Tuesday, 25 October 2016

Pilkington interview on clomipramine - partial transcript

Thanks to jo jo for the link to the interview.
https://soundcloud.com/user-959768434/episode-5-reboot-part-1

I've transcribed some of the more interesting quotes from the interview here:

26:37 ...in a rather large number of patients, there have been some sort of reports over the years, and we've been doing this now, work on this drug since the mid-1990s, and hundreds and hundreds of patients with malignant brain tumours have taken clomipramine, albeit as anecdotal cases and indeed at different dose levels. I think it's very difficult to put your hand on your heart and say that this is something that's working across the board because we don't know the circumstances. When patients are diagnosed with malignant brain tumors increasingly they go onto the internet, and they look for things, and they start self-medicating...

29:05 We need to initiate a properly controlled clinical trial and we need to design that trial appropriately.  We're going to be given a clinical trial, if indeed we're given a trial at all, if we do get permission for a clinical trial, the design of it may not give us the answers that are there to be had.  In other words if we have this tagged on at the end as a sort of a "salvage therapy" for patients who've already undergone a series of other therapeutic approaches, we may end up with a patient there whose cells really are just not going to be responsive to this approach. 

29:56 I think the design of the trial as well as the initiation of the trial is very important in this context. There are a number of patients, a large number of patients out there who I'm absolutely certain have done very well. You have to extrapolate to why they've done very well. Those patients happen to correlate with [those] that were taking clomipramine so you can make up your own mind on this.

7 comments:

  1. Hi Stephen,

    Thank you for posting this. I was not previously aware of Clomipramine. Pilkington talks about its effect on malignant tumours, do you happen to know if the same effects have been observed for lower grades?
    My partner has a grade 2 Asrocytoma and I was thinking about asking her neurologist if clomipramine could be worked into her cocktail of epilepsy medications..

    Thanks.

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    1. Given that the anecdotal evidence supporting clomipramine is based on patients "doing very well", such an effect would be even harder to detect in lower grade gliomas who can go for many years with no therapy beyond standard of care. I don't know of any specific evidence concerning clomipramine for lower grade gliomas.

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    2. As of June 2016 there was limited information available about this, to little to draw any conclusions:

      http://btcocktails.blogspot.ca/2016/06/liquid-aspirin.html

      I've not tried to dig up any information on this since then, so perhaps there is more available now.

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    3. Liquid Aspirin.
      I wouldn't be familiar with the process but I think that they won't publish until it has been peer reviewed. It will be interesting to hear what the other 2 drugs are. I understand that they are off shelf as well.

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    4. Yes, my comment directly above was about liquid aspirin, not about clomipramine.

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    5. jo jo,

      See this article: http://www.dailymail.co.uk/sciencetech/article-3663188/How-liquid-aspirin-help-fight-brain-cancer-Special-version-drug-ten-times-effective-killing-cancer-cells-chemotherapy.html

      The way I read it is that the aspirin itself kills the cancer cells. The other 2 drugs may be the ones that they use to make the aspirin truly soluble, "Dr James Stuart - found that combining aspirin with a ‘solubiliser’ and a ‘stabiliser’ resulted in a truly liquid state."


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    6. The most important piece of information in any in vitro study testing effects of drugs on cancer cells is: what drug concentration was used, and is that achievable in vivo. News articles never get into those details. There are probably hundreds of commonly used drugs that could kill cancer cells and do it 10 times more effectively than standard chemo drugs, IF you use a high enough concentration.

      We have no idea what any of this means without those important details.

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