Brain and Central Nervous System Cancer
General Information About Adult Central Nervous System Tumors
- An adult central nervous system tumor is a disease in which abnormal cells form in the tissues of the brain and/or spinal cord.
- A tumor that starts in another part of the body and spreads to the brain is called a metastatic brain tumor.
- The brain controls many important body functions.
- The spinal cord connects the brain to nerves in most parts of the body.
- There are different types of brain and spinal cord tumors.
- Astrocytic Tumors
- Oligodendroglial Tumors
- Mixed Gliomas
- Ependymal Tumors
- Pineal Parenchymal Tumors
- Meningeal Tumors
- Germ Cell Tumors
- Craniopharyngioma (Grade I)
- Having certain genetic syndromes may increase the risk of a central nervous system tumor.
- The cause of most adult brain and spinal cord tumors is not known.
- The signs and symptoms of adult brain and spinal cord tumors are not the same in every person.
- Tests that examine the brain and spinal cord are used to diagnose adult brain and spinal cord tumors.
- A biopsy is also used to diagnose a brain tumor.
- Sometimes a biopsy or surgery cannot be done.
- Certain factors affect prognosis (chance of recovery) and treatment options.
- Glioblastoma (grade IV): A glioblastoma grows and spreads very quickly. The tumor cells look very different from normal cells. This type of tumor usually cannot be cured. It is also called glioblastoma multiforme.
Read the full article on the National Cancer Institute website.
Additional Treatment Options for Brain and Central Nervous System Cancer
Caution: Always seek medical advice before you undertake any treatment.
1. Conventional treatments
Dendric Cell Vaccine
Dendritic cells (DCs) are antigen-presenting cells of the immune system.
This study says: Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax®-L) to standard therapy for newly diagnosed glioblastoma.
From July 2007 to November 2015, 331 patients were recruited in the trial… among the patients (n = 182) who were ≥ 36 months past their surgery date as of the date of this analysis, 24.2% (n = 44) were alive for ≥ 36 months and have a KM estimated median survival time of 88.2 months. Thus, it appears that patients who survive past certain threshold time points may continue onwards to unusually long survival times
UPDATE 17 November 2022
Northwest Biotherapeutics Reports Positive Top-Line Results From Phase 3 Trial of DCVax®-L for Glioblastoma
Lomustine-temozolomide combination therapy improved survival versus standard temozolomide therapy alone.
In this open-label, randomised, phase 3 trial, patients were enrolled from 17 German university hospitals who were aged 18–70 years, with newly diagnosed glioblastoma with methylated MGMT promoter, and a Karnofsky Performance Score of 70% and higher.
The study found:
Between June 17, 2011, and April 8, 2014, 141 patients were randomly assigned to the treatment groups; 129 patients (63 in the temozolomide and 66 in the lomustine-temozolomide group) constituted the modified intention-to-treat population. Median overall survival was improved from 31·4 months with temozolomide to 48·1 months with lomustine-temozolomide.
Adverse events of grade 3 or higher were observed in 32 (51%) of 63 patients in the temozolomide group and 39 (59%) of 66 patients in the lomustine-temozolomide group. There were no treatment-related deaths.
Selinexor improves survival in non-methylating GBM
14 January 2022
Selinexor, a drug approved recently for pretreated multiple myeloma and lymphoma patients seems capable of benefiting patients with GBM, even if they are neither methylating nor have an IDH-1 mutation.
Glioblastoma Multiforme or GBM is a terrible disease. Some patients are given a prognosis of just 5 months. The average survival is approximately 15 months. In 1986 a drug called Temozolomide was approved. It was known then that it only ‘worked’ with people whose tumours were methylating. In fact, at first the FDA turned it down, but approved it as long as patients were tested. Rather like Herceptin in breast cancer, with GBM just 20% of patients have the appropriate condition. Herceptin is not used on every lady with breast cancer, just those who are HER2+ve, but Temozolomide is used on everyone, even though it is doomed to failure with the 80% of GBM patients who are not methylating.
