Dichloro Acetic Acid (DCA)

Dr. Lemmo’s clinical experiences with DCA: intravenous and oral.

LEMMO Integrated Cancer Care Inc. is a pioneering centre in Vancouver, Canada incorporating the use DCA, when indicated, in cancer care since 2008.

Please see our new publication on the use of DCA in the peer-reviewed

Journal of Medical Cases

When Dr. Michelakis from the University of Alberta published his research showing how a simple vinegar-like chemical could have the ability to kill cancer cells in the laboratory back in October 2008 (and the following media attention he received) some of my more eager patients became enthralled with this potential chemotherapeutic agent and as a consequence so did my learning begin into DCA. Interestingly, the first data I found using DCA & cancer was published by a Dr. Pan from the Campbell Family Institute for Breast Cancer Research in Toronto and a Dr Bonnet in 2007.

As the name implies, DCA is short for Dichloro Acetic acid or Dichloro Acetate. It has a history in medicine for helping to treat a group of metabolic diseases (i.e. mitochondrial genetic diseases) in children primarily but also in adults for several decades. It has also been more loosely studied in other fields of medicine as well (i.e. exercise, COPD, heart failure, etc.). Because it is a rather simple chemical to make, it is considered a fairly inexpensive medicine. Moreover, because of its simplicity and low cost, most drug companies do not pay much attention to its use because of the more limited money or profit which can be generated as compared to medicines which are patentable or where the intellectual property (IP) can be secured.

I was happy to see the publicity that Dr. Michelakis had managed to stir about DCA and its relationship in cancer care and also exposing some of the politics behind getting non-patentable and lower cost medicines into more main-stream medicine. I even recall seeing Dr. Michelakis on CNN Larry King show on TV. As a consequence of this publicity, whether I wanted my patients to or not, the use of DCA for the treatment of their cancer(s) had become more of a common theme (i.e. it was becoming out of my control). Internet websites were popping up all over the place, selling DCA and providing treatment advice. Since that time, here in Canada and in the United States, DCA has been placed into a prescription category and its use has become more limited and regulated.

What I decided, in order to help my patients the best I could, was to help those individuals who were interested in using DCA and at the very least monitor and try help avoid any unforeseen danger. When you are more focused in the area of cancer, you are better able to follow up patients, order the appropriate testing and perform the examinations to make sure that things are moving in the right direction or, conversely, to make suggestions or recommendations if things are going in the wrong direction.

Throughout the years of monitoring my patients with DCA, which included its eventual side-effect in causing numbness in the body (i.e. hands, feet, face, etc.), I had an inclination as to one of its potential value would be in oncology medicine.

 

Case No. 1: anaplastic oligodendroglioma (1p/19q chromosome normal)—brain cancer

One of the first patients where I suggested the use of DCA was in a 39 year old woman who was diagnosed with a type of brain tumor known as an Anaplastic oligodendroglioma. She received surgery to get as much of the tumor the surgeon could (some was left behind) followed by radiation and the oral chemo pill known as Temozolomide which she continues to this day. The patient was stable for over a year receiving a comprehensive naturopathic oncology treatment alongside her standard oncology care. The patient thrived throughout. What was more unique about this patient versus others, however, is that even though her brain tumor was stable and she could be this way for many, many years as several of my patients have demonstrated, she had a goal of wanting the tumor completely gone! It was during this process (and eventual push) where DCA had come into question and her desire would become a greater reality.

I had noticed that DCA caused numbness in the hands & feet as a common side-effect which for me implied that the medicine managed to penetrate into the nervous system and possibly the brain and have an effect there. Based on these observations and gaining a better comfort with DCA, together, we decided to incorporate DCA into her protocol and see how things would go. However, in this case, while most patients were using DCA orally (in pill or powder form), I used an intravenous form that I used in helping out another patient with advanced ovarian cancer. To my knowledge, there was nobody else using DCA intravenously for the treatment of cancer anywhere and this was the first way on how I began using it. There is data using DCA by injection for non-cancer related medical conditions in research papers (i.e. COPD, exercise, congestive heart failure) which gave me some security about its potential use and safety for patients.

