{
    "title": "Euphorbia peplus -- Milkwood vs cancer",
    "inventor_name": null,
    "publication_year": 2011,
    "device_name": null,
    "goal": "Treat non-melanoma skin cancers using a topical plant-derived preparation.",
    "problem_addressed": "Superficial skin cancer lesions (basal cell, squamous cell, intraepidermal) that are unsuitable for surgery or have failed conventional therapy.",
    "concept_summary": "The milky sap of Euphorbia peplus contains the compound ingenol mebutate (ingenol angelate). When applied topically to skin cancer lesions, the compound induces rapid mitochondrial disruption and necrotic death of tumor cells while sparing healthy tissue, leading to lesion clearance.",
    "detailed_description": "A clinical study of 36 patients (48 lesions) applied a measured amount of E. peplus sap daily for three consecutive days using a cotton bud. Results showed a high rate of complete response after one month, with sustained clearance in many lesions after up to 15 months. The active ingredient, ingenol mebutate, is a potent cytotoxic agent that selectively destroys tumour cells via mitochondrial dysfunction. The treatment is topical, inexpensive to produce from the plant, but the sap is a severe irritant and can cause eye inflammation or severe skin pain if mishandled.",
    "category": "Medical & Dental Technologies",
    "principles": [
        "Topical delivery of a plant-derived cytotoxic compound",
        "Selective mitochondrial disruption leading to necrosis of cancer cells"
    ],
    "scientific_domains": [
        "Dermatology",
        "Pharmacology",
        "Oncology"
    ],
    "mechanisms_of_action": [
        "Mitochondrial disruption in tumour cells",
        "Primary necrosis of cancerous tissue"
    ],
    "materials": [
        "Euphorbia peplus milky sap",
        "Ingenol mebutate (ingenol angelate)"
    ],
    "energy_sources": [],
    "inputs": [
        "Skin cancer lesion",
        "Topical application of sap"
    ],
    "outputs": [
        "Tumour cell death",
        "Lesion clearance"
    ],
    "claimed_performance": "41 of 48 lesions cleared after one month; 75 % complete response for intraepidermal carcinomas, 57 % for basal cell carcinomas, 50 % for squamous cell carcinomas; two-thirds of lesions remained cleared after an average of 15 months.",
    "experimental_evidence": "A clinical study of 36 patients with 48 non-melanoma skin cancer lesions treated with E. peplus sap; results reported in the British Journal of Dermatology.",
    "replication_status": null,
    "keywords": [
        "Euphorbia peplus",
        "milkweed",
        "ingenol mebutate",
        "skin cancer",
        "topical therapy",
        "non-melanoma",
        "basal cell carcinoma"
    ],
    "related_technologies": [
        "Topical chemotherapeutic agents",
        "Photodynamic therapy"
    ],
    "controversy_level": "medium",
    "confidence_score": 0.9,
    "practicability_score": 0.6,
    "fringe_score": 0.2,
    "evidence_strength": 0.5,
    "risk_score": 0.4,
    "trl_estimate": 5,
    "source_urls": [
        "http://www.dailymail.co.uk/health/article-1350454/Milkweed-miracle-Applying-sap-common-garden-weed-cure-skin-cancer.html",
        "http://www.gardenorganic.org.uk",
        "http://www.wikipedia.org",
        "http://plantmed.blogspot.com/2004_02_01_archive.html",
        "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12472348&dopt=Abstract",
        "http://patents.google.com/patent/US20090292017"
    ],
    "organizations": [
        "Australian medical institutions",
        "British Association of Dermatologists"
    ],
    "applications": [
        "Topical treatment for non-melanoma skin cancer"
    ],
    "limitations": [
        "Small clinical sample size",
        "Variability of sap concentration between plants",
        "Potential severe irritation to eyes and skin"
    ],
    "open_questions": [
        "Long-term efficacy and recurrence rates",
        "Standardization of active ingredient concentration",
        "Comparison of safety and efficacy to existing treatments"
    ],
    "red_flags": [
        "Sap is a severe irritant; risk of eye injury",
        "Potential for unregulated home use"
    ],
    "evidence_quotes": [
        "After only one month 41 of the 48 cancers had completely gone.",
        "Two thirds of the 48 skin cancer lesions were still showing a complete response after an average of 15 months.",
        "Ingenol mebutate ... has been shown to destroy tumour cells.",
        "Side-effects were low, with 43 per cent of patients in no pain ... only one patient encountered severe short-term pain.",
        "The concentration of the active ingredients in the sap also varies between different plants, with high doses able to cause very severe and excessive inflammatory responses."
    ]
}