Q. Will tetrathiomolybdate (TM) work on all types of cancer?
A. We cannot give you a definitive answer because TM has not been tried on all types of cancer. However, every type of cancer tested to date has been found to be driven by angiogenesis (including leukemia, lymphoma, and multiple myeloma). We’re hoping that patients who are able to keep ceruloplasmin levels at 20% of base for periods longer than 90 days will see results similar to those achieved in the University of Michigan study. The bottom line is that capillaries are capillaries no matter what type of cancer they support.
Q. Why does It take three months after reaching target to see stable scans?
A. The target level of ceruloplasmin reflects what is happening in the blood. Once the level of copper is low in the blood, we speculate that it then comes out of the tumor. Since tumors tend to collect a lot of copper, it may take time to make the tumor itself copper-deficient. When the copper begins to come out of the tumor, the copper and ceruloplasmin levels in the blood may increase. This is actually a good sign and the level will decrease over time. Once copper is chelated out of the tumor, which takes about three months, it is postulated that the tumor is no longer able to make new blood vessels. The recommended procedure is to have scans three months after the target is reached and then repeat the scans at the six-month mark. If the TM has been successful, the repeat scans should be stable, i.e. no evidence of tumor growth. (*Note: Tumors can continue to grow to some extent during the three months after achievement of the target.)
Q. Will TM cause tumors to shrink?
A. Not directly. TM has no cytoxic effect on existing tumor(s) or their already established capillary bed. However, capillaries that have grown abnormally fast are typically “thin-skinned” and are constantly breaking and being replaced with newer ones. If TM is able to lower and keep ceruloplasmin levels at 20% of base and this halts or greatly reduces the release of growth factors by the tumor(s), then the growth of new capillaries should be greatly diminished. As its capillaries break and are not replaced, the tumor(s) should eventually get smaller. We would expect fast growing tumors to respond quickly and shrink over a period of months. Slower growing tumors could take much longer.
Q. How does TM lower copper levels?
A. TM is a complex molecule of sulfur and molybdenum that forms a stable three part complex with copper and protein. Taken with food, it binds to the copper (in the food) and keeps it from being absorbed. When taken on an empty stomach (2 hours away from any food) TM is absorbed into the blood stream where it forms complexes with copper and serum albumin. These newly formed copper complexes are gradually excreted through bile and urine.
Q. Where is TM available?
A. TM is produced and distributed by several compound pharmacies in the United States. The chemical compound is very sensitive and must be stored in an oxygen-free environment prior to compounding. You should use an experienced pharmacist who does this on a regular basis and can answer your questions. By prescription only.
Health & Wellness Pharmacy
Mark F. Binkley, D. Ph.
Pharmacist / Chemist
8900 Hillsboro Road; Suite 4
Nashville, TN. 37215 Phone:Fax:
Email: (615) 292-0066
Q. How should I store my TM?
A. The most important thing is that the TM not be exposed to air or moisture insofar as this is possible. Always keep it in the container in a cool, dry place. Don’t take capsules out far ahead of when you will use them. We have asked the pharmacist to stuff the bottle with cotton to keep down the air space as you use the capsules. The TM is stored under a special gas until it is put into capsules. When you receive your capsules, they have a 90% shelf life of 8 weeks. This means that in two months they will not have degraded more than 10%. To be on the safe side, we ask you to order only one month’s supply at a time.
Q. What side effects might I expect from TM?
A. Although the Michigan study reported no side effects, we have seen a few. None are especially serious unless you are on chemotherapy at the same time. (To be discussed later.*)
Gastrointestinal symptoms seem to be the most common, i.e. sulfur “burps” within 30 minutes of taking the TM; slight nausea; gastric reflux; constipation at the onset of treatment and/or diarrhea later on. (All of these symptoms can be treated with Pekana remedies.)
Some people experience leg cramps at night that can be very painful. Usually increasing your intake of magnesium will take care of this.
When first taking TM some people experience increased fatigue. This usually resolves with time or may come and go.
Other reported symptoms have also been transitory and consist of migratory joint pain, metallic taste in the mouth, “stomach ache”, headache, and aggravation of pre-existing neuropathy.
Bone marrow suppression can occur in some circumstances. The University of Michigan study reported significant bone marrow suppression only when ceruloplasmin was lowered to fast or below target level. If the depression is mild, it is of no particular concern and seems to resolve with time.
*If you are on regular or antiangiogenic chemotherapy, in addition to TM, careful attention must be paid to the blood counts on a weekly basis. Please keep track of all possible side effects on your flow sheet and report them to us.
Q. Can I take TM if I am on chemotherapy?
A. Yes, however, this has to be carefully coordinated with your oncologist because the combination of chemotherapy and TM is more likely to produce bone marrow depression. You will need to have weekly CBC’s and may need to take leukine (GMCFS) to increase you white blood cell count and/or procrit or epogen to increase your red blood cell count. Be sure that you take leukine rather than neupogen for the white cells because neupogen is an angiogenic agent whereas leukine is mostly antiangiogenic.
Q. What if I have surgery while I am taking TM?
A. There is no hard evidence that low copper interferes with wound healing, but theoretically it could. When TM is discontinued, copper levels rebound quickly. Notify your physician, who will cut your dose of TM to bring you to a low normal level for approximately six weeks postoperative.
Q. How does TM affect radiation therapy?
A. Conventional radiation therapy is more effective when copper levels are low.
Q. What if I neglect to take my TM or decide to stop it once my copper level is lowered?
A. In the Michigan study they found that when TM is discontinued, the copper level reverts to normal in a few days and tumor growth seems to spurt. DO NOT UNDER ANY CIRCUMSTANCES STOP TM ONCE YOU ARE CLOSE TO TARGET WITHOUT CHECKING WITH YOUR PHYSICIAN!
Q. What if I am totally compliant with my TM and my ceruloplasmin will not go down?
A. We postulate that when the liver is not functioning properly it has a need for extra sulfur. In this situation it uses sulfur from the TM, leaving TM unavailable to chelate copper. In that case extra supplements such as MSM, etc. to supply sulfur to the liver and allow TM to do its job are needed. Your physician will discuss this with you.
Q. Do I need to stay on a low copper diet while I am taking TM?
A. Patients in the Michigan study were not put on low copper diets. We have found that it is best (and faster) if you stay away from high copper foods. Two foods that you should definitely not have are organ meats and shellfish, which are very high in copper (except for scallops.) So far we have not found a very reliable table of copper content of foods since a lot of the content depends on the area of the country in which the food is grown. Generally, whole grains, especially buckwheat and wheat, nuts, chocolate, molasses, dried beans, tofu, black pepper, yeast, and dark leafy greens are known to be high in copper. Be sure that if you do eat these foods you are taking your TM with the meal so the ingested copper can be chelated out. Generally, the TM taken at the conclusion of a meal will chelate copper out of the food ingested.
Q. How does Low-Dose Chemotherapy fit into this picture?
A. Fairly new on the oncology scene is the concept of low-dose anti-angiogenic chemotherapy. Used in small weekly doses, many chemo agents act to inhibit growth of blood vessels to tumors rather than killing the tumor directly. A number of patients with Stage IV disease have responded well to a combination of TM and low-dose chemotherapy. Everything is anecdotal at this point so most oncologists are not participating. Some are, however.