The COC Protocol is a specific combination of conventional pharmaceuticals which may work together to restrict the overall ability of cancer cells to take up and use (i.e., ‘metabolise’) energy. The addition of non-cytotoxic agents with well-established safety profiles seeks to impede the prospects of cancer cell survival, especially in a hostile environment, such as during standard-of-care chemotherapy, radiotherapy, immunotherapy and hormone therapy.
Targeting Cancer’s Metabolic Pathways.
Metabolism is the conversion of food to energy to run cellular processes and construct cellular building blocks. It is widely accepted that the metabolism of cancer cells is usually fundamentally different compared to that of healthy non-cancerous cells. Altered metabolism is now considered a hallmark of cancer and a new discipline of “metabolic oncology” has emerged. (Hanahan and Weinberg, 2000; Hanahan and Weinberg, 2011; Bergers and Fendt, 2021)
Cancer cells need large amount of energy to survive and grow. They commonly use an adaptive process called aerobic glycolysis (the ‘Warburg effect’) to generate the excessive energy they need (Kroemer and Pouyssegur, 2008; Liberti and Locasale, 2016).
The COC Protocol targets various molecular processes involved in and surrounding aerobic glycolysis and cancer metabolism, aiming to restrict cancer cell energy supply and use, while simultaneously preventing the cells from adapting and using other pathways to take up energy.
As a result of ongoing metabolic restriction,(Jang et al., 2013),cancer cells may become weaker and less able to take in and use nutrients they need from their surroundings (e.g., glucose, lipids, and essential amino acids such as glutamine and arginine).
Gradually, metabolically-weakened cancer cells (including more resilient and previously treatment-resistant cells) can potentially become more vulnerable to attack from other cell‑killing cancer therapies such as radiotherapy, chemotherapy, and other therapies (Luo and Wicha, 2019, Zhao et al, 2013, Butler et al, 2013)
Why use a combination approach?
Cancer therapies may be most effective when used in combination. A review of peer-reviewed literature suggests that each individual element of the COC Protocol may target cancer cell metabolism in a distinct and potentially complementary way, and we have termed this action ‘mechanistic coherence’, which describes the possibility of attacking a cancer cell from different angles in a synergistic or additive fashion. This type of combination approach in cancer is discussed by Mokhtari et al, 2017, and others.
COC Protocol – Potential Mechanisms
Who is the COC Protocol for?
By targeting the altered metabolic mechanisms which are common to most cancers (but not usually healthy cells), we believe the COC Protocol can be used in patients with any cancer regardless of specific type, stage, or location.
Patients aged 18 and over may engage with Care Oncology Clinic at different points in their cancer journey. You could be someone who has:
- a new diagnosis and is about to begin systemic treatment for a type of cancer which carries a risk of progression or recurrence
- completed a course of cancer treatment and is on active surveillance
- no evidence of disease (NED) but is at risk of recurrence
- disease progression and commencing further lines of therapy
- commenced palliative care
If a patient is well in themselves (able to swallow oral medication, getting adequate nutrition, not confined to bed, not suffering from severe and prolonged nausea) and has satisfactory baseline blood results and organ function, they could be eligible for treatment. Check eligibility here
How are patients followed up?
Continued medical supervision is central to the Care Oncology Clinic’s service given that each patient’s health status, blood test parameters, standard of care treatment and other circumstances evolve over time. Our clinicians openly share treatment plans and updates. They will adapt or pause the protocol according to each patient’s individual needs and will always seek to ensure that standard-of-care therapy is prioritised.
8-week Follow Up appointments: the first follow up appointment for new patients is scheduled 8 weeks from commencement of treatment, during which a first set of interval blood results will also be reviewed. This ensures patient safety during the initial treatment phase and enables any necessary adjustments to consolidate the introduction of the regimen. Your doctor will review your COC Protocol, interval test results, changes to concurrent treatments/medications and answer any questions you may have.
12-week Review appointments are scheduled thereafter to discuss how treatment is progressing and to take account of additional clinical information (e.g., ongoing interval blood results and scan reports, introduction of new treatments/medicines). In between the formal quarterly appointments, there are no additional costs for contact by telephone or email for follow up questions or concerns and we also operate an Out of Hours telephone service.
What are Care Oncology Clinic’s results so far?
Preliminary results from a retrospective analysis of a cohort of Glioblastoma Brain Tumour patients were included in a perspective article published in June 2019 in Frontiers in Pharmacology – click to read.
We are now working on analysing data and reporting on results in other cancer types.