Download Shark cartilage

Concerted Action for Complementary and Alternative Medicine Assessment in the Cancer Field (CAM-Cancer) www.cam-cancer.org
Project initiated under the European Commission 5th Framework Program "Quality of Life", now hosted by the National Information Center for
Complementary and Alternative Medicine in Tromsø, Norway.
Scientific Co-ordinator Barbara Wider [email protected].
Written by Edzard Ernst and the CAM-Cancer Consortium.
Updated April 29, 2016
Shark cartilage
Abstract and key points
Shark cartilage is a popular anti-cancer
remedy, which is obtained from the
cartilage of mainly two shark species.
Even though some basic research
suggests that shark cartilage has
anti-angiogenic and cytotoxic effects,
there is no evidence from five controlled
and eight uncontrolled studies to show
that it is helpful in the treatment of cancer.
Medication is made from the cartilage of two shark
species
There is no good evidence that shark cartilage or
ingredients of shark cartilage are of benefit for
cancer patients
No major safety concerns have been reported
Records of adverse effects exist for the oral supplementation of shark cartilage as well as the injection or
enema procedure but no serious events are on record.
What is shark cartilage?
Scientific name / brand name / common name
The commonly used name for the preparation is shark cartilage. Commercial products are sold as Cartilate,
Cartilade, BeneFin, AE-941, U-995, Neovastat, Better Shark MC and numerous other brand names.
Ingredients
Cartilage is part of the skeletal system composed of elastic, translucent tissue. Sharks’ skeletal structure is
not made of bones but of cartilage. Shark cartilage is obtained from the spiny dogfish shark Squalus
acanthias and the hammered shark Sphyrna lewini and is available in either capsule or powder form. Shark
cartilage products contain glycoproteins, such as phyrastitin 1 and 2.
Application and dosage
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
1/7
Administration is usually either orally in capsule form or rectally by enemas of shark cartilage mixed with
sterile water or by subcutaneous injection but is not normally applied intravenously. From clinical studies
we know that for refractory metastatic renal cell carcinoma, a specific water-soluble shark cartilage extract,
AE-941 (Neovastat), 60 to 240 mL per day has been used.1,2 For the treatment of solid tumors, 30 to 240
mL daily has been used.3 For cutaneous Kaposi’s Sarcoma, shark cartilage 3,750 to 4,500 mg per day has
been used.4 Commercial products typically suggest doses ranging from 500 mg to 4.5g, given in two to six
divided doses daily.5
History / providers
In 1963 it was discovered that tumour growth was partly dependant upon angiogenesis.6 William Lane
published a book in 1992 entitled Sharks Don’t Get Cancer.7 The claim is incorrect – sharks can get cancer
of their cartilage.8,9 Numerous manufacturers offer commercial preparations available as food supplements,
sold without restriction, through various outlets. In 1995, over 40 brands were on the market.
In 2000 Lane was prohibited by the Federal Trade Commission from claiming that “BeneFin or any other
shark cartilage product prevents, treats or cures cancer”, until he can provide substantial evidence to support
this claim. Since shark cartilage has been promoted as a cancer cure, there has been a measurable decline in
shark populations.
Claims of efficacy
It is claimed that a protein in shark cartilage can shrink tumour size, slow or stop the growth of cancerous
cells and help reverse bone disease such as osteoporosis.7,10 Providers claim that shark cartilage is effective
in cancer because of anti-angiogenic properties. Shark cartilage is also claimed to have antitumor,
antioxidant, anti-inflammatory and anti-atherogenic actions, although these putative actions are so far poorly
supported by credible clinical research.
Mechanisms of action / alleged indication
Angiogenesis enables new blood vessels and, consequently, tumours to grow. All cartilage, including
human, contains anti-angiogenic factors. When shark cartilage is taken orally, they are being digested rather
than absorbed into the bloodstream. Therefore no effects after oral administration should be expected.