During the very first injection, the patient with brain cancer began to experience a “tingling” sensation in the area of the tumor site on her head. I had never seen this before in my years of specializing in cancer. I had initial concerns whether this was a good effect or a negative effect (which I later learned was OK). Together we continued a protocol of DCA twice weekly combined with low doses of vitamin C and B-vitamins mixed into the intravenous bag to theoretically help with any potential nervous system side-effects. Moreover, throughout, the patient also continued on the oral Temozolomide chemotherapy (there was no negative interaction). We had noticed that as time progressed, the tingling sensation in her head subsided and we were not certain what this had meant. The next MRI scan revealed again a stable image, and in the following several months, another MRI scan of the brain indicated the tumor was either dead or inactive. This observation was a wonderful outcome! Was this due to the combination of DCA and chemotherapy, DCA or the chemotherapy agent alone? Typically in this kind of brain tumor subtype, chemotherapy is considered not as effective and survival is poorer as compared to those with more favourable genetics (i.e. 1p/19q chromosome deletion). Following approximately 5 years the patient had stopped DCA along with other treatments including Temozolomide and she had a minor regrowth.  Surgery was decided to remove the region and she unfortunately passed away days later following a complication of the surgery.

 

Case No. 2: NSCLC—Lung Cancer with brain metastasis – Leptomeningial Carcinomatosis (LMC)

This case has been published in the Journal of Medical Cases

In another case, a 49 year old, non-smoker woman with a history of lung cancer better demonstrated the value of DCA and its effects on the body & brain. This patient was initially diagnosed with stage III lung cancer in 2006 and managed to respond amazingly well along with an extremely devoted Acupuncturist (i.e. Gerard Tan in Vancouver), an integrated cancer care approach, and the oral chemo-agent Tarceva for over 2 years. She had no signs of cancer throughout this period. She too thrived during this time without any complications other than a rash which was a positive sign of the Tarceva working.

Unfortunately, following this golden time she presented with a low grade headache that was eventually determined to be a metastatic cancer spread to the brain in July 2008 better known as Leptomeningial Carcinomatosis (LMC). She received whole brain radiation which did not appear helpful and she later received a surgical stent in the brain to help drain the fluid that was accumulating there. Chemotherapy was no longer an option. When I eventually saw her in my office, both her hearing and vision was quite poor (damaged) as a side-effect of the radiation treatment, and she had also lost a fair deal of weight. I personally felt that her time left with us was going to be very short (i.e. days to weeks)—I was thankfully wrong. The patient, like the previous, had a continued strong desire to live and she placed the pressures on all of us involved to try and help figure out a solution quickly.

After a series of attempts in recommending treatment ideas, I introduced the possibility of DCA. I shared with the patient’s husband my personal views and preliminary observations about using DCA and its potential to target cancers in the brain and central nervous system. Consequently, together with the patient’s husband, I suggested for the patient to take DCA orally mixed in juice. In addition, the Acupuncturist Gerard Tan continued to provide treatments which included home visits by this time which helped tremendously. I received a phone call a few days later from her very devote husband after beginning DCA that he noticed his wife’s cognition was much improved. Weeks continued and so did the improvement along with increased appetite and weight gain. Eventually, a brain scan in December (3 months later) showed stable disease and shrinkage!.  Such a response to LMC is truly noteworthy since there is not much out there especially in this kind of scenario. Interestingly though, the cancer in her lungs was slowly progressing and so it appeared to support my observation about DCA’s value for helping from the “neck up” or central nervous system cancers (i.e. whether primary or secondary sources).

Since the brain was not the primary problem anymore, this opened up chemotherapy options once again. The patient was also seeing a very progressive medical oncologist which greatly helped. She continued with DCA alongside for another 6 months which she later stopped. Three months later a repeat CT scan was ordered showing the brain continued to be stable even though the DCA had stopped.  She appeared to be responding to the new chemotherapy which was wonderful as well.  Eventually after a long and courageous fight, the patient had passed away related to infection/pneumonia complications in the lungs and not the cancer.

The patient had survived 454 days (64 weeks) following the introduction of DCA, approximately 74 weeks after the diagnosis of the brain disease LMC, and overall had survival over 3 and a half years after the original diagnosis of lung cancer.  Statistically, she should have survived only months following the brain metastasis.

