Our guest today is Dr. Joseph Pinzone, an endocrinologist who is leading innovative work at the Hyperthermia Cancer Institute (HCI).
I first learned about the HCI from a friend who had undergone treatment for stomach cancer. The HCI uses a hyperthermia-directed treatment that targets specific tissue in the body with temperatures ranging from 106 to 109 degrees Celsius. This therapy is administered alongside chemotherapy and radiation or radiotherapy and has minimal downsides. Additionally, the therapy is FDA-approved, and most insurance policies cover it.
I was thrilled to learn more about this exciting new treatment. Dr. Pinzone shares how this therapy is transforming patients’ lives. We hope to raise awareness among oncologists and patients alike that this therapy can be a viable supportive modality for certain individuals. Let’s dive in and learn more about this revolutionary approach to cancer care. Enjoy.
Listen to the episode here:
- Dr. Pinzone’s Journey to Hypothermia Cancer Institute [00:06:18]
- Prevention and Early Diagnosis of Cancer [00:11:30]
- Shifting to Hypothermia [00:16:21]
- Patient Education [00:20:08]
- Chemotherapy and Hypothermia [00:31:00]
- Knowing Which Treatment is Appropriate [00:38:21]
- Hot vs. Cold [00:46:40]
- Chemotherapy and Radiation [00:54:40]
- Looking at Genetics [00:56:30]
- Getting a Second Opinion is Okay [01:02:00]
- Lifestyle as Part of a Diagnosis [01:05:46]
- Emotional Health and Chronic Stress [01:08:53]
- Daily Reinforcements to Our Health [01:15:11]
- Opening The Hypothermic Cancer Institute [01:19:09]
- Hypothermia Success Stories [01:22:53]
- Getting Updated About Hypothermia [01:34:50]
- A Doctor’s Reminder [01:38:49]
- Expanding Hypothermia’s Reach [01:40:49]
#198 Revolutionizing Cancer Treatment with Hyperthermia Therapy: A Breakout Discussion with Endocrinologist Dr. Joseph Pinzone
Welcome to the Gabby Reece Show where we break down the complex worlds of health, fitness, family, business, and relationships with the world’s leading experts. I’m here to simplify these topics and give you practical takeaways that you can start using today. We all know that living a healthy balanced life isn’t always easy. Let’s try working on managing life a little better and have some fun along the way. After all, life is one big experiment and we’re all doing our best.
“Don’t try to be a doctor, it’s not a good use of your time, it’s confusing, and it can scare you. What you can do is you can use every bit of your cognitive and emotional ability to begin to ask the right questions of the doctors so that you dial into what’s right for you. Unlike the oncologist who says, “Don’t do hyperthermia,” you don’t wipe anything off the board, and that includes Western medicine.”
“The reason is you want to know your options and you want to know the specificity. many patients walk through this door and say, “I researched everything. Here’s what I’m going to do.” I’m like, “What is it that you’re going to take?” “I don’t remember the name of it and I don’t have my notes.” I’m like, “You don’t know what you’re going to take.”
“It’s to put a fine point on the idea that the same way you would do this with any professional, an attorney, or an accountant, leverage the professional, that’s the way to do it. You’re still free to not do what they recommend. How do you know what they recommend unless you have forced them to drill down into that option for you and what the expected outcome is and what the goal is?”
My guest is endocrinologist, Dr. Joseph Pinzone. I learned about Dr. Pinzone’s work through a friend of mine. He has created something called the Hypothermia Cancer Institute. My friend is getting her treatments for her cancer at Dr. Pinzone’s institute. I’m taking full ownership of this, I did not get him to clarify what exactly is happening. Hypothermia therapy is a type of medical treatment. What they do is they expose the body tissue to temperatures of anywhere from about 106 to 109 degrees and it’s usually applied as an adjunct to radiotherapy or chemotherapy. It works as a sensitizer in an effort to treat cancer.
The downside is pretty minimal or almost none. Occasionally, some of them might get a little red mark on their skin or a skin rashed. Generally, it’s safe and there are statistics and he reads them off at the end of the show to show, and you can’t point to it directly, how certain types of cancer have 1% of efficacy with either chemotherapy, radiotherapy, or radiation as it’s known, and a different one when you have hypothermia therapy. I did not know about this.
When my friend, unfortunately, was diagnosed with cancer, she was allergic to chemotherapy. This was one of the things and is one of the things she’s been doing to support getting rid of a solid tumor. It’s not for what they call blood or liquid cancers like leukemia. It is for solid tumor treatments. What I love about this conversation is getting the word out there and getting it to other oncologists so that they’re aware of the treatment. It is FDA-approved. Oftentimes, your insurance will cover a ton of the treatments. They won’t do the same treatment on the same day.
It’s letting people know that there are all kinds of modalities of treatment if, unfortunately, someone you know or love or yourself is diagnosed with cancer. I hope you enjoy my conversation with Dr. Joseph Pinzone. His group is called Hypothermia Cancer Institute. He does encourage you, if you do get a diagnosis, to call them and even if it’s to direct you to a place that will be best for your treatment and the efficacy of it.
Dr. Pinzone, thank you for having me at your office.
I’m excited to have this conversation because I feel like a lot of people don’t know about this option. There are plenty of people who are dealing with navigating cancer diagnosis. What you provide here is an interesting and bolt-on treatment for people. I’d like to start by asking how the Hypothermia Cancer Institute came to be.
I’ll be honest with you, the only reason I know about it was that I have a friend getting treatment here. I’m connected to a lot of people that will tell me about this new modality, this new treatment, this new supplement, or whatever it is. When I learned about it, I thought that this is important that more people know about it and are educated about it. Maybe you could share what your background was initially and how you are here.
I’m glad that you did take notes because that allows us to tell our story. It’s interesting because my original training was as an endocrinologist, that’s glands, hormones, diabetes, and thyroid disease. It also has growth factors so it figures into cancer. Interestingly, if I wanted to be hyperbolic, I have a cosmic connection to cancer. I’m a Western-trained doctor and did my fellowship in endocrinology. My fellowship was a year of clinical and two years of research. When I was in the lab, I did molecular research on pituitary tumors. I always had an interest in tumors, for sure, but I did not go down the path of being an oncologist.
When you say the interest, is it why they grow and how they grow in patterns that they grow? What about that? Was it to feel investigative to you? What about that intrigued you?
[bctt tweet=”No one is perfect and you do have to give yourself some grace but not too much.”]
I don’t know that I’ve put my mind to that exactly but I’m going to do that right this second. If I were to contemplate that, it’s the idea that it’s dysregulated growth and it’s based upon genetic abnormalities that are fully knowable. We don’t know them right now but we will. We will get to a point, and I can see this in the coming decades, where we’re going to say to ourselves, “Did we used to do surgery on that disease?”
Because we’ve figured out so much about the underlying pathology, especially with the introduction of machine learning and AI, it’s going to be important. It is a math problem in a sense. What happens with cancer cells is they accrue a certain number of mutations and that allows them both a growth advantage and also to escape from the organ of origin and metastasize.
That would be the definition of something that’s cancer versus something that’s benign. Benign can grow and benign can be a problem but it doesn’t escape to other places. When I looked at that whole process, I thought that this can be figured out. My background in growth factor analysis through understanding how hormones work is part of that story. What attracted me is that it’s a problem that we are going to figure out and I want to be part of that as time goes on.
In your practice as an endocrinologist, you’re helping people with their hormones and navigating these things. How do you take the step or the leap into this new type of treatment?
There are a couple of ways that happen and the first is organic in the sense that within the discipline of endocrinology, there are benign tumors that are part of the endocrine scope where an endocrinologist would be the primary doctor. Pituitary tumors, as an example, are almost never cancer. They are almost always benign growth, they are tumors.