Some basic research studies have suggested direct toxicity against tumour cells. The inhibition of tumour
angiogenesis has been relatively well documented in in-vitro studies One study, for instance, found that
tamoxifen has significant anti-angiogenic activity that can be potentiated by shark cartilage.32 Another
laboratory study suggested that the development of papillary and solid tumours in mice can be significantly
delayed.25
Shark cartilage contains inhibitors of tumour angiogenesis 11-13,34 and immune modulators 14 and may
have cytotoxic activity in vitro.35 The polypeptides identified included acidic and basic fibroblast growth
factor, angiogenin and transforming growth factors alpha and beta.15 Many of the formulations of
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
2/7
commercially available shark cartilage contain little or no anti-angiogenic activity. Furthermore, not all
cancers are affected by anti-angiogenic factors. Reliable dose-response data and bioavailability studies are
not available.
Prevalence of use
The popularity of shark cartilage seems to have peaked between 1990 and 2000 but more recent data suggest
it is still commonly used by cancer patients.16 Reliable prevalence data are not available. In a survey
including 100 patients with various types of cancer shark cartilage was among the most commonly used
therapies.17 In an earlier survey including 143 advanced cancer patients, 10.7% of respondents were
consuming preparations of shark cartilage.18 More recent survey data imply that 7% of lymphoma survivors
use shark cartilage preparations.36 An article in a non-peer-reviewed magazine reports that shark cartilage is
a $5 billion-a-year business, with pills and powders sold in health food shops to more than 25.000 people
every year.19
Legal issues
Shark cartilage products are marketed as dietary supplements and therefore are not submitted to medicines
regulation. Pre-market evaluation and approval by the US Food and Drug Administration (FDA) are not
required for dietary supplements. The FDA has not approved of the use of cartilage as a treatment for cancer
or any other medical condition. Providers of dietary supplements are not legally permitted to make any
claims on the packages of their products for preventing or curing any disease. In practice, such claims are,
however, often made via books, websites etc.
Costs and expenditures
A typical course of shark cartilage costs approximately 500 Euros.
Does it work?
Controlled trials
AE-941/Neovastat was administered in a randomised phase III trial of BeneFin including 331 patients with
advanced solid tumours (including lung, prostate, breast, and kidney tumours).3 They were randomly
assigned to receive either 30 to 240 mL/day cartilage or a placebo divided into three to four oral doses a day.
Survival was the principal endpoint measured in this trial, but quality of life was also assessed. The results
of these trials, however, have not been fully reported. A retrospective analysis involving a subgroup of
patients with advanced non-small cell lung cancer suggests that AE-941/Neovastat is able to lengthen the
survival of patients with this disease.
Two randomized phase III trials of AE-941/Neovastat in patients with advanced cancer have been approved
by the United States Food and Drug Administration (FDA). In one trial in patients with stage III non-small
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
3/7
cell lung cancer, treatment with oral AE-941/Neovastat plus chemotherapy and radiation therapy was
compared to treatment with placebo plus the same chemotherapy and radiation therapy. Overall survival was
not improved in patients taking the shark cartilage preparation 20 In the second trial, treatment with oral
AE-941/Neovastat was compared to treatment with placebo in patients with metastatic renal cell carcinoma.
21 Results from this second phase III trial have not been reported in the peer-reviewed literature.
Loprinzi published a double-blind, placebo-controlled randomised clinical trial of adjuvant therapy with
shark cartilage administered three to four times daily to 83 patients with incurable breast or colorectal
cancers.22 The primary endpoint, survival, showed no difference between the patients receiving shark
cartilage and those receiving placebo in addition to standard care. Similarly, quality of life showed no
inter-group differences.
Another randomised trial suggested an anti-angiogenic effects of shark cartilage in healthy volunteers.23
Uncontrolled trials
Several uncontrolled clinical studies have been published, which suggest anti-cancer effects of shark
cartilage.24-31 The results of these studies tend to imply that shark cartilage is effective in changing the
natural history of various types of cancer or positively influencing related variables. Yet, due to their
uncontrolled nature, these investigations cannot establish cause and effect.
Is shark cartilage safe?
Contraindications
Pregnancy, lactation.
Precautions/warnings
Liver diseases.
Adverse effects
Orally, shark cartilage can cause taste disturbances, nausea, vomiting, dyspepsia, constipation, hypotension,
dizziness, hyperglycemia, hypoglycemia, hypercalcemia, altered consciousness, decreased motor strength,
decreased sensation, erythema, peripheral edema, generalized weakness, fatigue, and decreased
performance.1,24,28,30 It might also cause signs of acute hepatitis, including low-grade fever, jaundice,
yellowing of eyes, right upper quadrant tenderness, and elevated liver enzymes.33-34
Interactions
Interactions with the following drugs are conceivable: diuretics, insulin, interferon, thalidomide.
