COC Protocol for Early Stage and Stable Disease

Historically, patients have often presented to Care Oncology physicians with advanced disease– either they have been diagnosed with a type of cancer associated with a particularly poor prognosis or they have suffered a recurrence/disease progression and feel their conventional treatment options are becoming more limited. 

However, there are good reasons to also consider the adjunctive COC Protocol if you are a patient with either an early stage cancer diagnosis or someone who is currently well with more advanced stage 3 or 4 disease. Indeed, the likelihood of a positive outcome is greater than with late-stage presentation.

First, a significant body of research literature suggests that using anti-metabolic drugs such as metformin and statins as adjunctive therapy to standard of care can enhance overall treatment response.

Second, in a scenario where the patient is well in him/herself and/or has a lighter burden of disease, there may be an even greater likelihood of effective disease control.

Our own cohort analysis of 95 patients with Glioblastoma IV (the most common and aggressive type of primary brain tumour in adults) supports this conclusion. These patients were all prescribed the COC protocol alongside their standard of care treatment. Median overall survival of the cohort as whole is considerably better than median overall survival with standard of care alone (  But, those patients who commenced the COC protocol during or soon after first line chemo-radiotherapy have a longer median overall survival than those coming to it after having suffered progression/recurrence. 

Importantly, in‘’well patients” with a good performance status, we would also expect to see better compliance with the COC protocol medicines and fewer side-effects and/or a requirement to interrupt or stop treatment as a result of abnormal blood counts or organ function. 

In addition to the work we are undertaking, a number of other studies are currently underway to explore reduced relapse in patients taking anti-metabolic medications, for example, the very large Cancer Research UK funded ADD-Aspirin trial enrolling 11,000 patients across 5 different types of cancer.

When a patient hears that they are well and perhaps ‘in remission’, they often assume that this means they are cured and are done with treatment. While the words‘remission’ and ‘no evidence of disease’ (NED) are clearly good news and can mark a major positive turning point in someone’s care and overall health,unfortunately, the true situation is often more complicated.

There is no way for doctors to know that all of the cancer cells in your body are gone, which is why many doctors don’t use the word “cured.” If cancer cells do come back, it usually happens within the 5 years following the first diagnosis and treatment. 5 year survival rates or survival statistics are available for all the different types of cancer seen in the community. These statistics are based on research from information gathered on hundreds or thousands of people with a specific cancer.

An overall survival rate includes people of all ages and health conditions who have been diagnosed with a specific cancer, including those diagnosed very early and those diagnosed very late.

Doctors are then often able to provide more detailed statistics based on the stage of cancer at diagnosis. For instance, 56% or a little more than half, of people diagnosed with early-stage lung cancer live for at least five years after diagnosis. The five-year survival rate for people diagnosed with late stage lung cancer that has spread (metastasised) to other areas of the body is 5%.

Because survival rates can’t tell you everything there is to know about your individual situation, the statistics may seem impersonal and unhelpful. But, many people feel that that knowing as much as possible about their cancer, actually helps them to reduce their anxiety, as they can then analyze the different options available to them.  

While, of course, it’s up to each individual patient to decide just how much they want to know about survival rates and overall prognosis, Care Oncology physicians believe the risk/benefit of metabolic adjunctive treatment to be in the patient’s favour if there is judged to be a significant risk of cancer progression or recurrence.

The COC protocol is:

  • Evidence-based; the weight of the available data demonstrates a significant opportunity for patient benefit. Some mechanisms which underpin the utility of the protocol drugs may be particularly helpful in a preventative setting e.g. inhibition of Cancer Stem Cells.
  • Low toxicity, generally well-tolerated and ‘easy to do’ (i.e. tablets, capsules to be taken at home).
  • An adjunctive therapy with a low drug interaction burden which can be incorporated alongside other lines of treatment
  • Almost always safe to combine with standard of care treatments (chemo-, radio-, hormone-, immuno-therapy)
  • Able to potentiate standard treatments by making cancer cells more sensitive to chemotherapy or radiotherapy than would otherwise be the case.

Click here for more information and research references

Click here to check your eligibility for the COC Protocol