For thyroid cancer, in almost all cases, I’m the primary doctor. There are some that will metastasize and will move on to an oncologist but the vast majority of them are cured or controllable of the most common types of thyroid cancer. It’s not dissimilar to a urologist being the primary doctor for somebody with prostate disease, particularly early prostate disease. It’s part and parcel of what I learn about. In other words, I know a lot about tumor biology simply from the discipline of endocrinology.
It’s not that it’s a confession but I am always trying to learn about new treatments or ways to avoid them. I’m into the idea of prevention altogether. It’s this thing of also never wanting to know. I’m curious for you when you’re an endocrinologist, first of all, are people coming for something else or they’re not feeling good and then you’re discovering this?
Sometimes this unknown thing keeps people from going to doctors or not tuning into how they’re feeling. I know you’re a big proponent of listening to those feelings and that we do have intuitions about certain things. How does it usually show up? If someone’s reading this, for example, and they think, “I’ve been feeling a little off.” What’s the first step to even going to see who?
That’s a question that the answer will cross disciplines. It’s applicable to endocrinology, which is the vantage point you started at. It’s also applicable to early diagnosis of cancer and cancer prevention. We’re taught in medical school that when we interview a patient, the answers come from them. It’s all about history. The exam helps but history is the key to figuring this out. People know themselves well and it’s whether or not they are in touch with that, sometimes they’re simply not.
Often, they don’t let themselves be in touch with it or they went go to explain something away. For example, if you have extra urination, that might be diabetes. You don’t have to freak out. You can simply go to your primary care doctor and get your blood sugar checked. If you have blood in your rectum, yes, that could be hemorrhoid. You don’t want to ignore it particularly. There are no perfect cutoffs. If you’ve got blood from your rectum and it’s going on for a week or a couple of weeks, it’s important to understand that.
Having said that, that’s predicated on the fact that you’ve gone through all of the steps of preventing what is preventable. Both in the case of diabetes, much of diabetes is preventable. I’m sure you can understand based on your focus on wellness. In the case of cancer, it’s preventable in some instances like colonoscopies to detect pre-cancerous lesions.
We can’t emphasize that enough. The exponential on early, from your vantage point of what you’ve seen, makes such a difference.
You are 100% spot on. The way that cancer works is that various cancers have different growth patterns. Every cancer has its own tempo. There are certain types of cancers that tend to be much more serious than other types. Pancreatic Adenocarcinoma tends to be extremely serious compared to something like thyroid cancer, which tends to be curable often. With every type of cancer, you have a period of formation, which typically takes months to more likely years. You then have the early growth phase.
What people don’t realize is even during the early growth phase, you’re shedding millions of cells into your bloodstream and your lymphatics. The idea is that for most of those early cancers, those shedded cells can’t take root, and your immune system can knock them off one at a time if you will. If not taken care of, the natural history of most serious cancers is that there will be a period where they may not seem like they’re growing very much.
A key part of what makes something cancerous and the reason why cancer does worsen with time is that it accrues more and more mutations so it becomes less differentiated less like the tumor of origin and then it’s going to hit an inflection point where its growth takes off and its ability to metastasize takes off. You could look at it through a number of lenses.
That could seem scary to people and that’s understandable. Notwithstanding the fact that some of them could prevent it but not everybody can prevent cancer, it just happens, but the earlier we get them in, the better we’re able to make a comprehensive plan and the better we’re able to use hypothermia as part of that plan. We’re part of the solution, a part of the puzzle.
When you’re in your practice as an endocrinologist and this is a part of your practice, some of this is in your lane, how do you get introduced? You have to then send patients across to oncologists and sometimes they have other care. When do you learn about it and say, “I’m shifting.” You’ve shifted to hypothermia.
We can talk about that shift. I separate the two disciplines. I do still practice some endocrinology. When I’m here in the physical location where we’re talking, it is just seeing patients with cancer. Those are patients whose care is coordinated by an oncologist. They are not endocrine patients by any stretch of the imagination. They are truly patients with cancer, breast cancer, or colon cancer.
Hypothermia is FDA-approved to be used in combination with either chemotherapy or radiation therapy for all solid tumors. We wouldn’t do liquid tumors like leukemias or lymphomas. For all other tumor types, the key thing is for that person to call me because we are a potential option that might help to make their chemotherapy work better or their radiation work better. That’s what hyperthermia does. It’s a bolt-on adjunctive therapy that gives people an edge that they wouldn’t normally have with just chemotherapy or radiation therapy alone.
When those patients come to me, I use my general internal medicine doctoring skills to help them. The reason why is that many are dialed in. They have their plan of care. Some are turned around so they don’t quite know the direction to be pointed in. They’re either fearful, confused, or both. As a non-oncologist, everything cuts both ways, there are some advantages to that in the sense that I’m a low-pressure person in general. It’s not to say that all oncologists are higher-pressure people but it’s their life.
I only treat adults. I want to make sure that they get the best care. I can only explain and recommend. It’s then up to them to make the decision about how are they going to approach their care. Some come already fully dialed in with a team and we add hypothermia to that, that’s probably the most common, but some do need some help and I love doing that.
A lot of oncologists are not even aware of this treatment themselves. Doctors are busy and they’re dealing with patients and practices. I have an uncle who is a diabetes specialist. I don’t want to say it’s low-grade compared to oncology. There’s a life-and-death element a lot in oncology that would be difficult to look up from and be like, “What’s new, cutting-edge, trustworthy, and FDA-approved?” Maybe your insurance will cover it and we could incorporate it into it. I did find it interesting that a lot of oncologists are not even aware of hypothermia treatment as an adjunct treatment.
You must have relationships with doctors here that know you and you have patients that you work together on. What’s it like when you get a patient maybe who knows about you and then says to their oncologist, “I would like to do this.” I’m curious because it’s probably a communication that you have to deal with. How do you approach them and educate them?
You were dialed into a key question about how I spend my day.
You have to be delicate and you have to be a little political, I would imagine. You have to say to somebody who’s good at what they do, “I’m going to educate you on something.” How do you do that?
We get most of our patients through their own self-referral as you point out. Some of them come from oncologists and some from radiation oncologists. I don’t think this business could have succeeded 20 ago without social media, without the internet.
Do you mean that not enough people would’ve had access to understanding it exists?
It’s the one time that the internet is great. Self-diagnose.
You can look up anything you want as long as you baseline it with an expert who can give you the proper guidance. Let me back up a little bit. This technology that we have has been FDA-approved since 1987.
What were they using it for?
Cancer treatment. The understandable miscalculation that was made early on in this field is the machines are expensive so why not sell them to institutions? It all makes sense. One issue is they ended up in the hands of radiation oncologists. Right up until the most recent edition, one of the main textbooks of radiation oncology, there’s a chapter on hyperthermia, it’s right there. Not a lot of places in the country do it and the reason why is that the oncologist is the quarterback so it probably would’ve been better in ’87 to push this out to oncology practices.
The radiation oncologist can’t prescribe anything without the oncologist. If the oncologist is not educated as you point out, it doesn’t get utilized. It withered. We’re reintroducing this to say, “Now is the time.” We have such amazingly good regimens that when I talk about the mechanism of action, it’s applicable across those regimens even though it wasn’t studied with every single regimen.
To answer your question, when a patient comes here and they do talk to their oncologist, they’re going to get varying responses anywhere from, “That’s awesome. I’ve heard of that,” or, “I’ve sent patients to Hypothermia Cancer Institute before,” to, “You should not do that.” When I’m talking to the patient, I try to figure out where they are and where their oncologist is. I love talking to my colleagues. There’s no real ego there on my part. There’s data. We’re here. We have many patients.
We do plan on expanding this because we have been successful. Part of the reason we’ve been so successful is that we are non-threatening and that goes for the patient and the doctor. We have hundreds of studies. Devices that are FDA-approved are a little bit different than drugs. We are approved for all solid tumors. That doesn’t mean that we have data on the rarest tumor that would not be practical in our situation. The device is going to do what the device does and we’ll talk about that mechanism as we proceed along our discussion.
