Review question/objective: The objective of this review is to synthesise the best available evidence on effectiveness of fermented wheatgerm extract (Avemar) as an adjunct therapy to conventional cancer treatments such as surgery, chemotherapy, radiotherapy and hormone therapies, in the treatment of haematological and non-haematological cancers.
Background: Cancer is a public health issue with an incidence rate and prevalence that has wide societal implications and impacts. Data from The World Health Organisation (WHO) indicate that cancer is a leading cause of death and accounts for about 13% of all deaths. The WHO estimate that this number will more than double within the next 18 years, with diagnosis of cancer of the lung, liver, stomach, breast and colon all expected to rise in conjunction with growth of middle class societies, increasing affluence and changes in lifestyle that are associated with rising socioeconomic status.Large amounts of money are invested annually in cancer research and new diagnostic methods and treatments are rapidly evolving. Surgery, chemotherapy and radiotherapy remain the forefront interventions and are all linked to improved prognostic outcomes. The improvement in outcomes can however, be limited by the type cancer, its stage, the location of the cancer, the treatment implemented and timing and continuity of treatment. The treatments can also have a range of ramifications and debilitating side effects. These include: hair loss, depleted immune system, nausea, vomiting and fatigue. As a result, for some patients, treatment may raise as many concerns as the diagnosis. Rarely, until faced with a diagnosis of cancer, does a person recognise the seriousness of the disease or consider the impact and experience of treatment interventions. The high level of cancer awareness across society is a reflection of the significance of the associated burden of disease associated with cancer diagnosis, cancer care and the social impact on families when a diagnosis is made.The prevalence of cancer is such that it is common for individuals to have a friend or close relation who has suffered from, been treated for or has lost their life to cancer. When faced with mortality, many patients experience deep uncertainty and, despite the substantive improvements in survival time and improved prognosis associated with cancer diagnosis and treatment, many will seek additional therapies to support their treatment journey. Common alternate pathways for cancer patients include natural and traditional systems of medicine. These include: Nutrition, Herbal Medicine, Chinese Medicine, Acupuncture, Ayurveda and Homoeopathy. The journey of accesing such modalities is a personal one, rarely supported by conventional treatment regimes or health services. Whilst many of these adjunctive therapies have been used for hundreds, even thousands of years, most lack quality, researched evidence.Since the early 1990's, international attention has accelerated in the investigation and use of a fermented wheat germ extract (FWGE) called Avemar. It was noted by Dr Abert Szent-Gyorgyi that the fermented wheat germ product had positive effects in preventing cancer cells from growing. It took another five decades for the properties of the nutritional preparation to be further investigated and implemented as a therapy for cancer sufferers. Avemar is the only patented fermented wheatgerm extract, made from a common, sustainable, biological food source and the availability of the patented extract is increasing. The fermented wheat germ extract has also been referred to as MSC by some scientists. Research programs related to Avemar have focused on aspects of safety and cellular mechanism of action. To date, research and testing with Avemar has been predominantly conducted with animals or in the laboratory on human cell lines. Some highlighted properties of Avemar that have been identified in this research is that it: 1) promotes apoptosis of cancer cells whilst leaving normal cells unharmed, 2) starves the sugar supply required by cancer cells to survive, 3) unmasks cancer cells so they can be more readily targeted by the immune system and 4) it prevents abnormal cells from repairing themselves.Encouraging results in the laboratory cell and animal testing have led to human trials. Initial searching across published literature reveal human trials have been conducted on a relatively limited scale and address some of the more common cancer expressions. These studies suggest there may be a role for Avemar in decreasing in the progression of the disease, potentiating conventional treatments such as chemotherapy and radiotherapy, improving quality of life for sufferers and potentially ameliorating or lessening side effects of conventional treatment. While the early evidence, particularly at the cellular level are promising, and of interest, the broader questions regarding Avemar as an adjunctive therapy in cancer treatment, and its clinical effectiveness have not been established to date.