This is why it is often given at the outset of treatment with radiotherapy for 6 weeks. At least the radiotherapy may achieve something. There is research that cutting blood sugar using metformin and/or berberine can make it slightly more effective and for more people (those who are methylating slightly). Phase II Clinical trials in the Lancet suggest Lomustine can improve its performance. And the Optune System – where you live with an electric field generating cap on your head, is also proven to extend survival times. Various other ‘drugs’ from Chlomipramine, to Celebrex and even hydroxychloroquine seem to help a little.
The key issue then is what is the best orthodox protocol for non-methylators; the 80%? Does one even exist?
Selinexor (KPT-330) and GBM
Selinexor is an FDA-approved chemotherapy for multiple myeloma and diffuse large B-cell lymphoma patients who have been heavily pretreated with other medicines. It was given Fast Track approval by the FDA in 2018/9.
Selinexor is a first-in-class, oral, Selective Inhibitor of Nuclear Export (SINE) drug, which functions by binding to and blocking the nuclear export protein XPO1. This results in an accumulation of tumor suppressor proteins in the cell nucleus, which in turn provides stronger tumour suppression leading to apoptosis of cancer cells, while having minimal effect on healthy cells.
In 2019, neurologist Dr. Andrew Lassman presented Phase II results of a clinical trial at the American Society of Clinical Oncology on Selinexor with GBM (1, 2). The initial interest was because increased XPO1 expression is also seen in GBM especially those that are more aggressive.
The researchers presented findings from 30 patients with recurrent GBM who had received an average of two prior cancer treatments, although some had received up to seven. The overall response rate was 10% even though some patients had been heavily pretreated, 19% of patients survived 6 months without cancer progression and Selinexor-treated patients survived 9.4 months on average. Lassman said that even where there was no IDH mutation or other biomarkers the responses were noted, with stable and durable responses; one patient had been stable on the trial for 3 years.
More is needed to be known about the relationship between the cancer characteristics and the drug.
Worldwide enrollment is currently taking place (3) to test Selinexor’s effects in combination with other treatments including standard current treatments.
Continue reading article at CANCERactive.com.
2. Non-conventional treatments
Antineoplastons were discovered by Stanislaw R. Burzynski, M.D., Ph.D. in 1967 who first identified their anti-cancer properties. Antineoplastons are naturally occurring peptides demonstrating ability to re-program cancer cells without destroying normal cells. Due to their low-toxicity and anti-cancer activity antineoplastons represent a revolutionary avenue in cancer research.
Tumor-treating Fields therapy
TTF therapy is a locally or regionally delivered treatment that uses electric fields within the human body that disrupt the rapid cell division exhibited by cancer cells. TTF therapy was developed to provide physicians and patients with a fourth treatment option for cancer in addition to surgery, radiation therapy and chemotherapy.
See Tumor-treating Fields page
Strict dietary and detoxification regimens promoted to prevent and treat cancer and degenerative diseases.
This study includes the following:
*Most cancer, including brain cancer, is primarily a disease of energy metabolism.
*Current standards of care for brain cancer management can provoke brain cancer growth and recurrence.
*Brain tumors use glucose and glutamine as major metabolic fuels, but do not use ketone bodies.
*Non-toxic calorie restricted ketogenic diets target glucose and glutamine and are anti-angiogenic, anti-invasive, and pro-apoptotic.
*Brain cancer can be managed based on principles of evolutionary biology, metabolic control analysis, and the Warburg theory of cancer.
It is our opinion that the brain of patients with malignant gliomas should rarely be irradiated and that radiation therapy for brain cancer management is largely counterproductive to long-term patient survival. This opinion does not mean that radiation therapy has no redeeming value for patients suffering malignant brain cancer. Of course radiation therapy can increase patient survival over the “no therapy” option. Radiation therapy can also be as good or better than chemotherapy alone. Our point is whether radiation therapy would be better than non-toxic metabolic therapy for long-term brain cancer management. The issue could be settled with clinical trials where patients receive metabolic therapy in the absence of radiation therapy.
Conventional chemotherapy has faired little better than radiation therapy for the long-term management of malignant brain cancer. Brain tumor chemotherapy is often associated with adverse effects that diminish the length or quality of life. Like radiation therapy, the widely used drug temozolomide can also enhance necrotic damage in brain tissue. This will contribute to the availability of glutamate and glutamine needed for tumor progression.