If I have a doctor who is resistant, I approach it simply to say, “I’m more than happy to share data with you.” There are many free-access review articles out there that summarize multiple studies, the vast majority of which are in favor of adding hypothermia. I look at it as if an oncologist or radiation oncologist or any doctor says, “You shouldn’t do that,” that should be backed up with a reason. They may be correct but more often than not, they’re not.
If it’s that they don’t know about us, I can accept that. If it’s, “I don’t know about you and I don’t have time to learn about you,” I can accept that. If you then take it one step further and advise the patient against something, that’s where I don’t agree with you. I’m good at simply being matter-of-fact with people, “I don’t agree with that. This is the patient’s decision.” Because our goal is to make chemotherapy and radiation therapy work better, I am more than happy to give the lion’s share of the credit to the underlying therapy. I say that both to the patient and the doctor. Without your therapy, oncologist, friend, or colleague, we couldn’t do our job.
Realize that we’re going to potentially help that work better. There’s no guarantee from you to the patient. There’s no guarantee from me to the patient. We’re on the same team. If you’ve looked at the data, you don’t want them to do it, they’re probably going to listen to you, but I’m also going to make the case to the patient. This is open and transparent. We’re not tussling, we’re simply providing our respective opinions. More often than not, there’s not a lot of resistance. The patient makes the final decision because they’re the boss.
It’s interesting when you’re in this vulnerable state as a patient that you’re still also having to navigate a real plan and a strategy constantly about how to get better. Quite frankly, doctors can be intimidating. My youngest daughter went to a doctor for something and she was like, “The person was smart. The way that she communicated.” I go, “That’s called bedside manner.”
[bctt tweet=”The key thing is don’t try to be a doctor, it’s not a good use of your time, it’s confusing, and it can scare you.”]
You find a lot of times these highly intelligent or sought-off doctors whether they don’t have the time for the bedside manner or whatever. It was interesting having that conversation. I can imagine when you’re dealing with a life and death situation and on top of it, it’s like, “What is the strategy? Who’s the team?” It’s a spot treatment and it’s about 45 minutes and you have to do it six days a week. It goes anywhere from about 106 degrees to 109 with overall protocols.
Here’s the thing about this practice that I have here. It is not patient-heavy. I have lots of time to spend with the patients because each patient gets 20 or maybe a lot more treatments. The whole idea here is that we are open six days a week. I can give you a sense of how often we work and how many home runs we’ve hit and cherry-picked some interesting wins. It is a commitment.
For every patient, whether they’re local or out of town, I’m talking with them before they walk through this door. That is highly unusual. I don’t like wasting people’s time or money. More importantly, I want to set us up for success. Because there’s an art to applying the science behind this, we have to make sure we have a target. As you pointed out, we are local therapy. We are going to be able to treat 1 or, at most, 2 tumors per day.
Many patients only have one tumor. Patients who have metastatic disease may have multiple tumors in multiple places. We do have to pick and choose where we’re going to treat. We’re going to have to make decisions that are weighted decisions. For example, if a patient has stage four disease and they have tumors in three places, realistically, might they be best off? The insurance typically does cover this, by the way. They typically do cover one treatment per day. We could alternate or we could focus on one of those tumors over the six days or we could do two treatments a day.
We’ve got a lot of different ways to think about what the treatment plan should be. I try to use my best judgment and coordinate that with the patient’s thought process so that I can say, “Our goal in this situation is we want to protect your critical organ, your liver, or whatever so that we can give you a little bit more runway may be so that your magic bullet is right around the corner.”
The innovation cycle for biotechnology is faster, and that’s my understanding and it’s what I’ve read, than Moore’s law is in computers. It’s accelerating. Now we’re coming out with drugs almost on a daily basis if you look across the full cancer spectrum. That’s one goal. Do we say, “We have something that’s causing pain.” Although there are no studies that say that hypothermia reduces pain, we have noticed, particularly in lesions that go to the spinal column, that we do often result in lower pain.
Let’s say someone is doing chemo and hypothermia training. The chemo is doing more of the whole system and you’re spot-treating. Let’s say, in this case, they have a tumor by the spine, you’re saying, “While they’re getting this and trying to kill cancer if you will, we could also make you more comfortable on top of assisting the healing.” In the sense if you can get to that tumor specifically. The downside would be maybe you’d have some irritated skin for the most part.
What are the adverse effects? Red skin would be one of them. We don’t heat enough to get a third-degree burn. It’s unusual to get blisters or a heat rash but they can happen. There are one-off things like if you’re treating over the stomach, you might get a bit of nausea. There are different things that happen but many patients sleep through this because we’re heating to 106 to 109 degrees so that’s cooler than the hottest California day but it is like a super fever. Of all the treatments, it tends to be gentle relative to other treatments.
We’re in California. You’re going to have patients. Do they ever ask to try this first and this only because they’re reluctant to how difficult chemo and radiation can be on your body and then what happens then?
You’re asking yet another key question about how I spend my day in terms of both thinking and communicating with people. Let me give you a couple of scenarios. First, I’m clear with people about where data exists and where it ends. For example, there’s no data that says that hypothermia lowers pain. I’m not going to say we didn’t notice it if we did because we’re allowed to say that because we do notice that in some patients and not all.
Now, let’s think about what we represent to patients. Although it’s FDA-approved to be used with chemo and radiation, the FDA doesn’t tell me how to practice it. I need to go on my own medical judgment for that. One scenario where I will not utilize hypothermia is in somebody with that relatively slow growing eminently curable small thyroid cancer who says to me, “I’ve read about hypothermia and I want to use it instead of surgery.” I said, “This is not the therapy for you. I’m not prepared to do that because that’s not the way it’s designed to be used.”
It doesn’t mean I’ll never do it. In this situation, I would be participating in letting that cancer grow potentially because we have inadvertently and intentionally on occasion used hyperthermia alone. Let me get into the situation. where we do that. That’s one where I won’t do that. I won’t participate in that because it’s not the right use of it. Ones where I will do it is fully upfront to say two things. This is not the majority of our patients.
You have to walk an intense line. Even though it’s been around since the ‘80s eighties, you’re ultimately in a new deal and you have to walk so many interesting lines. I appreciate that.
I need to do that both from my own conscience and also to establish a field that is respected. For example, if somebody comes to me and they’ve gone through 6 or 7 different regimens and they don’t have any other options. In the early days before we were in a network with a lot of insurance, there would be delays and things. We would inadvertently treat tumors with hypothermia for longer than we had intended to do. We know that a breast tumor, for example, will soften right up.
What does that mean?
Tumors are, not always, firmed hard. In a tumor that we can examine like a breast tumor, when hypothermia is applied for several treatments in a row, that tumor gets softer. Something goes on in the tumor. In the setting of no chemotherapy and no radiation, it’s not designed to be used that way so I say those words to the patient. I say, “There’s no data.” Occasionally, we’ve seen mild shrinkage. What are the expectations here and is it appropriate to use in that situation?
In the case of somebody who has no options, I don’t feel right about holding therapy back from them. Even though it hasn’t been studied, I don’t know the limits of that therapy as long as they’re aware to not expect something major but we don’t know everything about everything. It’s the way it’s. There’s then the patient that’s in the middle of those two.
What I mean by that is they have this sense that they don’t like the idea of chemo and they don’t like the idea of radiation. They want to do naturopathic things and they look at this as a natural therapy because we use a natural force and not much of it, heat. In those situations, I will say to the patient, “I’m a Western-trained doctor.”
Let’s say you went to an oncologist or a radiation oncologist. You’re not going to get any guarantees. You shouldn’t get any guarantees from them. It would make me feel that you are doing the right thing if you would go to my trusted oncologist. I don’t employ them. There are certain people in the community that I trust. With my trusted radiation oncologist, please get the information. Enough of those people, with me requesting they get information, go to another doctor who I know is brilliant and low-pressure. Sure enough, a number of those people will then incorporate that therapy. This becomes like a gateway therapy to them getting what they ought to get anyway.
