The sad saga of Fabio Lanzoni’s sister Christina’s battle with ovarian cancer, partially revealed

Let me begin this post by offering my sincere condolences to Fabio Lanzoni. His sister died about a month ago. As you might recall, she had ovarian cancer She was unfortunate, and she suffered and ultimately, apparently, died of her disease at far too young an age. If that were all there were to the story, that would be all there is to this post. Unfortunately, that is not all there is to the story; so that can’t be all there is to this post. You might recall that Fabio brought his sister Christina to be treated by Stanislaw Burzynski and, in doing so, allowed himself to be sucked into promoting the most recent propaganda film about Burzynski by Burzynski’s very own propagandist, Eric Merola. He appeared at a screening of the film in April, where he used the story of his sister to provide a testimonial of how awesome Burzynski is, how Burzynski is supposedly curing cancers that conventional medicine can’t, how he fully expected that Burzynski was the one man who might be able to save his sister.

I actually knew that Fabio’s sister had died not too long after it had happened, but I didn’t have any hard evidence, just anonymous reports. So I didn’t say anything, not being able to verify that it was in fact true that his sister Christina had died. Now I can, as Fabio has written a tribute to his sister and posted it on the website of his fan club entitled In tribute to my sister, Christina Lanzoni. It’s a simultaneously moving and disturbing tribute. It’s moving because, as I pointed out in previous posts, it’s very clear that Fabio loved his sister deeply. It’s disturbing because he still seems to be laboring under the delusion that Burzynski could have saved his sister. It’s written in a rather strange fashion as well, starting with describing the sense of loss and grief his family if enduring and thanking all the well-wishers who had sent their condolences. He then expresses his thanks to “doctors, nurses and staff at University General Hospital and at the Burzynski Clinic for their tireless efforts in prolonging my sister’s life and easing her pain.” This struck me as odd. I had never heard of University General Hospital before, and I found it odd that it was mentioned in the same breath, so to speak, as the Burzynski Clinic. So I did a bit of Googling.

University General Hospital (UGH) is a publicly owned 72 bed general acute care hospital in Houston. Its website, which is rather bare-bones, describes it as having been “designed from the ground up to suit the most exacting requirements of superb, state-of-the-art medical treatment while pampering patients and families with an inviting environment that encourages relaxation and healing” and advertises concierge services for visitors, luxurious private rooms with “five star” decor, flat panel televisions with 45 channels, wifi, free valet parking, and world-renowned physicians using the “most advanced technology available.” It also claims “patient care dedicated to excellence.”

All of this sounds well and good, but I took a look at its oncology doctors. Among them are Stanislaw Burzynski, Alejandro Marquis, Jose Valladeres, and Zanhua Yi, all of whom are doctors at the Burzynski Clinic. This struck me as very strange indeed. For one thing, none of these doctors, save Drs. Yi and Valladares, are board-certified or board-eligible in hematology and oncology. Indeed, Burzynski and Marquis aren’t even board-certified or board-eligible in internal medicine! It’s very strange that UGH would grant these two privileges in even internal medicine, much less hematology and oncology, but grant them it did. It’s also very strange just how bare bones the UGH profiles are on these doctors and pretty much every other doctor. In fact, I have yet to find a doctor profile at this hospital that is anything more than a name and medical school. Similarly, its Facebook page is minimally active.

More interestingly (and appropriately when it comes to Burzynski), UGH has been sued for fraud by joint-venture partners in an Alvin, Texas regional hospital project, and has been criticized for high Medicare expenses, while there have been complaints by patients about the facilities. These days, the hospital system seems to be doing quite well financially at least, although it had to pay down a $2 million lien placed on it by the IRS in 2009 for unemployment and quarterly withholding taxes and is apparently facing multiple other lawsuits, including a $1.4 million lawsuit by Kingswood Emergency Center, LLC for unpaid management and guaranteed fees, among several others.