We contend that all cancer regardless of tissue or cellular origin is a disease of abnormal energy metabolism. As such, the non-toxic targeting of tumor cell energy metabolism becomes an attractive alternative to the current standard of care for brain cancer management.
This study says:
Metabolic therapy, as an alternative to the standard of care, has the potential to improve outcome for patients with GBM and other malignant brain cancers.
Ketogenic Diet (KD) with Hyperbaric Oxygen Therapy (HBO2T)
A diet high in fat and low in carbohydrates (sugars) that causes the body to break down fat into molecules called ketones. Ketones circulate in the blood and become the main source of energy for many cells in the body. A ketogenic diet is used to treat some types of epilepsy and is being studied in the treatment of some types of cancer – National Cancer Institute
In medicine, breathing hyperbaric oxygen increases the amount of oxygen in the body. It is being studied in the treatment of some types of cancer. Hyperbaric oxygen may increase the amount of oxygen in cancer cells, which may make them easier to kill with radiation therapy and chemotherapy – National Cancer Institute
See Ketogenic Diet page
This study concluded:
Nebeling et al. demonstrated that the KD significantly decreased glucose uptake in pediatric brain tumor patients…Our study strongly suggests that combining a KD with HBO2T may be an effective non-toxic therapy for the treatment of metastatic cancer. The efficacy of combining these non-toxic treatments should be further studied to determine their potential for clinical use. Based on the reported evidence, it is highly likely that these therapies would not only contribute to cancer treatment on their own, but might also enhance the efficacy of current standard of care and improve the outcome of patients with metastatic disease.
This study says: We conclude that the administration of HBO can provide many clinical benefits in the treatment of tumours, including management of highly malignant gliomas.
3. Off-label drugs
When a doctor prescribes a drug to treat one condition with a drug that is approved to treat a different condition, it is said to be off-label use. It is a common practice.
Care Oncology Clinics
The Care Oncology Clinic is a London based cancer clinic offering metabolic and immune stimulating medical treatment using existing licensed safe medicines that aim to fight patients’ disease while preserving an acceptable quality of life.
The following statement appears on the Care Oncology website.
NEW GLIOBLASTOMA TREATMENT DOUBLES SURVIVABILITY
Care Oncology announces its first publication in a peer-reviewed journal
Care Oncology is pleased to announce the publication of its preliminary results in treating patients suffering from glioblastoma. Using a combination of off-patent medicines which collectively target cancer metabolism, the Care Oncology protocol is used as an adjunctive treatment alongside patients’ standard of care (SoC) cancer therapies, working in conjunction with the NHS (or other primary treatment providers). The treatment was administered by experienced doctors with specific training in the use of these medicines in an oncology setting concurrent with the SoC that patients were receiving at any point in time.
The data was analysed by an independent auditing company (Cytel Inc.). Survival outcomes from a group of 95 patients were compared to results from Public Health England database, and a highly significant survival benefit was demonstrated. Furthermore, Care Oncology’s approach of using old drugs which are known to be safe was validated, as side-effects were generally manageable.
Falcarinol and falcarindiol
Antifungal compounds in carrots and other Apiaceae plant species.
The authors of this study say they provide several pieces of evidence suggesting that falcarindiol has the anticancer role by targeting glioblastoma cells, as well as glioblastoma stem-like cells.
An anti-diabetes drug.
For Glioblastoma patients, this study found that a combination of high-dose Metformin and Temozolomide showed the highest cancer cell death activity.
Clomipramine is a drug used for depression, called a tricyclic anti depressant. Some researchers think it might help to treat glioma brain tumours. There has been some lab based research that showed the drug could encourage death of cancer cells, but not healthy brain cells. Clomipramine page
Artesunate (AS) is a medication used to treat malaria.
This study says Artesunate has demonstrated empirical cytotoxicity against a variety of cancer cells including glioma.
Mebendazole is used to treat infections caused by worms. It works by keeping the worm from absorbing sugar (glucose), so that the worm loses energy and dies. – Mayo Clinic
This study concluded:
In summary, MBZ offers a highly promising opportunity for clinical application on GBM. This is because it has a long track record of safety, there is evidence of preclinical efficacy, an anti-cancer mechanism has been revealed, cost is relatively low, the drug widely available as a generic drug, there is good CNS penetration, and there is a great need for better GBM therapy.