Also, putting them in the right direction. You said something important, low pressure. I only have a little bit of experience with friends with cancer. For the householder who isn’t that familiar, is it the type of cancer or the stage of cancer that chemo or radiation is more appropriate? A lot of us don’t know and get confused about which is for what or when. Is just super diverse for every individual?
It is diverse for each individual and that’s the key thing. The best thing that you can do is to get in front of an expert who has information and that information is both qualitative and quantitative so it’s, “Here’s the best approach based on my opinion, and here’s the data to support it.” You have cancer type X and you’re at stage Y. In that situation, you can begin to form a framework, “An expert in the field and a Western-trained medicine thinks this. Let me start there. What are some of the adverse effects of these therapies?”
Interestingly, in 2013 or 2014, I wrote a book.
A sexy topic, doc.
The title is provocative. I’ve only been a medical director and then chief medical officer here. Way before that, I had an interest in cancer. I realized that the knowledge base of the householder, as you put it, a lot of folks will want to do research because we have Google out there. There are right ways and there are wrong ways.
Whenever I wrote the book called Fireballs in my Eucharist, the title of it came from a patient that I was seeing during my residency. She was in the ER and I was asking about her prior medical history. She was thinking, I’m writing, and I’m sitting there and listening, “She was like, “I have fireballs in my Eucharist.” What she meant to tell me was she had fibroids in her uterus. You can’t make that stuff up. I thought, “Let me at least write some guide to be able to have trusted resources.”
The key thing is don’t try to be a doctor, it’s not a good use of your time, it’s confusing, and it can scare you. What you can do is you can use every bit of your cognitive and emotional ability to begin to ask the right questions of the doctors so that you dial into what’s right for you. Unlike the oncologist who says, “Don’t do hyperthermia,” you don’t wipe anything off the board, and that includes Western medicine.
The reason is you want to know your options and you want to know the specificity. Many patients walk through this door and say, “I researched everything, and here’s what I’m going to do.” I’m like, What is it that you’re going to take?” “I don’t remember the name of it and I don’t have my notes.” I’m like, “You don’t know what you’re going to take.” It’s to put a fine point on the idea that the same way you would do this with any professional, an attorney, or an accountant, leverage the professional, that’s the way to do it.
You’re still free to not do what they recommend. How do you know what they recommend unless you have forced them to drill down into that option for you and what the expected outcome is and what the goal is? As you also point out, you want to get in front of somebody who’s also compassionate and an excellent communicator. It’s a lot to ask. It’s a complicated disease. It’s scary.
I am blessed to have so much time to interact with patients in this particular practice because they’re getting so many treatments that I have a lot of time to spend with them initially. We get a lot of directionality. I often send them back with homework with the right questions to go and ask their oncologist.
As an endocrinologist practicing with patients, do you oftentimes have to do your own homework? It is complicated. You’re dealing with a hormone system, one of the most complicated systems. The orchestration of that is beyond. Do you have people that you go to and be like, “I’m not solving this. Do you have ideas?” Where do you go to get help? I would imagine sometimes it’s confusing.
I have an answer for you. In the oncology world, one of the ways I got here was I had an NIH-funded lab in molecular biology on breast cancer pathogenesis and the reason why breast cancer spreads to bone. I know a lot about tumor biology. I’ve never given chemo and I’ve never given radiation therapy. That’s not in the scope of my clinical practice. My knowledge base allows me to think in that world and help patients think in that world.
Take it to the endocrine side of things for a second, which was your question.I had a patient who was in the middle-20s and he ended up with a high calcium level. That high calcium level almost certainly came from a tumor in what’s called the parathyroid gland, which is right behind the thyroid gland. Women tend to get this. It’s not an uncommon situation but it tends to occur in 60-plus-year-old people and it tends to occur more commonly in women than men.
When you have a young man that has this, that is the harbinger of potentially having something called multiple endocrine neoplasia, a rare syndrome. Here’s where there’s no ego involved. I trained at arguably the best endocrine program in the country. I know what to do. In the current practice where I do practice endocrinology, I don’t have access to getting the genetics for that patient.
Rather than starting down a path, why not get them to a major medical center, and we’re not short on those here, where they can get the proper workup, which I can do but they can also get the genetics to determine which of these multiple syndromes they might have. I go to colleagues and I know my limits. It’s important for people to know their limits and that includes the patient and that includes the doctor.
You mentioned super fever. I have a friend whose mother passed away from cancer. She fought it for many years and she ended up in Austria getting fever induced. They’re throwing the kitchen sink at it by this point. To your point, they’ve tried six treatments and they weren’t having success. We joke about doing sauna and ice and all these different things for health and things like that. When I was talking to my friend that comes here, she wanted me to see and talk to you about whether is there anything or if is this shooting fairy balloons in the air.
I love doctors and scientists, they won’t talk about anything other than science or data, which I appreciate. Is there anything that shows up for you that you think, yes, a sauna is hot, it’s not spot-treating, and that there’s something important or beneficial other than heat shock proteins and all the million things that they talk about from a more superficial layer.
[bctt tweet=”Every cancer has its own tempo. There are certain types of cancers that tend to be much more serious than other types.”]
Let me answer that question in two ways. First, if somebody had melanoma and they took a heating blanket and they put it on that melanoma, they would be heating that melanoma. Having said that, your skin is such an unbelievable insulator that the technology that we have uses ultrasound waves. They are not fundamentally different than diagnostic ultrasounds. It’s just they’re at a different frequency. Instead of bouncing off, they penetrate up to ten centimeters not including the layer of fat, which they travel right through.
We can get down deep into the body. You can’t do that with a sauna. You can do that with a fever. Let me riff off into the history of hypothermia. Think about when was the first time that doctors understood it. You could pick a time in history but call it the smallpox epidemic where people were febrile to 105 for three weeks. A small percentage of those folks with identifiable tumors. Let’s call it breast cancer only because you can detect it.
A small percentage of those folks would end up with either shrinkage, complete or partial, and temporary or permanent after they got infected with smallpox and got a fever. It probably was both, the infection of the bug and the fever. We know that because of William Coley. There’s the William B. Coley Award that’s given to the preeminent immunologist today. This is in the 1890s in New York, he was a surgeon. He noticed a young woman who had sarcoma, which is a specific type of tumor, and got a case of erysipelas. Erysipelas is a strep disease and she got over it. When she got that disease, her tumor went away.
Those were the Wild West days and he decided he was going to inject streptococcus into the tumor. He got a response. Not only that, he got an abscopal effect from the Latin away from the scope, meaning the metastases shrunk but it was potentially dangerous.Heat killed streptococcus and then heat killed what we now call Neisseria to a gram-positive and a gram-negative, two different kinds of bacteria, to simply induce a fever. He died in 1936 and with him, that line of therapeutic approach withered and died away.
He got about a 50% long-term disease-free survival rate in patients who had metastatic sarcoma by injecting this into one of their lesions, one of their tumors. That was fascinating evidence to say, “Wow.” I’ve read some of his original paper, it’s cool.To read the papers in the 1890s and the way they did it. Fast forward to the ‘80s and then thinking that the infection itself might certainly cause an immune reaction but it was the people who got the fever that got the best result.
In doing so, when this technology got approved, prior to that, we had to figure out what was exactly doing. That’s an important thing to know. What happens is unlike the sauna, we are able to get at depth an increase in blood flow. Why is that important? When a tumor grows, it’s not an organ, it’s a massive cell, and it’s disorganized, it’s dichotomous. Although an individual tumor cell is ostensibly fragile, it’s also tough to get rid of. You’ve got this tumor and it doesn’t form blood vessels well.