Business concerns aside, I’d be very concerned about a hospital that would grant admitting privileges to doctors like Burzynski and Marquis, neither of whom could even be credentialed for managed care plans because they are not board-certified or board-eligible. From my reading, I gather that UGH started out as a bariatric surgery center and only more recently has evolved into a multispecialty general acute care hospital. It’s also obvious that it’s trying to appeal to the high end, at least as far as facilities go, in that it’s advertising all sorts of luxury accommodations, seemingly far more than its medical services. When a hospital system can’t even be bothered to put pictures and brief bios of your physicians, to me that’s an indication that it just doesn’t really care about its doctors and that medical care is not necessarily at the top of its list of concerns.

Be that as it may, unfortunately Fabio’s sister spent a lot of time at UGH in her last days. I say “unfortunately,” because it sucks for her that Fabio’s sister would spend so many weeks in the hospital at the end of her life so far from home instead of spending that time back at home in Italy with her family. In any case, the rest of the tribute to his sister reads as though it were fed to him by Burzynski and Merola themselves; it just doesn’t sound like the writings of a man whose only desire was to memorialize his recently departed sister. It’s a bunch of bullet points:

• When I went to visit my sister in Italy in March, she ways literally days away from dying from dehydration. Her Italian doctors recommended giving her a multivitamin and said she had only 2 weeks to live;
• I flew her out to my home in Los Angeles and made immediate arrangements for her to check in to the Burzynski Clinic in Houston;
• She arrived at the clinic in a wheelchair. Right away the clinic addressed her infection that was causing discomfort and pain, her dehydration and severe electrolyte abnormalities, and began the diagnostic process. She had her tissue analyzed. She harbored a unique gene signature. They tailored her medicines appropriately. Within 3 weeks, she went from wheelchair bound to exercising on a treadmill. Within approximately 6 weeks of treatment, an important biomarker of her disease called CA125 went from the 6000 range to the 3000 range. This signified improvement.

These first three bullet points give us more detail about Christina’s situation at the time Fabio first saw her after her treatment for ovarian cancer. First of all, if she really was that dehydrated, then simply treating her dehydration, even if whatever Burzynski did had zero effect on her cancer, would be guaranteed to rapidly make Christina look and feel much better. Now one thing that has to be remembered is that, as far as we can tell, Christina did not undergo treatment with antineoplastons, as she appears to have arrived in the US after the FDA had extended its partial clinical hold on pediatric antineoplaston clinical trials to adult clinical trials as well, as that happened in January or early February, and Fabio started appeared at the screening of Eric Merola’s movie in late April.

So what is being described above appears to be Burzynski’s “personalized gene-targeted cancer therapy” (for dummies, as I call it, or “making it up as you go along”). The first thing I wondered about was the CA-125 levels, which were off the charts. In the case of an ovarian mass, a CA-125 level of around 65 is highly suspicious for ovarian cancer, and a normal CA-125 is usually under 35. A value of 6,000 suggests that poor Christina’s tumor burden was massive indeed. Also, there are different kinds of CA-125 tests, a first generation and a second generation test, and these can produce different results. We don’t know when the two tests being compared were taken? Was one done in Italy and the other done after Christina had received treatment? Another important issue is Christina’s reported dehydration. If she were as severely dehydrated as reported, it’s possible that her CA125 level could be elevated. Finally, CA-125 tests is that they can fluctuate quite a bit over time; that’s why it’s the overall trend that matters. A single decreased level, although a hopeful sign, doesn’t necessarily tell a clinician much other than that things could be going in the right direction. Moreover, when the value we’re talking about is between 150- and 300-fold higher than normal, there’s a lot of tumor there.

Next up:

• After the CA125 drop there was a setback. Due to her compromised immune system from prior therapies (27 rounds of chemo), she developed a major blood infection that thankfully was caught, saving her life, but forced her off treatment and back to a hospital. In fact, her last round of chemo was for sarcoma and not for ovarian cancer (This is the beauty of socialized medicine);