This study concluded:
our results strongly support the clinical use of mebendazole as a replacement for vincristine for the treatment of brain tumors.
Chloroquine, a drug currently used to treat malaria.
Chloroquine (CQ) may be useful in treating patients with metastatic cancers according to a new study by University of Kentucky Markey Cancer Center.
This study reports:
In May 1998, one of the first clinical trials on CQ use in cancer was started, which was an open, prospective, randomised controlled study with 18 glioblastoma multiforme (GBM) patients. The test group consisted of nine patients who received 150 mg CQ daily after resection of the lesion, in addition to radiotherapy… and four cycles of carmustine-chemotherapy every six weeks (200 mg/m2), while the nine patients in the control group received placebo instead of CQ. In the abstract of this study, the authors reported that adjuvant CQ administration significantly enhanced patient survival [33 ± 5 months for CQ-treated patients and 11 ± 2 months for controls.
Malaria drug successfully treats 26-year-old brain cancer patient
Source: United Press International
Doctors at the University of Colorado Anschutz Medical Campus in Aurora, Colo., have been successful in treating a 26-year-old brain cancer patient who had become resistant to chemotherapy and other treatments with the malaria drug chloroquine.
The patient, Lisa Rosendahl, was diagnosed at the age of 21 with an aggressive form of glioblastoma and her cancer had become resistant to chemotherapy and targeted treatments. Doctors had given her just a few months to live. Read the full story
4. GP administered treatments
Vitamin C and Doxycycline
Doxycycline is an antibiotic
This study found that antibiotics, such as Doxycycline, could eradicate Cancer Stem Cells in multiple cancer types. These include: DCIS, breast (ER(+) and ER(-)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma. The study authors propose the combined use of Doxycycline and Vitamin C as a new strategy for eradicating CSCs.
5. Over the counter supplements
Chinese Skullcap (Scutellaria baicalensis)
An herb commonly used in traditional Chinese medicine. A member of the mint family. Available as a supplement.
This study showed results that support the efficacy of Chinese Skullcap as an anticancer agent for glioblastomas multiforme.
Also known as Indian frankincense, is an herbal extract taken from the Boswellia serrata tree. Available as a supplement
The resin from Boswellia serrata has an important role in treating brain cancer. ..Boswellia may be doubly useful for primary brain tumors. Studies tell us that in addition to helping reduce cerebral swelling around the tumor, boswellia also kills glioblastoma cells.
See Boswellia serrata page
Artemisinin is a compound extracted from the sweet wormwood herb. Well established for the treatment of malaria.
Available as a supplement
This study looked at the treatment of glioblastoma (GBM) using herbal medicine (Phytotherapy [PT] ) including Artemisinin. It found:
The results presented in this paper suggest the possibility of introducing PT as a completely new and harmless method of treating GBM. It is quite safe to conclude that the introduction of PT as a supplementary treatment in patients undergoing oncological treatment or as monotherapy in those cases where the treatment had been completed contributes to the quality of treatment and prolongs the survival of patients. The results achieved in patients in which tumor regression occurred exclusively due to the use of herbal medicines particularly point to such a conclusion.
This study concluded:
In the present study, we investigated effects of artemisinin on cell proliferation and apoptosis-related protein expression in vivo and in vitro. The results suggested that artemisinin inhibited the proliferation in C6 cells and induced cell cycle arrest and a caspase-3-dependent cell apoptosis. It also inhibited the growth of C6 brain-glioma in vivo and enhanced living state of rat brain-glioma model. Our results indicate that artemisinin may serve as a potential clinical anti-cancer drug in future.
Apigenin is found in Dried parsley, dried flower of chamomile, celery seeds, vine spinach and Chinese celery. Available in supplement form.
Apigenin and quercetin, can reduce the self-renewal capacity of Glioblastoma stem-like cells. These findings underscore the therapeutic potential of the flavonoids to suppress Glioblastoma metastasis by regulating the migration and invasion of Glioblastoma Stem Cells, according to this study.
An endogenous non-proteinogenic amino acid.
Available as a supplement
This study of 322 patients aged 23-73 years with suspected malignant glioma says: Tumour fluorescence derived from 5-aminolevulinic acid enables more complete resections of contrast-enhancing tumour, leading to improved progression-free survival in patients with malignant glioma.
