"" Ralph Moss—Cancer Consultant

Friday, September 14, 2018


Ralf Kleef, MD, Vienna, Austria

In mid-September 2018, the medical journal Integrative Cancer Therapies (SAGE), published a peer-reviewed article on a highly significant finding in breast cancer from a European integrative cancer clinic. Here is a link to the full article:


The title is self-explanatory: "Complete Clinical Remission of Stage IV Triple-Negative Breast Cancer Lung Metastasis Administering Low-Dose Immune Checkpoint Blockade in Combination With Hyperthermia and Interleukin-2."

The paper is the result of an international collaboration that involved more than two years of intense effort by scientists in five countries. The first author is the treating physician, Ralf Kleef, MD, of the Kleef Clinic, Vienna, Austria. The other authors are Prof. A. Marcell Szasz of Semmelweis University, Budapest and Lund University, Sweden; Dr. Arthur Bohdjalian of the Rudolfinahaus Hospital, Vienna's leading private hospital; Prof. Hans Bojar of the NextGen Cancer Group, Dusseldorf, Germany; and Tibor Bakacs, MD, PhD, DSc, of the Hungarian Academy of Sciences. I (RWM) am the second author of the article.

In this paper, we report on the case of a 50-year-old woman with breast cancer who experienced disease recurrence at the axillary (armpit) lymph nodes and, later on, lung metastases in both lungs with severe shortness of breath.

The woman in question received low-doses of two Food and Drug Administration (FDA)-approved immune checkpoint blockade drugs (nivolumab {Opdivo®} and ipilimumab {Yervoy®}) weekly over 3 weeks. She also received regional hyperthermia (heat therapy) 3 times a week. This was followed by systemic fever-range hyperthermia induced by another FDA-approved drug, interleukin-2 (IL-2) for 5 days. The patient then went into a complete remission of her lung metastases with only transient grade I-II diarrhea and skin rash. The patient remained alive for 27 months after the start of this treatment. Eventually, there was a recurrence of metastases as a sternal mass, and up to 3 cm pleural metastases and she passed away in the summer of 2017. 

The authors concluded that this exceptional response should instigate further research efforts with this protocol, which consisted only of FDA-approved drugs and treatments. We believe that at these reduced doses, when combined with complementary treatments such as hyperthermia, the results are at least as good as with conventional higher doses, and the rate of serious side effects is concomitantly lower.

A patient with such far advanced lung metastasis would typically have had an extremely 
limited expected survival. Therefore, we wanted to report this case as an exceptional response to lower-dose immune checkpoint blockade therapy, resulting in a more than two year survival from the beginning of immune treatment.

The idea of using a lower-than-typical doses of immune checkpoint drugs was derived from a January 2014 article in the peer-reviewed journal Pharmacological Research. The authors of that pioneering article were Prof. Shimon Slavin, of Tel Aviv, Israel and Dr. Tibor Bakacs of Budapest. (Again, I was second author.) Here is the link:


The development of immune checkpoint blockade drugs, first approved in 2011, has been among the most important breakthrough in cancer treatment. I believe that James P. Allison, PhD, of the M.D. Anderson Cancer Center, Houston, is fully deserving of a Nobel Prize in Physiology or Medicine for this epochal discovery. But Ralf Kleef, Tibor Bakacs and their medical collaborators also deserve great credit, since they have paved the way for a safer and more effective method of using these same agents.

NOTE: Integrative Cancer Therapies has an Impact Factor of 2.657. In 2017, Pharmacological Research had an Impact Factor of 4.897. 
Sources: http://journals.sagepub.com/home/ict and http://www.letpub.com/

Monday, March 12, 2018


If you have had prostate cancer (PC), or are at high risk of the disease, it would be prudent to stop eating more than an occasional egg, especially if you live in North America.

