A fermented wheat germ extract previously available only in Europe is showing significant benefits to cancer patients in North America, as clinicians here start to integrate the compound into their practices. Avemar, as the compound is known in Europe, is used as adjuvant therapy for various types of cancer. It has been shown to prolong progression-free and overall survival in colorectal cancer patients (Jakab F, et al. Br J Cancer. 2003 Aug 4; 89(3): 465–469), to delay disease progression in melanoma patients (Demidov LV, et al. Int J Cancer. 2002; 100(S13): 408), and to reduce chemotherapy-induced febrile neutropenia in pediatric cancer patients (Garami M, et al. J Pediatr Hematol Oncol. 2004 Oct; 26(10): 631–635).

These findings, part of an unusually voluminous body of work focused on a natural product for cancer, are being reflected in the experience of integrative physicians using the compound here, said James B. LaValle, ND, RPh, CCN, a holistic practitioner in Cincinnati. Dr. LaValle’s work with cancer patients focuses on natural modalities supportive of the primary therapy chosen by the patient.

“What I’m finding is that people using this compound are stronger, they recover from chemotherapy and surgery quicker, they don’t get as much constipation, their blood cell counts hold up better, and they’re less prone to sepsis,” said Dr. LaValle. “What the published research suggests is that when these effects are seen—as I am seeing them now in my patients—the patients will live longer. That’s really encouraging,” he added.

The methoxy-substituted benzoquinones that appear to be the key anti-cancer substance in fermented wheat germ, were initially discovered by Albert Szent-Gyorgyi, MD, the visionary Hungarian researcher who won the 1937 Nobel Prize for discovering vitamin C. Several decades later, biochemist Mate Hidvegi, furthered Szent-Gyorgyi’s findings, developing them into a viable therapy. Avemar is a widely used medical food for cancer care in Hungary and other European countries.

Known in the US and Canada as Avé (American BioSciences, Blauvelt, NY; 888-884-7770), it is available as a powder, packaged for convenient daily dosing. Patients simply mix the packets with water or juice, and take Avé as a drink.

Starving the Cancer Cells

The physiologic mechanisms by which Avé exerts its therapeutic effects are varied, said Dr. LaValle. The methoxy-substituted benzoquinones in the fermented wheat germ restrict cancer cells’ access to the large amounts of glucose they need to grow and divide rapidly, noted Dr. LaValle.

Studies at UCLA tracing isotope-labeled glucose through cell metabolic processes showed that Avé reduces glucose utilization by cancer cells, shunting it away from the non-oxidative pathway, thus slowing cancer cell growth and proliferation (Boros LG, et al. Pancreas. 2001 Aug; 23(2): 141–147).

In various cancer cell lines tested, the more rapid the original rate of glucose utilization, the greater the metastatic potential, and the more dramatic Avé’s effects were. Interestingtly, the compound showed no effect on normal cells at dosages up to 50 times higher than that recommended for therapeutic use (Szende B. Cancer Biother Radiopharm. 2004 Jun; 19(3): 343–349).

Improving Immune System Activity

Avemar has been shown to suppress the display of MHC-1 on the surface of cancer cells, and this increases NK cell targeting, increases cancer cell death. It also enhances T-cell response to antigen presentation, and improves B-cell response and production of appropriate antibodies (Hidvegi M, et al. Immunopharmacology. 1999; 41(3): 183–186).

The compound also enhances production of ICAM (intracellular adhesion molecule), improving T-cell and macrophage migration, invasion, and attack of tumors. It increases macrophage production of Tumor Necrosis Factor-alpha (TNF-α), and up-regulates genes coding for IL-1α, IL-1, IL-5 and IL-6, helping increase the numbers, growth, and mobility of immune system cells (Telekes A, et al. Ann NY Acad Sci. 2005 Jun; 1051: 515–528). Avemar selectively induces apoptosis in cancer cells by reducing concentrations of poly (ADP-ribose) polymerase (PARP), used to repair damaged DNA before cell division (Comin-Anduix B, et al. J Biol Chem. 2002 Nov 29; 277(48): 46408–46414. Epub 2002 Sep 25).

Protecting GI Tract, Preventing Secondary Infections

When working with patients undergoing treatment for cancer, Dr. LaValle’s supportive therapy is focused on three key areas: preserving gastrointestinal function and motility, preventing opportunistic infections, and boosting immunity.

“Forty percent of cancer patients who succumb to their disease actually die of malnutrition but that doesn’t necessarily reflect poor diet. More often, it is due to damage to the GI tract from cytotoxics (chemotherapy drugs),” he noted. “People undergoing chemotherapy often become dyspeptic, they don’t absorb their nutrients, their gut gets compromised, they often get gastritis, Candida, thrush, these types of things.”

“To deal with that, we might use anything from glutamine washes, to making sure they’re on probiotics, to using an herb like Cat’s Claw (Unicaria tomentosa or U. guianensis) to keep the inflammation down in the gut. We can do things as simple as that, or also employ various homeopathic or herbal combinations that help to maintain GI tract motility and prevent the GI disturbances that occur when undergoing chemotherapy—nausea, bloating, and sometimes diarrhea.”

“Another large portion of cancer patients die from secondary infections; the thing I find is that bacteria end up overtaking the individual, so you really want to help protect against that, which is why I think that probiotics, and certain herbals like Cat’s Claw can be of tremendous benefit.”

The third key piece of Dr. LaValle’s supportive regimens is immune system support. “There is a chronic inflammatory cascade initiated during cancer. We want to do things that manage the chronic inflammatory cytokine activity so that we’re not getting an over-expressed inflammation cascade going on.

We can use fish oils, for example, which are very good for that, and there are a lot of different natural remedies that may or may not help in terms of overall immune response. There are a lot of mushrooms out there being used. I like ImmPower, because it helps to make NK cells more aggressive. Our goal is to get the immune system stimulated and able to fight a little better.”

Improved Efficacy, Cost-Effectiveness

“One really great aspect of Avé is that because of its multiple effects, it’s one agent that can replace several I might have had to use in the past. That increases patient adherence, and also saves money,” Dr. LaValle said. “And patients find it easy to use—it’s a powder mixed to make a once-a-day drink.”

He added that the most compelling aspect of Avé is that it, “seems to have its greatest effects on more aggressive or metastatic processes. The whole aspect of slowing down cancer cell uptake of sugar and making the growth of the cancer more sluggish … is very exciting, there’s not a lot out there that can do that.”

With the unusually large amount of quality research clearly showing clinical benefits, there is an increasing interest in the extract among both holistically oriented practitioners, as well as conventionally trained oncologists.

“We have this in common, we all respect science,” Dr. LaValle said. “I try to spread the word about truly effective new agents I learn about, and when you show clinicians the research—significant improvement in survival in Stage IV colon cancer, significantly reduced febrile neutropenia in kids undergoing chemo—these things matter, and I think we’re going to see this compound becoming more frequently used in the supportive arena for cancer patients.”