A common amino acid may help restore function to cancer-fighting T-cells in persons with glioblastoma, say researchers.
See Arginine page
An alkaloid extracted from a variety of herbs.
Available as a supplement.
This study found:
In summary, our work shows that BBR targets GBM cells both in vitro and in vivo, and support further assessment of using BBR in the adjuvant clinical setting for GBM.
This study concluded:
Among mebendazole polymorphs, C reaches therapeutically effective concentrations in the brain tissue and tumor with fewer side effects, and is the better choice for brain cancer therapy. Its efficacy can be further enhanced by combination with elacridar.
[Elacridar is an oral bioenhancer that targets multiple drug resistance in tumors – drugbank.ca]
St Johns Wort ( Hypericum perforatum )
An herbal extract prepared from the plant Hypericum perforatum (St. John’s wort) with photodynamic, antineoplastic, and antidepressant activities.
This study in 42 patients (7 with anaplastic astrocytomas and 35 with glioblastomas) who had a diagnosis of recurrent malignant glioma, concluded: the results from this phase 1/2 trial of orally administered, synthetic hypericin in patients with recurrent malignant gliomas indicate that it is well tolerated and exhibits modest efficacy in this patient group.
See St Johns Wort page
Niacin is a B vitamin that’s made and used by your body to turn food into energy. Available as a supplement.
This study says:
In conclusion, we propose the immune-stimulatory activity of niacin, a common vitamin that could be rapidly translated into clinical use, as an adjunctive treatment for patients with GBM.
6. Other treatments
Check for parasites
A study by Dr. Alan Macdonald demonstrated Borrelia burgdorferi (the Lyme Disease parasite) DNA was found in mutliple slides derived from brain biopsy in five of five Glioblastoma Multiforme patients studied. See his website for more.
is a drug used to treat parasitic infections in humans.
This study says: In summary, MBZ offers a highly promising opportunity for clinical application on GBM. This is because it has a long track record of safety, there is evidence of preclinical efficacy, an anti-cancer mechanism has been revealed, cost is relatively low, the drug widely available as a generic drug, there is good CNS penetration, and there is a great need for better GBM therapy.
Gene Therapy Shows Early Efficacy Against Recurrent Brain Cancer
Source: American Association for Cancer Research
More than a quarter of patients with recurrent high-grade glioma, a form of brain cancer, treated with the retroviral vector Toca 511 and the prodrug of the chemotherapy 5-fluorouracil, Toca FC, were alive more than three years after treatment, according to data from a subset of patients in a phase I clinical trial presented at the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics, held Oct. 26-30.
“Given the deadly nature of this disease, three-year survival is rarely reported in the recurrent setting. It is notable that the survival benefit was seen across a range of patients and not just limited to patients with specific genetic mutations,” said Clark Chen, MD, PhD, Lyle French Chair in Neurosurgery and Head of the University of Minnesota Medical School Department of Neurosurgery in Minneapolis. “This finding indicates that many patients could benefit from this treatment.”
The treatment for the 56 patients with recurrent high-grade glioma in this clinical trial involved two steps. First, patients were injected with Toca 511, which is a replicating virus that selectively infects actively dividing tumor cells. Once inside the cancer cell, the virus delivers a gene for an enzyme, cytosine deaminase (CD). As the virus replicates and spreads to other cancer cells, it programs them to make CD. Next, patients received a tablet, Toca FC, which is an inert compound. Once inside the cancer cell, CD converts Toca FC into the anticancer drug 5-fluorouracil, which kills the cancer cell.
In addition to destroying cancer cells, 5-fluorouracil kills certain immune suppressive myeloid cells, thus boosting the patient’s immune system to recognize and attack the cancer cells.
Exposure to Xenoestrogens
Xenoestrogens are “foreign” estrogens, substances that are close enough in molecular structure to estrogen that they can bind to estrogen receptor sites with potentially hazardous outcomes.
This study found a significant correlation between exposure to xenoestrogens and increased, gender-related, cancer risk…Brain tumours are characterized by disturbances in oestrogen receptors.
