Cancer pain drug tested

By LAUREEN McMAHON

Could a small, round fish, covered in spines and primarily known as a pricey delicacy for Asian diners, hold the secret of pain relief for legions of cancer patients?

St. Paul’s Hospital oncologist Dr. May Ong-Lam is among a group of Canadian physicians directing landmark Phase III trials of Tectin, a drug derived from a toxin extracted from the puffer fish (also known as the blowfish and the fugu) which is showing great promise in alleviating the refractory pain of end-stage cancer and associated conditions.

Dr. Ong-Lam told The B.C. Catholic that she is tremendously encouraged thus far by the success of Tectin in treating pain due to malignant cancer and its treatment or surgery.

“Definitely one of our patients received a significant benefit after she had damage to nerves in her arm from radiation treatment which was very painful,” said Dr. Ong-Lam. “This patient took Tectin for two days intramuscularly and the analgesic effect lasted about three weeks, a significant result.”

Tectin’s most common side effects of nausea and dizziness are relatively mild and can be controlled using medications, said Dr. Ong-Lam.

It is exciting, she said, that with the drug’s success in controlling cancer pain, she expects Tectin to be used for other severe and chronic pain conditions in the future.

More patients are currently needed for the St. Paul’s Tectin trials, so Dr. Ong-Lam is encouraging those suffering moderate to severe pain to ask their doctors to contact the St. Paul’s Pain Clinic or her office at 604-688-2580 directly to see if their symptoms meet the protocol.

Pain control is central to the issue of euthanasia; lack of control of severe pain is one of the most frequently-used arguments of right-to-die advocates, who argue that patients have the right to demand euthanasia or assistance to commit suicide if they suffer “uncontrollable” pain.

The Tectin trials, therefore, are taking place at an opportune moment. Evelyn Martens, a director of the Right to Die Network of Canada, is heading for trial on charges of assisting a suicide and two counts of counselling to commit suicide in the deaths of two B.C. residents, Monique Charest of Duncan and Leyanne Burchell of Vancouver.

The Euthanasia Prevention Coalition of Canada is holding a one-day symposium on euthanasia and eugenics Sept. 25 at the Plaza 500 Hotel in Vancouver.

Dr. Williard Johnston, president of the B.C. Euthanasia Prevention Coalition, which opposes the promotion and legalization of euthanasia or assisted suicide, told The B.C. Catholic that the development of Tectin and other similar drugs points the way to a time in the not-too-distant future when “the physical comfort of palliative care patients will be solved, allowing us to focus on the emotional and spiritual aspects of this stage of life.”

“Euthanasia,” Dr. Johnston pointed out, “is really the abandonment of someone experiencing severe emotional and spiritual as well as physical symptoms. Rarely are we unable to at least partially control pain. Untreatable pain was never a valid argument for euthanasia but, unfortunately, hard-core euthanasia proponents don’t always need the excuse of physical discomfort; they would like to claim that personal freedoms lie at the heart of someone’s choice to end his or her life.”

Double-blind placebo-controlled testing of Tectin is also being conducted at 225 medical centres across the country, said a spokesman from International Wex Technologies, Inc., a neuro-bioscience company behind the development of Tectin and other pain management pharmaceuticals.

In addition to its effectiveness, Tectin has been shown to be extraordinarily safe for patients in all previous studies, he said.

Last May, the extremely promising results of open-label Phase IIa trials were presented at the second joint scientific meeting of the American Pain Society by lead investigator Dr. Neil Hagen, head of the Division of Palliative Medicine at the University of Calgary’s Department of Oncology.

Tectin was found to induce a clinically meaningful analgesic response in three-quarters of cancer sufferers over a two-week period when administered intramuscularly, Dr. Hagen said. This success and the ability of patients to tolerate Tectin satisfactorily pushed open the door to the newest phase of trials, he said.

The puffer fish has been known for thousands of years to cause a variety of strange sensations in many people who consume it. These are caused by the release of the toxin known as tetrodotoxin in its body. Some individuals who consume puffer fish experience numbness in the tongue and lips. Headaches can follow along with nausea, vomiting, paralysis of the face and extremities, and even death, which is why only specially trained and licensed chefs may prepare puffer fish for Japanese restaurants.

The toxin, however, becomes completely safe and beneficial to patients when processed into Tectin.

International Wex, which is dedicated to developing medical products from naturally-occurring toxins for use in moderate to severe pain, first used tetrodotoxin in the treatment of opiate withdrawal in addicted individuals. When it was noted that the main factor in the toxin’s success was its ability to reduce pain, Wex decided to test Tectin in cancer patients.

The company expects that next year’s results of the Tectin trials will lead to the investigation of its clinical use in patients suffering from non-cancer chronic pain. Drugs trials are expected to continue for the next 12 months, with results to be announced in 2005. More information is available at Wex’s Web site: www.wextech.ca.