What ends up happening is, at the middle of the tumor, they collapse. You think to yourself, “2I’m going to get central necrosis. The middle of that will die.” Sometimes it does but more often than not, these things are mutation factories. They will adapt to live in a low-oxygen environment at the center of the tumor. Chemo can’t get there. When we heat, we get chemo delivery to the center of the tumor and radiation. You’ll definitely get some killing while you’re on the table when that energy is delivered for sure.
One of the reasons why people don’t get scans until a month or 2 or 3 after their last radiation treatment is because radiation works partially by taking oxygen and using it to damage the DNA of the tumor.When it does that, we provide the substrate. We push oxygen to the center of the tumor so that now you’ve radiosensitized. You’ve allowed that radiation to work better at the center of the tumor. Your body doesn’t know the difference. It goes to repair the DNA. Here’s where I will often treat patients even after the radiation is done with full disclosure.
If you stopped after the radiation, you would be going with the data, don’t feel shortchanged. However, because your body goes to repair that DNA, if you extend that treatment, there’s at least a medical rationale to do that. No data. I’m clear with people. That’s mechanism number two. Mechanism number three is something you alluded to. We are able to get heat shock proteins, heat shock protein 70, and heat shock protein 90.
What that does is those heat shock proteins are going to occur locally but that’s fine because we want the immune cells within the tumor to become activated because the tumor actively suppresses your immune system. That’s what all this new immunotherapy is about, it unlocks that immune system. The problem is for many of those drugs, the percentage of people who respond is low. They’re figuring that out and that’s great.
In the meanwhile, we’re inducing these heat shock proteins and it’s causing dendritic cells, a cell in the immune system, to take all of the abnormal proteins that are now exposed because they were killed by the chemo or radiation. Those proteins are now going to look foreign to your immune system. They’re going to be presented from the dendritic cells to the T-cells and the T-cells are going to come back and go against the tumor to kill those tumor cells.
Every step of what I told you has a variable ability to act within a patient. 1 in 10 or 1 in 20, we hit a home run. Probably 20% or 30% of people, we don’t help them. We don’t know that ahead of time but we don’t help them because their underlying therapy is not helping them. Radiation typically does its job. It’s the chemo that’s variable but when it works, it works, as you pointed out, in the whole system, in their whole body. Consequently, I would say a solid 50% or 60% of people, based on the literature and I’ll quote you some numbers, we’re able to help them quite a bit.
Everyone is more familiar with chemo. What is the distinct difference between how radiation and chemotherapy work? The thing is there’s so much information out there that we all think we know and understand but we don’t. We’ve heard it a million times, like, “They have chemotherapy. They have radiation.” We don’t know what’s happening.
That is another important question. Let’s think about this. We know radiation. First, let’s make sure we define what we mean. I break it down into local therapy versus systemic therapy and the reason I do that is that we don’t only have traditional chemotherapy, we have targeted therapies that target a specific pathway. Sometimes we know that pathway is disrupted in that particular tumor type and we get amazing results. Sometimes it’s the best guess.
The answer to your question is that, in general, photon-based radiation, which is the most common, shoots photons at your body. It works by the mechanisms that I told you. There is something called brachytherapy that is used in certain types of cancers where they place a little radioactive pellet and either leave it there or place it for an hour and then take it out. That’s usually done in a day surgery-type setting and it’s pretty invasive.
For the chemotherapy side, that works pretty much the same way, it disrupts the tissue because of the energy, and then the oxygen-free radicals that damage your DNA. For the chemo side of things, until we had targeted therapy, which is relatively new, it’s been out for a couple of decades now and more is coming out because we’re understanding the genetics and the path and molecular pathways so much better.
When you say genetics, do you mean how the genetics respond to the treatments or how to decode the genetics and identify them when you say that specifically?
Yes. Let me drill down on that for a second. We’re going to come to a point where things are a little bit more standardized. Part of the issue that is in any emerging field, particularly as the advances come more quickly, is it’s harder to incorporate them in a way that one center does it similarly to another center. It’s not that you should have cook medicine but some standard operating procedures. It’s not to say that we have none.
Let’s say you go to an advanced center. There are two ways to look at your genetics, they could take a cheek swab or, more commonly, some blood, send that off, and say, “Do you have any mutations that make you susceptible to cancer?” If you do that, cancer has that mutation in it probably with another set of mutations as well. If that’s a targetable mutation, you can target it with the targeted therapy.
The other way to do it is to take a piece of the tumor and do genetic or genomic studies, genomics is things that are produced by the genetic material that we have, and look and see does the tumor have a targetable mutation. That will either give you a better sense of prognosis, which is great but I want treatment, or it will allow you to have pharmacogenomics, which is looking at the whole genetic profile of the tumor to say, “Can we target that tumor better with certain drugs that are better because the person has mutation X, Y, or Z?”
With something like that, would it be a month to get that feedback if you did a test? Give or take?
It’s different for different places and I don’t have a good feel for that because that’s in the oncologist realm.
I’m curious because it is amazing that we can drill down like that now. As you said, the ever-changing where one group they maybe get into one type of treatment and before you know it, it’s changed. Now you go to a different center that’s spending time with that. As a patient, I would prefer those options than feeling like everything is standardized, quite frankly.
I fully agree. This is the nascent first step into personalized medicine. What I described to you, what you asked, and what I answered, take a personalized approach. Let me not try to make anybody’s head spin. The acknowledgment that even if you came and you had two tumors, the genomics of those two tumors can be separate.
Let’s then take you two years from now, we were able to beat it back, and not cure it in a sense. Maybe it comes back and now you’ve got four tumors. All four of those tumors have different genetic and genomic profiles, including the two that were the original tumors. They change. They accrue more mutations.
The idea is going to be that we get an algorithm that allows us to understand what mutations you currently have and what you are likely to have and then get ahead of it and think about how these regimens should be personalized maybe a hybrid combined with some that we know work well with this cancer. The lowest dose that we can reasonably give and expect to get an outcome, particularly if we’re combining them.
Right now, arguably there are eight growth pathways. You could divvy it up a bit differently but you’re almost never hitting all eight. You might not need to but you wouldn’t know that unless you did the genetic and genomic studies to look at what’s happening in those tumors. When we talk about your original question, how does the chemotherapy work? The earlier chemotherapies were generally relatively crude and they would themselves go in and often damage DNA or damage metabolic pathways that were ubiquitous among cells and that were normal end cells that were dividing. It’s just that they would preferentially hit cells that were dividing faster.
The joke was that is it the chemo or cancer going to kill you first? If you can endure the chemo, maybe you can then survive cancer.
It all goes back to what level of analysis you have. You can’t substitute that for getting into a major medical and being an expert in that field. Not everybody needs that but for people with the most advanced and serious cancers, you want to be in front of somebody who knows what they’re doing.
That feels like an important point because that might take a little time. If you get a diagnosis like that, the tendency is going to be like, “I need to get going.” Sometimes getting into some of these places does take a little bit of time but it feels like knowing what you’re dealing with at the highest level and then making a move from that point seems more productive even if it feels like it takes a little longer.
You got to thread that needle between not taking it. It is tricky. The key thing is to be open with your doctors from the beginning. I’ll tell you a story that’s somewhat disturbing. I had a young lady in here and she had breast cancer. She went for a second opinion. She didn’t tell her oncologist that she was doing this and her oncologist found out because they had shared medical records and admonished the poor young lady. I said to her, “That’s not appropriate behavior from that oncologist.” If somebody wants to get a second opinion from me, please, have at it. No problem. Whoever or whatever makes you most comfortable.
I would say there is a sweet spot of maybe 1, 2, or 3. You don’t want to bounce around. You can even ask your oncologist. Within the endocrine sphere, somebody asked me, “For this particular disease, I want to take it to the max. Time is not an issue. Money is not an issue. Travel is not an issue. Where would you go to get this treated?” I would tell them as I did with the patient who was in his mid-20s, “No problem.” You need specialized care. It’s a fact. It should not be ego involved in this decision and it should be an open discussion, “I’d like to get a second opinion. Where would you go?”