Interest in this topic began in 2004, but the thinking at that time was that eggs were innocuous. But this was followed by a “bombshell” study from the Harvard School of Public Health, Boston, showing that “greater consumption of eggs…was associated with [a] 2-fold increases in risk” of a diagnosis of fatal PC compared to men who consumed the fewest number of eggs. A 2011 follow-up study from the same group found that “men who consumed 2.5 or more eggs per week had an 81 percent increased risk of lethal prostate cancer compared with men who consumed less than 0.5 eggs per week.” This led to considerable publicity in the United States.

A follow-up 2015 study found a 47 percent increased risk of life-threatening prostate cancer. A 2016 study from the same group similarly found that high intake of eggs was associated with a doubled risk of advanced PC. 

These are observational studies, of the kind that can find correlations, but do not provide proof that eggs themselves cause PC. That idea is simplistic, in any case. (The Chinese have the highest rate of egg consumption in the world and also one of the lowest rates of fatal PCs.) But there is a biochemical mechanism by which eggs could plausibly promote PC: yolks contain an abundance of choline, a B-vitamin like substance that is found abundantly in prostate cancer. The Harvard authors also found that men with the highest intake of choline had a 70 percent increased risk of being diagnosed with lethal prostate cancer. (Choline is even the basis of an FDA-approved PET scan for prostate cancer.)

The studies in question did not take into account the quality of the eggs consumed. Could it be that American or Canadian commercial eggs are harmful, but that eggs from organic free-ranging chickens are not? Eggs are the basis of a huge mass production business in the United States. To quote the American Egg Board:
“In the major egg producing states, flocks of 100,000 laying hens are not unusual and some flocks number more than 1 million. Each of the roughly 280 million laying birds in the U.S. produces from 250 to 300 eggs a year. In total, the U.S. produces about 75 billion eggs a year, about 10 percent of the world supply.”
These hens are often kept in so-called ‘battery cages” the size of a piece of letter paper! Hens may be starved to increase their egg production. 

Could this production method, or other factors in the production, distribution and consumption of eggs, contribute to the production of unhealthy eggs in the US? We don’t know, but there is a measurable chemical differences in eggs from hens that are raised in cages vs. those that are free-ranged or are enriched with n-3 polyunsaturated fatty acids (PUFA).

There is another important insight contained in the CapSURE study:
“When associations were analyzed separately by geographical region (North America vs. other continents), positive associations between…egg intake…and advanced…and fatal cancers were limited to North American studies….Observed differences in associations by geographical region warrant further investigation” (emphasis added).

Since these effects were limited to North America, it raises the question of whether there is something in the way American eggs are raised or prepared that could account for their particular harmfulness. According to Business Insider:

“In the US, large-scale laying houses are preferred over the free-range systems commonly used in the UK [and many other countries, ed.]. The factory farm environment means more eggs can be produced on a smaller amount of land, but it also makes eggs more susceptible to contamination….”

Could the increased diagnosis of fatal prostate cancers be limited to factory farm-produced eggs in the United States and Canada?  Definitely. But, in the meantime, I recommend erring on the side of caution: I would suggest that all PC patients, or others at high risk, cut back or eliminate their consumption of all eggs, especially the yolks. It is the prudent thing to do.


Acknowledgement: Thanks to Dr. Geo Espinosa for bringing this topic to my attention through his blog at www.drgeo.com


Keum N, Lee DH, Marchand N, et alL. Egg intake and cancers of the breast, ovary and prostate: a dose-response meta-analysis of prospective observational studies. Br J Nutr. 2015 Oct 14;114(7):1099-107.

Wilson KM, Mucci LA, Drake BF, et al. Meat, Fish, Poultry, and Egg Intake at Diagnosis and Risk of Prostate CancerProgression. Cancer Prev Res (Phila). 2016 Dec;9(12):933-941

Richman EL, Kenfield SA, Stampfer MJ, et al. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: incidence and survival. Cancer Prev Res (Phila). 2011 Dec;4(12):2110-21

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