncology.

In the past, Dr. Bakacs and I often found our articles and letters on this topic rejected by the major journals. (This is a saga in itself.) Nonetheless, we continued to publish in less impactful scientific journals. We are now guardedly optimistic that our perspective on NDV will be heard by those who are in a better position to change the course of treatment.

We are well aware of the formidable barriers to acceptance that remain for non-toxic, inexpensive and widely available treatments. In addition to confronting scientific dogma, one also has to confront the economic barriers to acceptance.

This takes some explaining.

It takes many millions of dollars to gain approval for new treatments. Some people have pegged the cost of developing a new drug at $2.6 billion! Although this is probably exaggerated, the process is still exceedingly expensive. This high cost actually serves the interests of Big Pharma, since it serves as a barrier to the entry of inexpensive drugs into the marketplace. 

The high cost of drug development then becomes the main justification for charging unconscionable amounts for new drugs. For example, in 2017 the Food and Drug Administration (FDA) approved a new form of cancer immunotherapy (called Kymria®) at $475,000 for a single infusion!

This has created a "gold rush" atmosphere around cancer drugs. No profit-driven company is likely to develop a simple natural treatment in such an atmosphere. Treatments made from attenuated non-engineered viruses are too readily available to be of much interest to Big Pharma. Most of the talk these days is of engineered forms of the virus. This means producing unique and patentable forms, which cannot be easily "knocked off," and whose sale can be legally monopolized for years. That's where the big money is. But if inexpensive vaccines are eliminated in favor of highly expensive engineered ones, this will also have disastrous consequences for billions of people worldwide. They will not be able to afford the treatment, or will be bankrupted in the process. So a great deal is at stake in how this debate over NDV is resolved.


2018 Science Translation Medicine e-letter:


Research into bioengineered forms of Newcastle Disease Virus Vaccine:

Zamarin D, Holmgaard RB, Ricca J, et al. Intratumoral modulation of the inducible co-stimulator ICOS by recombinant oncolytic virus promotes systemic anti-tumour immunity. Nat Commun. 2017 Feb 13;8:14340. 

1999 Review of NDV in Anticancer Research:

Csatary LK, Moss RW, Beuth J, Töröcsik B, Szeberenyi J, Bakacs T. Beneficial treatment of patients with advanced cancer using a Newcastle disease virus vaccine (MTH-68/H). Anticancer Res. 1999 Jan-Feb;19(1B):635-8.

Freeman, Bakacs, Moss Abstract in the JCO:


Cost of Kymria: 


Cost of new drug development:


Sunday, December 17, 2017


Source: Wikimedia Commons

A few years ago I toured Israeli cancer hospitals and clinics. I was happily surprised to find a widespread acceptance of medical marijuana (MM), especially in the pediatric setting. Now, a new study of American doctors has shown widespread support for the use of MM in the USA as well. The study, published in the journal Pediatrics, showed that 85 to 95 percent of American doctors who deal with cancer in children, would be willing to help them get marijuana. This is despite the vicious and irrational campaign of the federal and some state governments against this relatively harmless weed.

All patients with cancer should have access, should they choose, to medical marijuana. It definitely seems to provide relief of nausea and other side effects of chemotherapy.

Perhaps we then can begin to tackle the thornier question of whether or not marijuana extracts have specific anti-cancer effects as well. A lot of people have strong opinions on this question, but there is very little actual clinical data. My guess is that it does help some patients. But as long as the government insists on misclassifying marijuana as a dangerous "Schedule 1" drug (like heroin) we are unlikely to arrive at any clear answers.

The Pediatrics article abstract:


Friday, November 3, 2017


Alcohol poses a danger in terms of causing or promoting cancer. Research suggests that even moderate use is dangerous. We suggest treating it with extreme caution. It also lowers your inhibitions and gets you to eat more sugar and carbohydrates in general.

Tuesday, October 31, 2017


Fever is actually beneficial for those receiving immune therapy (such as IL-2) for cancer. In fact, it is an essential part of the treatment. Patients whose fever was left untreated lived almost twice as long as those who had their fevers reduced! Therefore, it is a mistake to use fever-lowering drugs in this context. Here is the article:


Friday, July 14, 2017


My good friend, Thomas Seyfried, PhD, an outstanding biologist at Boston College, is senior author on an amazing case report of a complete remission in a patient with triple-negative breast cancer. The treatment took place at an innovative cancer center in Turkey and involved a combination of chemotherapy with hyperthermia, hyperbaric oxygen and a ketogenic (i.e., a very low carbohydrate + high fat) diet.

The article in question appeared in July 2017 in the online PubMedCentral-indexed scientific journal, Cureus. Here is a link to the article:

Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer.

I have a special favor to ask my readers: If, after reading, you like this article as much as I did, please RATE IT and leave a review at the site. This is important because the paper is in a best outcome competition at the journal and winning this contest will advance the cause of innovative cancer treatment. You may need to sign up with Cureus first.

Here is my comment: Based on the prevalence of the Warburg effect, and the enormous amount of preliminary work on the glucose-dependency of cancer, it would be logical to pursue such strategies as a ketogenic diet, water fasting, and extending the nightly fast, to the cancer situation. This would most logically be done at first as an adjunct to other, better established treatments. Despite this great promise, there has been little human clinical research on this topic. Thus, this paper, although it concerns only a single patient, is highly suggestive that this approach is fully deserving of a full-scale randomized clinical trial.

Tuesday, April 25, 2017

I'm Now an Honorary Member of ARTOI

International participants at the 2016 ARTOI meeting in Florence, Italy. (Author is third from left.)