I wrote about Fabio’s account of Christina’s prior therapies before and how the chemotherapy that was likely used can be used for both sarcoma and ovarian cancer. Fabio’s harping on this reeks of a line fed to him by Burzynski and bespeaks an ignorance of cancer therapy. Of course, no one expects Fabio—or any other non-professional—to be knowledgeable about cancer biology and therapy. What I hate is how Burzynski is using Fabio, feeding him a line of BS, all to convince him that, if it hadn’t been for a couple of bad breaks, he really could have saved Christina. Given her tumor burden, there was no way Burzynski could have saved her. Sadly, there was no way anyone could have saved her, but Burzynski played on Fabio’s false hopes and convinced him that he, alone of all cancer doctors, might be able to save his sister. In any case, notice how Burzynski blames the infection on a compromised immune system from previous treatment, even though he had been treating Christina for over six weeks. That’s more than long enough for the immune system to recover from most chemotherapy. If Christina was immunosuppressed, it was far more likely due to the advanced cancer itself, the witches’s brew of chemotherapy and expensive targeted agents that Christina received courtesy of Stanislaw Burzynski, or a combination of the two than it was likely to be due to the chemotherapy Christina received in Italy.

This leads us to the final four bullet points:

1. Even though there was success in treating the cancer as indicated by her CA125 drop as well as radiological scans, she still complained of pain in her abdomen. At that point she was seen by a surgeon who performed a laparoscopic procedure;
2. The procedure revealed that the treatment was working. Then she needed to be rehabilitated in order to prepare for another surgery to remove adhesions, scar tissue and fluid that had solidified;
3. During the second surgery, the surgeon found a lot of solidified fluid, and to his surprise noted that she had virtually no small intestine left due to a botched surgery that had been performed in Italy;
4. This explained her malnutrition. She could no longer properly absorb any food;
5. The final surgery she had, completely relieved her from any pain and allowed her to be taken off pain medication.

I would love to know what gynecologic oncologist or surgical oncologist operated on Christina not just once, but twice. More than likely, the pain in her abdomen was due to either tumor burden or a partial bowel obstruction due to the tumor. If indeed she was in such bad shape, I’d have to wonder why anyone would operate. What was the intended result?

Ovarian cancer is a nasty actor. In general, rather than metastasizing distantly (i.e., to the lung or outside of the pelvic and abdominal cavities), it tends to spread along the peritoneal surfaces throughout the abdomen. The treatment of ovarian cancer differs from that of most other solid tumors in that the goal is not to remove every last bit of visible tumor, as is the case for almost every solid tumor. Rather it is to debulk the tumor such that the smallest remaining visible nodules fall below a certain size and then to treat with chemotherapy to eliminate those nodules. No doubt that is what surgeons in Italy tried to do. Indeed, in my previous post, I discussed what Fabio said about his sister in April, noting that she had undergone surgery to remove her ovaries and uterus for her ovarian cancer but that she had developed a recurrence that had led to surgery that ended up requiring the resection of a “three foot piece of bowel.” Interestingly, back in April, Fabio matter-of-factly discussed this. Now he’s describing it as “botched surgery.” As a surgeon myself, I have no idea what the Italian surgeons found, but clearly they thought it necessary to resect a large chunk of bowel. Sometimes, as a surgeon, you have no choice, and sometimes you accept the risk of short gut syndrome because that much bowel has to be resected. I bet that’s what happened in Italy; Christina’s surgeons probably couldn’t adequately debulk her ovarian cancer without removing that much small bowel.

It’s also hard to reconcile Fabio’s description of his sister’s surgery as having involved removing three feet of small bowel with his later description of her having “virtually no small intestine left.” The reason is that removing three feet of bowel should not in most cases cause short gut syndrome. What the surgeon at UGH appears to have found is adhesions from previous surgeries plus the “solidified fluid,” which could very well have been mucin from mucinous ovarian cancer. All of this is a sign of advanced disease, but then we know that already.

Finally, Fabio directs a comment that I can only view as being directed at me:

As for the so called doctors on the internet who discredit her treatment program, it seems shameless and irresponsible for you to offer any opinion without having met her, let alone having examined her first. Your actions do nothing to save lives or advance medical science. They are no more than simple marketing gimmicks and promotional tools. And that is something I do know a thing or two about.

I can understand why Fabio might lash out. Seriously, I can. He’s grieving, and he thinks that bloggers like me are attacking the person who, were it not for an unfortunate turn of events, would have cured his sister. That he’s wrong about Burzysnki’s ability to save his sister (he couldn’t) doesn’t make the intensity of his belief or his grief any less. Sadly, it is just these sorts of emotions that allow Burzynski to do what he has been doing for 36 years.