Patients need to know that that’s okay to ask that even if it’s all scary and you’re probably not in the mindset. Have you ever had to be like a layman’s advocate for someone in your life for something like this?
[bctt tweet=”The reason is you want to know your options and you want to know the specificity.”]
Sure. I would say many people in my family come to me with all kinds of issues. Here’s the deal, I am super comfortable because what I can do for them varies depending on the seriousness of what they have, where they are in my life, and what they want me to do. When I take all those factors, I can do something as simple as having communication doctor to doctor with their doctor and that’ll often make a big difference in their understanding. Sometimes the patient doesn’t understand and the doctor can now say, “We’ve got someone here that can help translate if there’s an issue.” It’s not that I’ve never written a prescription for a family member. I’m not their doctor.
You have an understanding.
From that perspective, I could never be a layperson but there’s an educated layperson’s role in a sense.
It is interesting when it’s someone that you’re close to going through this. I’d have to ask because these are the things that interest me. A lot of times, you hear that they don’t have an opportunity to factor in lifestyle components, especially nutrition in medical school because there isn’t time. From more doctors I speak to, I see that your group is the group that’s trying to bring it together. Even this hypothermia technique or modality seems also still like a bridge to me. Do you have conversations with your patients, regardless of a diagnosis, about their lifestyle, their food, alcohol consumption, and all these things? Do you have to have those conversations?
I do but at a basic level. It’s for two reasons and the first is because the ability to look at one diet compared to another is extremely difficult to do in a rigorous fashion over the course of time. There’s limited knowledge that we have and that’s about to change because nutriomics or looking at the microbiome is going to give tons of actionable information but we’re not quite there yet.
It doesn’t mean you don’t need to address it. It means that the basics of understanding that if you’re treating head and neck cancer, you’re likely to lose a lot of muscle mass so how do you deal with that? How can you preempt that? If you are dealing with any sort of cancer, it’s important to be hydrated before and after chemotherapy. Those are the things that I’m competent to be able to weigh in on. As far as what type of diet might resonate best with particular cancer, I don’t have the knowledge. I don’t know the data and whether it exists.
I can tell you that for most of the diets that people go on, there probably is not strong data. It’s only because it would have to be looked at on top of any therapy that you get and that would have to be controlled for. I’m not throwing my hands up. It’s hard to get firm data on what diet itself did X, Y, and Z did to cancer.
I am going to ask you an abstract question because I’m always curious. I have had several friends that have had cancer and it’s not in their genetics. You don’t think that they’ve been exposed to asbestos. It does feel like stress or something emotional. I have people that are healthy. I’m wondering if you ever think to yourself, “It’s important to figure out how we process and manage stress because it could show up in this negative way inside our bodies.” A conversation that people wonder about is how we process emotional things and emotional stress if it redirects itself against us a little bit. Do you ever think about that or do you deal with, like, “This is what’s in the body. This is what’s showing up. It doesn’t matter why and we’re going to deal with it.”
Stress is extremely critical to understand and there are two aspects to it. What’s happening in the body because of stress? For example, there’s extra cortisol, which is a catabolic hormone. That’s true. It’s no coincidence that right after a big stress is over, you’ll often get sick because you’ve got high adrenaline, it’s protective, and then your defenses are down. There’s something that has to be going on inside the body that’s not perfectly worked out.
I have no doubt there are physiological changes that happen with chronic stress. Having said that, probably the more straightforward thing to think about in terms of stress management is that it leads to behaviors that increase the risk. For example, if you’re not mindful about what you eat, you’re more likely to gain weight. Gaining weight also increases fat mass, which increases the amount of estrogen in women, which increases the risk of breast cancer. There’s that connection to stress that is biological. There are emotional and cognitive components.
This is universal. What I’m about to say is, as theoretical as your question, in the sense that if you’re stressed, you can’t be at your best at a certain point, and yet if you’re not stressed enough, it’s not good. There has to be that sweet spot. A number of patients that walk through this door, a lot of times, the ones whom I’m guiding towards more advanced treatments don’t understand the danger they’re in, and yet some people come in completely stressed out over the top where they’re in danger. They’re so stressed out.
The first group needed to be a little more stressed out, and activated. The second group is stressed out that they’re paralyzed or they’re making decisions that they normally wouldn’t. A lot of these people are highly intelligent and highly healthy. Like money, a disease will typically magnify whatever’s there. That is true of the underlying general predisposition and what might be going on in your life at that moment. If everything piles on, you’re not going to be able to be the same savvy and calm person that you were.
Similarly, if you’re not a calm and savvy person, you’re not going to have been making good decisions all your life. I’ll give you an example of how stress manifests in one of our patients. A wonderful lady came to me, she had a clean colonoscopy at age 50. She had a colonoscopy at age 60 that showed a pre-cancerous lesion. She was advised to come back in five years. I’m not a gastroenterologist. I’m going to stay in my swim lane but I will tell you, if you have a pre-cancerous lesion, there’s judgment there. Maybe there are guidelines. I don’t want to go overboard. It’s a lot of years to sit with a pre-cancerous lesion, even though they “removed” it. I get that. Regardless, she was told five years.
COVID came and then a family member was ill and she had to take care of that family member. That turned into seven years. At year seven, a stage 4 rectal cancer. That’s an example of stresses that’s not just simply the endogenous I can’t deal with but external stresses that cause internal stresses that throw you off your game. 50 and 60, I was like, “You’re good.” Unfortunately, 65, no go because of stress.
The thing is it’s the door opening for the vulnerability. In your normal self, maybe the door, you would manage it and it wouldn’t happen. When we get thrown off kilter, someone gets a divorce, someone passes, then the door opens a little for that vulnerability as you’re saying in external stress. That’s an important point because it’s also giving yourself the grace to be like, “I need to give myself a minute here and try to deal with this because otherwise, it can show up.”
If you could back yourself into doing that moment by moment, it’ll pay off huge dividends. That’s the holy grail. We all have evolved. Particularly high-functioning people who tend to improve through the decades of their life, you evolve to do that in a better and more effective way. No one is perfect and you do have to give yourself some grace but not too much.
You can’t let yourself off the hook.
To sit and reset is an important thing.
It’s easy to talk to you as a doctor and you can be like, “The data shows and all this.” You have a family, children, relationship, and all these things. Do you have things instilled in your day-to-day life that reinforce you? Granted, there are people I meet all the time and I’m always in awe of them. They’re smart and they seem emotionally resilient like you. There are things that probably show up easier for you than maybe other people but you still must have things that you do or that are in place for you to support you. How do you deal with it? You’re dealing with a lot. You act, like, “Yeah,” but there’s a lot.
I will tell you that there are a couple of important things and one is the idea that it’s important to protect everyone around you. When I say that to myself every morning, I think, “How can I be the best that I can be?” I can’t control how people are going to react. Where can I stay calm? What could throw me off? I’ve learned, and it’s far from perfect, to be able to take that minute every day and say, “I’m getting a little extra hungry. I’m getting a little extra distracted. Things are feeling a bit overwhelming. I’m going to pause.” When I do that, I’m able to pivot over to a to-do list.
Rather than seem overwhelming, it’s a little bit of a sense of control because I can then come back and say, “I’m slightly reset. I’m not perfect. I should go to the gym. I shouldn’t eat this for myself. For my family, this is what they need.” I wish I could do it more than I do but I do it as much as I can and it certainly is more than ten years ago.
I see people like you. A lot of times, your real life suffers because you give so much to your work and your patients. Do you have a way you protect the everyday people in your life?
It’s a lot to give to patients and they’re dealing with a lot. How do you do that?
