Protocol for Lynch syndrome patient

[Anant Vinjamoori]

I have a patient who has Lynch syndrome (MSH2 mutation).

Wondering what people’s thoughts here are on the best protocol, and especially if they have experience working with these patients.

My thought given the defective DNA repair is to really work on oxidative stress (prevent damage), and facilitate open chromatin patterns (to promote maximal expression of functional repair machinery)
-Butyrate 4g/day
-Ketone ester (ketoneAid) 5-10ml twice daily
-NAC 1000mg daily
-On top of diet/exercise, etc

-No GHRHs/GHRPs given Ca risk- does anyone disagree here?

One open question is around rapamycin- this is typically part of my protocol for cancer prevention, but I could see this being counterproductive given the DNA repair problem; my thought is that any diminishment immune surveilance may be problematic

[Miguel Bertonatti]

We have a policy that pt’s cannot administer GH peptides unless they’ve had 2-5 years of cancer remission.

 

Using Thymosyn alpha 1 wouldn’t hurt the pt.

[Anant Vinjamoori]

Thank you! I’d love to get the perspective of the SSRP faculty (or Dr. Seeds himself) as I think this case could be a pretty good integration of a lot of the concepts we have talked. To provide a bit more detail, this patient is in his late 70s and actually has a variant of Lynch Syndrome known as Muir-Torre syndrome, and has a mutation in the MSH2 gene. He now has a recurrent sebaceous carcinoma (rare skin tumor associated with this syndrome).

The idea behind a protocol here would be to facilitate clearance of residual tumor after surgery, prevent recurrence, and also prevent development of other Lynch associated malignancies.

Help would be appreciated!

[Kristelle Reyes]

Hello @byurthgmail-com, @andkeller2gmail-com, @drhusaininterlinkedmd-com, and @madisonseeds-md, we would love to have your insights here. Thank you!

[deborah dunn]

Hi Anat,

In terms of the Rapa, I believe the low dose data is actually immunostimulatory.

Mannick JB, Del Giudice G, Lattanzi M, Valiante NM, Praestgaard J, Huang B, Lonetto MA, Maecker HT, Kovarik J, Carson S, Glass DJ, Klickstein LB. mTOR inhibition improves immune function in the elderly. Sci Transl Med. 2014 Dec 24;6(268):268ra179. doi: 10.1126/scitranslmed.3009892. PMID: 25540326.

Here is a skin paper:

Dao V, Liu Y, Pandeswara S, Svatek RS, Gelfond JA, Liu A, Hurez V, Curiel TJ. Immune-Stimulatory Effects of Rapamycin Are Mediated by Stimulation of Antitumor γδ T Cells. Cancer Res. 2016 Oct 15;76(20):5970-5982. doi: 10.1158/0008-5472.CAN-16-0091. Epub 2016 Aug 28. PMID: 27569211; PMCID: PMC5065775.

Best,

DD

 

 

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