 

Case No. 3: ATRT Grade IV – pediatric brain cancer

One of the youngest patients to have received DCA is a 21 month old infant with a diagnosis of Atypical Teratoid Rhabdoid Tumor (ATRT) Grade IV in April 2010. This type of brain cancer is extremely rare and aggressive. Because there have been so few cases of this disease (i.e. 5-7 cases across Canada), the conventional treatments & options are more experimental (i.e. like DCA) and the outcomes thus far have been quite poor. As a consequence of this, the parents decided to try less harmful treatment approaches first and if there were signs of disease progression, changing the game plan would be in order. One of the recommendations I suggested was the use of DCA amongst other things. While I’ve never used it in a paediatric setting, I knew it would be easy to take (mix in juice), it appeared safe, and I suspected that the potential positives outweighed the potential negatives (which I knew from adults the negative effects were reversible). Keep in mind that the primary use of DCA originated in children with metabolic diseases for several decades. Along with a naturopathic oncology program, we very cautiously began the use of DCA. At first, the medical oncologist has hesitant on the idea. As months passed and the infant did not show any signs of disease progression, the oncologist’s views began to change in a much more positive direction. Eventually, he began refilling the prescription of DCA for the family personally. On September, 2010, an MRI was ordered which revealed that the brain tumor had grown again. As you can imagine, this was a tremendous disappointment for everyone. However, the medical oncologist had felt that there was, in fact, a positive benefit. He suspected that the grow rate of the tumor had actually slowed down (i.e. instead of doubling every 15 days, it doubled every 30 days). Because the child was taking more than DCA as a treatment, we do not know which of the recommendations could help account for this effect. However, I hope that this can serve as an example for future parents and oncologists, to consider incorporating DCA, perhaps in higher doses, (and other naturopathic approaches) alongside other standards of care so that a better response can be ultimately attained for future children.

How DCA may work:

Patients often ask how DCA targets or impacts cancer in the body. It appears that a large part of how DCA works to kill cancer cells is by affecting their mitochondria function which is the “battery” center. DCA may interfere in the way the cancer cells use energy leaving them somehow more vulnerable. This effect is a newer way of targeting cancer cells from a metabolic point of view which stems from some very old research by Dr. Otto Warburg (i.e. the noble prize winner in 1931). Basically, he had shown that cancer cells use sugar to grow (i.e. the Warburg-Effect) and so by interfering in that metabolic energy process could potentially disrupt more sensitive growing cancers. There is also a recent study in a colon cancer cell line showing when the oxygen environment is normal, the cancer cells dies with DCA (i.e. apoptosis). However, it was also observed that when the environment is low in oxygen (i.e. hypoxic) DCA appeared to be more protective for the cancer which implies some caution, and that oxygen or oxidative mechanisms may also be involved in how it selectively kills cancer.  Research also suggests that DCA may also target and restore the immune system as a consequence of the cancer leading to increased anti-tumor activity.

What are the concerning side-effects or toxicity concerns with using DCA?

We have to first remember that DCA is considered an environmental hazardous chemical of which chronic use has been shown in mice to be damaging to the liver and induce cancer growth. Ironically, the DCA doses used in animal toxicology experiments are very similar to those used clinically or as a medicine for the chronic or acute treatment of metabolic or cardiovascular diseases. So for patients who are considering long-term use of DCA, and especially in those who are using DCA for reducing their cancer recurrence risks (i.e. long-term users), this may be something to consider.

The more common side-effect which I see in practice is numbness & tingling symptoms. In my experience, this effect has been reversible upon discontinuation and we have patients who have been using DCA for over 2 years. We have not seen any point of concern thus far. Older and more frail patients may be more sensitive to these side-effects than younger patients. In unmonitored patients, there has been a recent published case where DCA caused very bad numbness and severe brain irritation (i.e. encephalopathy) in a patient with metastatic melanoma after using DCA for only 1 month (1200mg/day) along with high doses of vitamin A (150,000 IU/day) and it took over 8 months for the person to recover which involved physical therapy. I have not personally seen this. A personal communication with the author of this reported revealed that the patient had lived for over 3 years with this metastatic disease which, by conventional standards, is considered extremely impressive (i.e. above average). Nonetheless, it is strongly advised that patients need to be medically monitored while using DCA!

Another possible side-effect when DCA is used orally, because of the vinegar-like properties, is it may irritate the stomach and especially in those who are sensitive already. It may be advised that in interested patients, that a stomach protective medicine be used alongside DCA.  This potential side-effect is fairly uncommon.

We also see a small group of patients who may feel “sleepy or spaciness” upon the introduction of DCA.  In particular, we see this potential effect in those with brain cancers (i.e. Glioblastoma) and we suspect this may occur because the brain may already be irritated as result of surgery, chemo-radiation, etc.  If this is an issue, doses can be adjusted so that the DCA can be resumed.