It’s interesting because, in this particular practice that I have, I do give my cell phone out to anybody who needs it. I’ve never had anybody abuse it. I don’t think people want to be on the phone with me, first of all. Second, there are good cutoffs. I’m an early riser and so I tend to do my reading and a bit of work on Saturdays and Sundays but I make sure I go right when the gym opens and work out. The rest of the time is all spent relaxing, reading, spending it with my family, and loving it.
I wish I could take more time off, that would probably help but that’ll come. We’re building a business and it’s exciting. You’re right, there are maybe sometimes too much but most of the time I asked for it. I recognize that and make it like, “You step up and you do that.” In the end, once I have that lens to look through, if I’m successful and I am not always successful, then I feel fulfilled. That’s what it’s about. I never look at it as avoiding work so much as managing the whole ball of wax.
You love what you do but it’s still a lot. When did you make the leap from your practice to saying, “Now we’re going to open up the Hypothermic Cancer Institute.” You shared about your overall curiosity about tumors and why they grow and things like that. How did that opportunity show up for you?
My career had some interesting parts to it. I was in academia and I practiced endocrinology and I got more specialized pituitary tumors towards the end of my practicing life in academia. That was about ten years. I was in biotech for a while. I came out of biotech, left on good terms, consulted back with that company, and then I ended up trying to start a practice that never took off. It was more like a concierge practice before its time.
I was thinking to myself afterward, “Thank goodness it didn’t do that.” What it did do was it got me to lease the space that you’re in right now. I then had too much of it so I met my partner who’s not a doctor because you know he needed some space. I then converted from that practice that never took off to do a lot of pharmaceutical consulting and some media work, which I love. It was instructive in terms of how things get approved, how you work with different companies, and how you build companies. I had done an MBA during my time when I was in academia. It was free when I was a professor.
When I got here, he had this practice for a while and the person was exiting who was the head of it and we had become good friends by that point, my partner and I. I said, “I’ve always wanted to have something where I could build equity and do something novel. I could do this.” To his credit, this is a man who’s a successful business person and he was patient. We did it. Without his grace, I couldn’t have done this. We’ve since become the closest of friends.
Our friendship, I don’t think it’s ever going to come down to that but it would always trump a business relationship but that’s not the point. The point is similar to the work-life balance. There are no bright lines. There should be some, for sure, but there are many that aren’t. If you can work in the world of uncertainty and hybrid well, you’re going to be okay. If everything has to be perfect, it’s going to be impossible for you.
Can we share a couple of the success stories? My friend, who said we could talk about her case, is allergic to chemotherapy. That’s what happened. A young woman and healthy. I’ve known her for more than ten years. When I say healthy, healthy living, healthy-healthy. She did have signs for a year that something was not right and she pushed it to the side. When the time came, the cancer was already pretty aggressive. In the first chemotherapy, she had a pretty radical reaction, and that’s how she arrived here. Maybe we could about her case and another case that you have experienced that was a great representation of what this therapy can do.
Let me talk about four cases and these are cherry-picked. This is not the typical outcome. These are good outcomes. I say that because I don’t oversell what I do. For some people, it’s transformative. With Tara, she had a stomach tumor. It was interesting because as you point out, the first round of immunotherapy never agreed with her at all.
She was fully planning on a whole treatment plan, it just couldn’t manifest itself so we treated her. That’s an example of where we were intending to do that but we inadvertently treated her with hypothermia alone for a long time. Interestingly, on follow-up scans, she ended up getting some improvement in the tumor we were treating. As it happens, she ended up with a tumor in a different part of her body.
It parachuted or something. Isn’t that right?
They’re called drop metastases. I like that you put a parachute on them.
I saw her in the hospital and it was heavy duty.
[bctt tweet=”Tumors are not always firmed hard.”]
What ended up happening was the tumor within her abdomen dropped down to her pelvis and invaded her rectum. Unfortunately, that’s where it took root. Hypothermia alone, we weren’t going to get rid of that cancer. Having said that, we certainly did make headway and her oncologist was dumbfounded. He was like, “I don’t understand. The stomach tumor didn’t grow but you’ve got all these other ones.” That’s good evidence. We can’t do this in every case but in her case, we added something to that therapy.
As you point out, the drop metastases seemed to come down by gravity. It was right around her colon and probably also was in her blood still. If you’re not getting rid of a tumor, it’s still there. We’re disabling it metabolically a lot. We’re causing some shrinkage in her case. It wasn’t a cure as I’ve said many times because she needed systemic therapy.
Now, she got the appropriate treatment, it was a rectal tumor, to isolate that tumor. Now we’re treating that tumor with hypothermia. She’s got a new regimen that’s a systemic therapy. Fingers crossed, she’ll be able to get rid of it all. Can she? I don’t know, time will tell, but we are going to be part of that solution. That’s an example of how we’re part of the solution.
We’re going to talk about these other cherry-picked cases. If I was not well, I would want a doctor like you. You have straightforwardness but stay upbeat. Are you feeling something different inside when you’re dealing with them and you go, “It doesn’t benefit them to be any different,” than to be like, “We’re going to give this a go.”
As a doctor, it’s interesting, I’m a happy person so that helps. We have relatively few tiers here. The staff is hand-picked and laughs all day long. Patients come in as patients and leave as family. We have developed a unique culture here and we are about to expand to other locations. Having said that, the key is going to be to keep the same tenor here. To your point, there are certain patients where, inside, it is tough for me.
What I do in those instances, it’s usually around when something is progressing. That’s going to happen. This is not a perfect world. We’re not claiming the cure for cancer. We’re claiming that we have an edge and we do. I’ll read you some numbers. I take that caring and I meet with a patient every five treatments and I say, “I’ve been thinking about you. How are you doing?” I let them tell me.
If I think they need to be a little bit more diligent about their disease, I’ll give you an example. We had a woman who has breast cancer and we treated one side of her chest where there was a recurrence. We got rid of the tumors and we treated both sides of her chest but on one side we treated deep. We have a superficial setting so we can do one of each. We then went to the other side. She went back to her surgeon, she had a double mastectomy, and she wanted to get these removed.
The surgeon said, “I’m amazed that this side of your chest had responded. I don’t think I can do anymore.” She says, “I don’t understand. I’ve been stable. Can’t they take these few tumors off?” They’re small. I said, “What your surgeon is telling you is that’s not the right resource. Why don’t we do this? Let me get you to one of my trusted oncologists. You’re not obligated to do anything.
There may be a maneuver that’s happened because she’s been dealing with this for years that you’re not aware of something. This way, you get something and it could work together with hypothermia.” She’s like, “I hadn’t thought of that.” That’s an example of something where I’m not an oncologist, I shifted her frame a little bit. Is it going to make a difference? We don’t know but you can try. That’s one case.
The other case where we knew we did something positive for the patient is we had a woman come in with breast cancer. She was taking chemotherapy with the idea that she was eventually going to have surgery. She had a left side of breast cancer and her left axilla, her armpit, where you get lymph node metastases, was questionable. It didn’t seem worth it to split the treatment because the big tumor was in her breast. We treated her breast.
Next scan she gets, no evidence of disease in her breast. Her axilla, full-on tumor. We then treated the axilla, no evidence of disease. She went in for the surgery anyway but no evidence of disease. That’s another example of something that we were able to do that it was incontrovertible that we helped that person. I’m going to tell you about two cases where they are unbelievable. I can’t separate what we did from the other therapies that the person had.
When you can’t do that, it’s hard to allocate. It doesn’t matter to me. They did well. It does in a sense that I like to see our therapy working but I’d rather have the patient get better and not know. That’s the most important thing. One of them was a gentleman in his early 50s and he had stage 3 rectal cancer. He hadn’t gotten a colonoscopy and was in his early 50s. Colonoscopy has saved lives as do many other cancer screenings.
In any case, he had a rectal tumor. We penetrate 10 centimeters and his was 6 centimeters from the anal verge, meaning that we treat right at the anus. It’s hard to describe the treatment but you could see it on our website. It’s pretty straightforward to do and it’s not painful. We treated his rectal tumor. He had a lymph node in the absolute middle of his abdomen. It was right below his belly button, midway between the belly button and the back.