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
4/7
Quality issues
Large variations exist in the purity and concentration of commercially available preparations.
Citation
Edzard Ernst, CAM-Cancer Consortium. Shark cartilage [online document].
http://www.cam-cancer.org/The-Summaries/Dietary-approaches/Shark-cartilage. April 29, 2016.
Document history
Assessed as up to date in April 2016 by Barbara Wider.
Most recent update and revision in April 2013 by Edzard Ernst.
Fully revised and updated in November 2011 by Edzard Ernst.
Fully revised and updated in April 2010 by Edzard Ernst.
Summary first published in September 2005, authored by Edzard Ernst.
References
1. Neovastat clinical trial abstracts. Presented at the American Association for Cancer Research 92nd
annual meeting. March 27, 2001.
2. Batist G, Patenaude F, Champagne P, et al. Neovastat (AE-941) in refractory renal cell carcinoma
patients: report of a phase II trial with two dose levels. Ann Oncol 2002;13:1259-63.
3. Sauder DN, Dekoven J, Champagne P, et al. Neovastat (AE-941), an inhibitor of angiogenesis:
Randomized phase I/II clinical trial results in patients with plaque psoriasis. J Am Acad Dermatol
2002;47:535-41.
4. Hillman JD, Peng AT, Gilliam AC, Remick SC. Treatment of Kaposi Sarcoma with oral
administration of shark cartilage in a Human Herpes virus 8-seropositive, Human Immunodeficiency
Virus-Seronegative homosexual man. Arch Dermatol 2001;137:1149-52.
5. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. 1st ed.
Springhouse, PA: Springhouse Corp., 1999.
6. Folkman J, Long DM, Becker FF. Growth and metastasis of tumour organ culture. Cancer
1963;16:453-67.
7. Lane IW. Comac L. Sharks don’t get cancer. How shark cartilage can save your life. New Your:
Avery, 1992.
8. Wellings SR. Neoplasia and primate vertebrate phylogeny: a review. Natl Cancer Inst Monograph
1969;31:59-128.
9. Prieur DJ, Fenstermaher JD, Guarino AM. A choroids plexus papilloma in Elasmobranchs. J Natl
Cancer Inst 1976;56:1207-9.
10. Cassileth BR Shark and bovine cartilage therapies. In: Cassileth BR, ed.: The Alternative Medicine
Handbook: The Complete Reference Guide to Alternative and Complementary Therapies. New York,
NY: WW Norton & Company, 1998, pp 197-200.
11. Prudden J. The clinical acceleration of healing with a cartilage preparation: a controlled study. JAMA
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
5/7
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
1965;192:252.
Prudden JF, Balassa LL The biological activity of bovine cartilage preparations. Clinical
demonstration of their potent anti-inflammatory capacity with supplementary notes on certain relevant
fundamental supportive studies. Semin Arthritis Rheum 1974;3: 287-321.
Lee A, Langer R Shark cartilage contains inhibitors of tumor angiogenesis. Science 1983;221:1185-7.
Bargahi A, Rabbani-Chadegani A, Bargahi A et al. Angiogenic inhibitor protein fractions derived
from shark cartilage. Biosci Rep 2008;28:15-21.
Folkman J, Klagsburn M. Angiogenic factors. Science 1987;235:442-7.
Hyodo I, Amano N, Eguchi K et al. Nationwide survey on complementary and alternative medicine in
cancer patients in Japan. J Clin Oncol 2005;23:2645-54.
Bernstein BJ, Grasso T. Prevalence of complementary and alternative medicine use in cancer patients.
Oncology 2001;15:1267-72, 1274-5.
Oneschuk D, Fennell L, Hanson J, Bruera E. The use of complementary medications by cancer
patients attending an outpatient pain and symptom clinic. Journal of Palliative Care 1998;14:21-6.
Dold C. Shark therapy. Discover 1996;4:51-7.