Some of the published data

In mainstream literature there have been 5 cases in patients with brain tumors (i.e. Glioblastoma) where 3 patients appeared to respond on MRI scan and 4/5 were stable after 15 months. DCA was used alongside their conventional treatment program. There is also a case report of a patient with Non-Hodgkin’s Lymphoma Stage IV who has gone into remission after beginning DCA alone. There are other medical centers, like myself, who are beginning to publish some of their positive findings in journals.

Some interesting areas of DCA’s application in cancer also include  positive case responses in bile duct cancer (cholangiocarcinoma) and also in helping with pain even when conventional methods have failed.  We have seen patients where the integrated use of DCA has been correlated with a fairly good response in bile/gall bladder cancer.  This may be another population group to explore the use of DCA as well.

According to research from Dr. Michelakis in Alberta, it was shown that approximately a 3 month period of time was needed before DCA can be detected in the blood when used orally. Perhaps it better accumulates in tissues and the cerebral spinal fluid, which is not common and somewhat challenging to test. I suspect that an initial loading dose by intravenous injection may be needed followed by a maintenance oral dose in a group of patients to help attain a more rapid, optimal therapeutic effect. The intravenous route may be an ideal means for patients who are able do this followed by an oral maintenance dosing program (i.e. the same has been observed with the use of vitamin C oral vs intravenous)

Together with other treatments appears ideal

I suspect the ideal situation for most using DCA is combined together with chemotherapy/radiation, immune-system, and related anti-cancer protocols as they may better enhance each other. I know that most oncologists warn patients about negative interaction concerns especially when dealing with experimental agents like DCA, but there are creative ways of cycling situations (i.e. breaks in between) for those that are worried and want to do both.

A review on how DCA may interact with some chemotherapy agents and radiation:

DCA and Zelboraf reportedly induced a greater reduction in intracellular adenosine triphosphate (ATP) levels and cellular growth than either compound alone in BRAFV600E-mutant melanoma cells. In addition, melanoma cells with in vitro acquired resistance to Zelboraf retained their sensitivity to DCA. DCA has also demonstrated augmentative effects with platinum agents, 5-fluorouracil, metformin, capecitabine, arsenic trioxide, estradiol analogue C9, paclitaxel, tamoxifen, temozolomide, sorafenib, sulindac, bevacizumab, bortezomib, doxorubicin, topotecan as well as radiation, photodynamic therapy, and hyperthermotherapy. However, further data are required as one paper demonstrated DCA tumor radiosensitivity in vitro but attenuated tumor growth in an in vivo human colorectal adenocarcinoma mouse xenograph model. DCA-induced in vivo tumor hypoxia was also noted and may have a link to this observation. Moreover, another paper reported hindered cytotoxicity with doxorubicin and cisplatin in pediatric cell lines. DCA, to date, has not been associated with adverse interactions with other drugs.

Note: We have also discussed this area which includes references found in our published case report found in the Journal of Medical Cases

The bottom line is not enough data either for or against the use of DCA with chemotherapy agents (just like most drugs as well) and radiation, so it does become a person’s individual choice. Like my patient with brain cancer who has taken DCA together with her chemo, her choice has translated to an above average response.

Hyperthermia

DCA appears to be further enhanced by the use of hyperthermia or high temperatures in its abilities to target cancer. LEMMO Integrated Cancer Care provides cutting edge hyperthermia technology and the experience in integrating DCA (whether oral and/or intravenous) in this area of cancer care.

Final Thoughts

DCA appears to have an affinity for targeting cancers in the brain & nervous system for some reason (whether it started or spread there) and it also appears to work quickly when the conditions are right which is why a whole-person approach to cancer is important. We have recently published an article discussing this issue as well which can be found at the Journal of Medical Cases . In patients with cancers which have tendencies for spreading to the brain and central nervous system (i.e. advanced lung, melanoma, kidney, breast cancers, etc.) DCA may also have a potential application for acting as a preventative or protective agent as well? To my knowledge only radiation is used in this capacity.  Some of my colleagues are using DCA for other types of cancers and are reporting some interesting findings – again using a combination approach appears to ensure the greater success.

Because DCA is a prescriptive item in Canada and the US, people who are interested in its use need to be evaluated by a licensed healthcare professional and preferably by one who has cancer care experience. LEMMO Integrated Cancer Care Inc has been pioneering the use of DCA by intravenous injection and oral routes since 2008.  The intravenous route may hold an added key in helping those patients in more acute situations, where time is critical to try and achieve a more rapid therapeutic effect.