I am proud to report that I have been asked to be an honorary member of ARTOI, the "Association for Research and Treatment in Integrative Oncology," based on Rome, Italy. According to Massimo Bonucci, MD, founder and president of this vibrant group:

"On behalf of all members of ARTOI I would like to express our desire to have you as an Honorary Member of ARTOI. It would be an honor for us to consider you a participant in our initiatives. Your commitment to the integrative field is very much in keeping with our mission: to help patients live in the best way the experience of illness."
I am extremely happy to receive this great honor. I will admit to having a 50-year love affair with the entire country of Italy. But, beyond that, I think that complementary medicine fits in perfectly with the values of the Italian people. The emphasis on quality of life accounts for the incredible enthusiasm for "CAM" that I witnessed on my recent visit to Florence, Italy, this fall.

For a description of that meeting, see my previous entry at ralphmossblog.com

Wednesday, March 22, 2017


(Some of the speakers at the ARTOI meeting; the author is in the middle, between Bharat Aggarwal, PhD, Professor Emeritus, M.D. Anderson and Gary Deng, MD, of Memorial Sloan-Kettering Cancer Center.)

This is a belated report on an important cancer meeting that I attended this fall. It was the Eighth International Conference of ARTOI, the Research and Therapy Association for Integrative Oncology of Italy. This was in many ways an amazing conference, which lasted for three event-filled days.

I spoke at the first ARTOI meeting held in Rome in 2008. At that time, we had about 20 attendees, who as I remember, drifted in and out of a classroom in a Roman hospital. But my involvement with the inception of this conference goes back even further. The founding director of ARTOI is my friend and colleague, Massimo (Max) Bonucci, MD, a medical oncologist and pathologist in Rome. Decades ago, we first met at the German Oncology Society (DGO) meeting in Baden-Baden and shared our interest in non-conventional treatments, particularly that of the DGO founder, Hans Nieper, MD. Max Bonucci proposed the formation of a similar society in Italy. It seemed like a far-fetched idea, as there was no organized movement towards complementary and alternative medicine (CAM) for cancer on the Italian peninsula.

On my first tour of Italian CAM clinics, I found only a few isolated individuals, such as Paolo Lissoni at the state hospital in Monza, and Giancarlo Pizza at the University of Bologna, trying to further this cause, but absolutely no concerted effort. However, in the intervening years an astonishing thing happened. ARTOI has grown large and influential, more so than I could ever have imagined. This time there were over 300 participants, mostly from Tuscany (the home province of Florence) but also from all over Italy and from other countries as well.

This time the conference was co-sponsored by Azienda USL Toscano Centro, a giant healthcare organization with 11 hospitals in Tuscany alone, in collaboration with the Cancer Institute of Tuscany “as an opportunity to foster the exchange of knowledge and to promote the integration of care.” 

The conference proper began on Friday, November 11, with an international panel in the Salone dei Cinquecento of the Palazzo Vecchio. Yes, THE Palazzo Vecchio, the ancient City Hall of Florence, whose construction began in 1299! The Cinquecento Room is the most glorious room in the palace. It was built to house the Grand Council of the Republic, which consisting of 500 members, cinquecento in Italian. The monumental paintings that line the walls are by Michaelangelo’s friend and disciple, Giorgio Vasari. I have spoken in some beautiful conference halls around the world, but nothing like this!

In addition to Dr. Bonucci, and many of the political and medical luminaries of Florence, my fellow panelists that evening were as follows:
  • Gary Deng, MD, Memorial Sloan-Kettering Cancer Center, New York
  • Jun J. Mao, MD, President, Society of Integrative Oncology and Memorial Sloan-Kettering
  • Bharat B. Aggarwal, PhD, Professor Emeritus, M.D. Anderson Cancer Center, Houston
  • Ping Chung Leung, PhD, Institute of Chinese Medicine, Hong Kong
  • Gianni Amunni, The Tuscan Cancer Institute, Florence
  • Eran Ben-Arye, MD, Lin Medical Center, Haifa, Israel
  • Lucia L. Li, MD, Zhejiang Chinese Medical University
  • Anil D. Kulkarni, MD, The University of Texas Medical School
  • Philip A. Salem, MD, St. Lukes’ Episcopal Hospital, Houston, TX
  • Thomas Breitkreuz, MD, Federation of Anthroposophical Medical Associations, Germany
  • Yumin Zhang, MD Healthcare Hospital of TCM, Huangshi Province, China
  • Giovanna Franchi, MD, Italian League for the Fight against Cancer
This was an amazing line up of speakers, representing leaders of the CAM cancer field from Europe, America, the Near East (Israel) and China. 

Where other than in the historical country of Italy can one hold a meeting in a 700-year-old building, in a palatial room that is itself one of the wonders of the world? On the next few days, the general meeting was held in the Istituto degli Innocenti, another world famous building--a child welfare association that has worked uninterruptedly for over six centuries.

The conference line-up here was no less significant, with presentations on almost every imaginable aspect of CAM and cancer care. The whole conference was one of the most stimulating I have attended. I don't have room here to go into all the presentations made. But readers can get some idea of the scope of the conference by looking at the agenda:


I am amazed at what my friend Max and his wife and coworker Federica Bonucci have accomplished in a few short years. They and their many coworkers have not only put Italy “on the map” when it comes to CAM and cancer, but have set an example to leaders in other countries on how to skillfully build a popular movement from the ground up through perseverance and dedication to principles.

On a break at the conference...

Sunday, February 19, 2017