Lu C, Lee JJ, Komaki R, Herbst RS, Feng L, Evans WK et al. Chemoradiotherapy with or without
AE-941 in stage III non-small cell lung cancer: a randomized phase III trial. Journal of the National
Cancer Institute 2010; 102(12):859-865.
Batist G, Champagne P, Hariton C, et al. Dose-survival relationship in a phase II study of Neovastat
in refractory renal cell carcinoma patients. [Abstract] Proceedings of the American Society of Clinical
Oncology 2002;21:A-1907.
Loprinzi CL, Levitt R, Barton DL, Sloan JA, Atherton PJ, Smith DJ, Dakhil SR, Moore DF Jr, Krook
JE, Rowland KM Jr, Mazurczak MA, Berg AR, Kim GP; North Central Cancer Treatment Group.
Evaluation of shark cartilage in patients with advanced cancer – a north central cancer treatments
group trial . Cancer 2005;104:176-82.
Berbari P, Thibodeau A, Germanin L, Saint-Cyr M, Gaudreau P, Elkhouri S, Dupont E, Garrel DR,
Elkouri S. Antiangiogenic effects of the oral administration of liquid cartilage extracts in humans. J
Surg Res 1999;87:108-13.
Mathews J. Media feeds frenzy over shark cartilage as a cancer treatment. J Natl Cancer Inst
1993;85:1190-1191.
Barber R, Delahunt B, Grebe SKG, Davis PF, Thornton A, Slim GC. Oral shark cartilage does not
abolish carcinogenesis but delays tumor progression in a murine model. Anticancer Research
2001;21:1065-70.
Yagita A. Role of angiogenesis inhibitor in novel immunotherapy for cancer (NITC). BiotherapyJapan
2000;14:973-82.
Maruyama S, Yagita A, Sukegawa Y, Daido A, Takeuchi S. Effect of a new immunotherapy for
advanced colorectal cancer. BiotherapyJapan 2000;14:460-3.
Leitner SP, Rothkopf MM, Haverstick L, et al. Two phase II studies of oral dry shark cartilage powder
(SCP) with either metastatic breast or prostate cancer refractory to standard treatment. [Abstract]
Proceedings of the American Society of Clinical Oncology 1998;17:A-240.
Rosenbluth RJ, Jennis AA, Cantwell S, et al. Oral shark cartilage in the treatment of patients with
advanced primary brain tumors. [Abstract] Proceedings of the American Society of Clinical Oncology
1999;18:A-554.
30.
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
6/7
30. Champagne P, Aeterna Laboratories, Incorporated Phase II Study of AE-941 (Neovastat) in Patients
With Early Relapse or Refractory Multiple Myeloma, AETERNA-AE-MM-00-02, Clinical trial,
Closed.
31. Miller DR. Phase I/II trial of the safety and efficacy of shark cartilage in the treatment of advanced
cancer. J Clin Oncol 1998;16:3649-3655.
32. McGuire TR et al. Tamoxifen and shark cartilage: potential anti-angiogenic combination (Abstract
from American College of Clinical Pharmacy Annual Meeting St. Louis, 1994). Pharmacotherapy
1994;14:362.
33. Ashar B, Vargo E. Shark cartilage-induced hepatitis. Ann Intern Med 1996;125:780-781.
34. Simard B, Bouamrani A, Jourdes P, Pernod G, Dimitriadou V, Berger F et al. Induction of the
fibrinolytic system by cartilage extract mediates its antiangiogenic effect in mouse glioma.
Microvascular Research 2011; 82(1):6-17.
35. Bargahi A, Hassan ZM, Rabbani A, Langroudi L, Noori SH, Safari E et al. Effect of shark cartilage
derived protein on the NK cells activity. Immunopharmacology & Immunotoxicology 2011;
33(3):403-409.
36. Habermann TM, Thompson CA, LaPlant BR, Bauer BA, Janney CA, Clark MM et al.
Complementary and alternative medicine use among long-term lymphoma survivors: a pilot study.
American Journal of Hematology 2009; 84(12):795-798.
Legal notice
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge.
However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness,
accuracy, up-to-date status or completeness of the information it contains. This information is designed for health
professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the
CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.
Please visit the CAM-Cancer website for more information about the project:
www.cam-cancer.org
Published with Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
www.cam-cancer.org
7/7