He needed two deep treatments and insurance will typically not cover two of the same treatments in a day. He paid out of pocket for that. He was a wealthy guy. It wasn’t a problem. That’s neither here nor there. The point is that along with the chemo and the radiation, he ended up with no evidence of disease, which was not the expected outcome. That was probably less than a 20% chance of that happening. He avoided a life-changing surgery.
The last case and I’m going to quote you some statistics. We had a woman who was referred to me from a radiation oncologist and she had HER2-positive breast cancer. HER2-positive breast cancer is a specific receptor where there’s targeted therapy against that receptor, which is a growth receptor that can be overexpressed in a particular tumor. If it’s overexpressed, you are on 1 of 4 different regimens. She had tried 3 out of the 4 regimens, Herceptin, Perjeta, and Kadcyla, all of them worked and then it didn’t work.
She came to us with an open chest wound, a liver tumor, and a tumor in her back. She said, “Dr. Pinzone, I don’t want radiation because I want to have reconstruction. I want to try this newer drug in Enhertu.” Like Kadcyla, it’s against the HER2 but it also delivers chemo at the site. It’s novel therapy. “Let’s be open with the radiation oncologist whom I spoke with,” and she’s like, “Sure.” That was an example of being open.
She tried the Enhertu. We cleared her chest in three months. Her liver lesion shrunk to some degree with Enhertu. We got rid of that. Nothing seemed to touch the spinal lesion. We then turned to the spinal lesion. We’re talking over the course of months. She is now on her fifth PET-CT scan and no evidence of disease. They don’t know what to do with her. She’s outlived any of the trials of the Enhertu. Now, they made up a regimen. They’re like, “We’ll give it to you once every nine weeks, twice a year.”
Part of it is that she gets pretty tired and somewhat symptomatic. It’s not a free lunch. It happens to be her magic bullet right then and there served up on a platter. Now she gets it. That’s why I want people’s eyes to be open. That’s why I want them to get the therapy. Don’t say I’m “against” chemo. That then rules out all of the targeted therapies. It rules out everything because that means you’re not going to get in front of an oncologist. Maybe there’s a trial. Maybe there’s something palatable to you. That’s rarefied air and those are our rejoice patients as are many.
That’s important because it is ever-changing. It’s impossible to know the latest greatest until you get inside and get in the mix and talk to people like you and go, “You should go talk to this person over here and get more educated on what’s out there.”
You can go on to ClinicalTrials.gov. You can look for a clinical trial. You can look at any appropriate resource. The key thing is you’re not going to administer it to yourself. Rather than make a final decision, why don’t you bring it in for a collaborative discussion with an expert? That’s all I’m saying. Let me give you a couple of statistics.
When you look at breast cancer, recurrent breast cancer to the chest wall, you’ve got a 59% complete response rate, meaning that particular tumor is gone when you have radiation plus hypothermia compared to 41% with radiation alone. If you look at cervical cancer, that’s an 83% complete response rate, meaning no evidence of tumor with radiation plus hyperthermia compared to 57% with radiation alone.
If you look at head and neck cancer, 83% complete response rate compared to 41% without hypothermiam, just with the radiation. I might add, these are regimens that are much older because once you’re FDA-approved, people always ask me, “Are we doing studies?” We’re not doing studies. We’re not set up to do studies here. We’re relying on data like that. Colon rectal cancer, the five-year post-treatment survival rate in patients who’ve had radiation plus hypothermia, 72% compared to 48% with radiation alone.
That’s why I need to get this information out. I would say a lot of ads or a lot of communications, whether they be advertisements on television or podcasts, there are a lot of doctors in this country. As much as it’s a direct-to-consumer, doctors are going to hear this too and I want them to mm-hmm. You don’t have to refer every single patient. If you refer none, does that make any sense?
Especially after being given those statistics. You mentioned that you’re going to open other places.
That’s our plan.
I don’t know if it’s still true but it is FDA-approved, that’s true, the insurance will cover it, and you talked about the limitations of the same treatment, not twice in one day. If people don’t live here. This is the part I don’t know. There’s an opportunity maybe to make it more accessible for them to come here to get treatment. Is that still possible like Angel Flight? Is that still possible?
Very much so. Matt Reid, who’s our director of patient relations, does all of the pre-work prior to consultation, except for my call to them before they walk through the door to make sure that everything is tied up with a bow. Nonetheless, he gets all the medical records. He’ll help with transportation. He’ll help with either a rental or hotel or whatever. It is a multi-week therapy. They have to stay here for 6 to 8 weeks or it’s not worth it for them to come. Many people do. My double-checking is that I want to make sure they’re the best possible candidate to have this therapy so that they don’t leave their family and turn their life upside down. That’s not my goal.
Dr. Pinzone, wrapping this up, because you’re in this, you’re dealing with patients here and on your own in your practice. Is there an invitation or a reminder that sometimes you’re like, “If people would X, Y, or Z.” Is there an invitation or some type of reminder to people that maybe are putting off going to see their doctor that you would want to make for them?
If you have something that doesn’t feel or seem right to you, it’s important to go to your doctor and you should trust yourself. It’s not that you should be a hypochondria but if you don’t get an answer that makes sense to you, you should get a second opinion. One other thing I’ll say is the biggest thing I want patients to walk away with is, God forbid, if you’re diagnosed with cancer, the minute you’re diagnosed, please call me. I will let you know the data. You can make the decision yourself. We can talk things through. I can’t help you if you don’t let me know you have a problem.
As someone who has watched friends go through this and also friends who’ve taken care of family members, I was grateful to come. When I heard about it, I was like, “That’s amazing.” I had heard about the onset fever. My friend went through that in Europe. The fact that this was available. Maybe we can remind people HCIOncology.com. Hypothermia Cancer Institute, email, call, and things like that. Dr. Pinzone, I not only thank you for your time but thank you for the work and the enthusiasm because that spirit for people coming in here is helpful.
Thank you very much for making this possible. I appreciate it.
Before I go, Justin, you get one question.
I was going to ask but we summed it up in the last one. In order for this therapy to become more mainstream, does the technology need to get smaller? It sounds like you have to get the word out there.
What will it take for this technology to become mainstream? It’s going to, for lack of a better term, crowdsource. What’s going to end up happening is we are going to feed forward. With the popularity of this center and the results that we’re able to drive and the satisfaction that patients are genuinely able to show, once we have the next center and then the next center, we are going to have that same growth curve to outstrip the growth curve of cancer. That’s our goal. Also, to participate with all of the other ongoing therapies, all the other doctors, and all that stuff. It’s a safe place here. When we create more of them, we’ll have that much more opportunity to help people, one individual at a time. That’s how it’s going to grow.
He’s not just cute and good with technology. He asks great questions. Thank you. Dr. Pinzone.
Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guest or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button, and leave a rating and a comment. It not only helps me, it helps the show grow and reach new readers.
Subscribe to The Gabby Reece Show
About Dr. Joseph Pinzone
Dr. Pinzone practices Endocrinology including treatment of patients with diabetes, thyroid problems and other hormonal disorders. He sees ambulatory patients at Magnolia Family Medical Center and Conejo Valley Family Medical Group. Dr. Pinzone is on staff at Ventura County Medical Center and sees hospitalized patients there. He is Assistant Clinical Professor of Medicine at the David Geffen School of Medicine at UCLA. Dr. Pinzone is a Fellow of the American College of Physicians.
Dr. Pinzone graduated from New York University School of Medicine and completed internship and residency in Internal Medicine at Columbia-Presbyterian Medical Center. He then completed a fellowship in Endocrinology, Diabetes & Metabolism at Massachusetts General Hospital and Harvard University, where he achieved a National Research Service Award from the National Institutes of Health (NIH) to investigate the cause of pituitary tumors.