This study identified chemicals suspected of mimicing oestrogen, including those found in
*hygiene products [Bisphenol-A]
*food containers [Bisphenol-A]
Other sources include:
- Pesticides, herbicides and fertilizers
- Commercially-raised meat and dairy products
- Processed foods
- Car pollution,
- Some deodorants, antipersperants (Aluminium)
- Shampoos and skin creams – (parabens)
- Most sun tan creams
- Tampons and pads
- Birth control pills
- Polychlorinated biphenyls PCB’s,
- Fuels and car fumes
- Polycarbonate plastic bottles including some babies bottles,
- Plastic food containers and film
7. Survivor Stories
See Introduction here
This film charts the remarkable story of Ben Williams, professor emeritus of experimental psychology at University of California, San Diego. Diagnosed in 1995 with the most lethal cancer known to medicine, a primary brain tumour called glioblastoma multiforme, he was given just a few months to live. But a natural born maverick, and rigorous scientist, Ben decided he woud not go down without a fight. Nineteen years later his story is an inspiration to patients the world over, whilst his case is dismissed by the medical community as just one of a handful of statistical outliers...more at SurvivingTerminalCancer.com
The Professor who cured his own ´terminal´ brain cancer with a cocktail of non-cancer drugs and supplements
Professor Ben Williams beat GBM, brain cancer using orthodox therapies supported by his own concoction of compounds he added based on his own extensive research.
20 years after his diagnosis, and having celebrated his 70th birthday, he tells how he used cheap, common medicines to build his complementary and integrative programme. And he defied all the odds.
31st March 1995 and Ben Williams, a psychology professor from University of California, San Diego, is undergoing emergency surgery, diagnosed with a terminal glioblastoma, a grade 4 brain tumour. The entire right side of his brain was ‘infested’ with cancer, according to his narrative.
He was told he’d be dead inside a year.
But in 2015 he visited London, and has been clear of cancer since 1998.
At the time of his diagnosis, Ben was 50.
Even today with new treatments, the average survival time is just 15 months. Only 8 per cent of older people last 5 years.
Ben had the surgery. There was still 2 cms of tumour invasion. He considered many options spending hours in the University library, on the Internet and talking with medical friends.
He opted to have BCNU – carmustine – but alternated it with PCV, a three drug combination that has been shown to have positive effects in 75% of people, and negative side-effects in 91%.
But his research had shown him other options. He was interested by how, given one attacking drug, the cancer would mutate and become resistant, so he decided to use several simultaneously. But not the drugs you might expect!
Ben built his own Complementary and Integrative treatment package. He added Tamoxifen (the anti-oestrogenic breast cancer drug – many brain tumours are held in the stem cell state by oestrogen) and verapramil, a calcium channel blocker used for blood pressure treatment, which research showed would enhance chemotherapy action. He also added accutane, a retinoid – of vitamin A origin – used to treat acne but with anti-cancer properties – and melatonin – the insomnia drug, but known to have antioxidant, anti-growth hormone and anti-oestrogenic properties. Finally he used cimetidine (tagamet) which is an antacid. An antihistamine, it is known to stop cancer cells sticking together and forming new tumours.
Throughout his treatment he added supplements like the anti-oestrogenic genestein, PSK (a mushroom extract with strong anti-cancer benefits), flax seed oil (for the fatty acids, helpful to brain tissue, borage seed oil (for gamma-linoleic acid) selenium, milk thistle and green tea extract. He also consumed large quantities of broccoli sprouts, garlic, raspberries and blueberries, onions and soy products. He has been clear according to MRI scans for 20 years now.
Update 2/9/18 (Ben Williams)
Source: Virtual Trials
Although I have never had any kind of recurrence since my treatment 22 years ago, I have had side effects of my treatment, specifically the radiation, that have been problematic. The blood vessels in the radiated areas of my head and brain have been damaged to the extent that skin grafts don’t take due to the poor blood supply, and my left hand has periodic episodes of paralysis and numbness. These problems have been stable for a couple of years, but the future deterioration due to the radiation damage is impossible to predict. Otherwise, I live a normal life, albeit with many of the maladies of an aging body.
More information here
Book: Surviving Terminal Cancer: Clinical Trials, Drug Cocktails, and Other Treatments Your Oncologist Won’t Tell You About 1st Edition, Kindle Edition
Hannah Bradley was successfully treated for Brain tumor by Dr Burzynski
Page updated 2023