PART 3. BURDEN OF CANCER AND BURDEN OF INFECTION

CHAPTER 3. The Karnofsky Scale

Tatyana

The story of the international Max-Well USA brand ended roughly where it began—with the investor’s sudden escape to London. 

At that point, without investors, but with a small and stubborn group of like-minded colleagues, I decided to create a center of our own, even if tiny. It would become a testing ground for the treatment methods for severe chronic diseases that we had developed while working with the first two centers. We weren’t trying to “replace” classical medicine—on the contrary, we aimed to complement it. Our primary focus was etiotropic therapy, targeting the underlying cause of disease rather than merely suppressing symptoms. This was especially true in oncology, where every incremental increase in treatment effectiveness could mean an added layer of hope.

But we had no investors, no budget, and no administrative backing. It was just us—me, Sergey, and a talented oncologist, Igor Ponomaryov. We began searching for any space suitable for a day-hospital format. Eventually we reached an agreement with the director of the Institute of Microbiology and Virology: he agreed to lease us the sixth floor of their building, a floor that had been vacant for years.

Finances were still nonexistent. So, Sergey—a man with golden hands and iron determination—volunteered to do everything himself. Over several weeks, he, his sister Alla, a young physician named Fatima, and our colleague Marina transformed the abandoned floor into a mini clinic with their bare hands. Two four-bed wards, a procedure room, a reception area, and office spaces—all built without major investment, essentially in full DIY mode.We named it Max-Well USA—equal parts irony and hope for an international future.

Looking back now, I realize how audacious the whole endeavor was. The idea that chronic infections might be the cause of many illnesses sounded almost heretical at the time. We tried to present it calmly, scientifically—but the beds often remained empty.

My son Alan, his future wife Marina, Sergey, and Alla stood in Kyiv’s metro stations, markets, and pharmacies handing out flyers—hoping someone, anyone, would listen. We didn’t exist because there was demand; we existed because we still had hope.

One day Sergey came to me with an expression that made it clear: nothing good had happened. A young woman had been brought in—just 23 years old, in critical condition. Her name was Tatyana. She had arrived with her father from Odesa—their last hope for saving her life.

The documents indicated that she had been diagnosed at the Kyiv Institute of Cancer: anaplastic astrocytoma, Grade III, inoperable. The tumor was deep within the subcortical brain structures. Surgical intervention was impossible—touch the area, and the consequences would be irreversible. Biopsy results showed rapid growth. The prognosis was bleak.

Tatyana and her father had gone to the Cancer Institute hoping for a miracle—surgery, chemotherapy, anything. But after reviewing the scans, the doctors refused to operate; the tumor was deemed too dangerous to approach. With no other options, they stumbled upon our modest clinic—perhaps they saw a flyer in their building or heard about us from someone. That’s how they ended up in our hands.

At that time, I was working closely with Igor—a thoughtful, meticulous oncologist. Together we reviewed the case. According to the Karnofsky Performance Status (KPS), which evaluates a patient’s functional ability, Tatyana did not reach even 30 points. This meant she had almost completely lost the ability to care for herself and was rapidly approaching a fatal threshold.

For context, the Karnofsky Scale ranges from 0 to 100:

• 100–80 — normal life, full activity

• 70–50 — increasing need for assistance

• 40–20 — severe disability, full-time care

• 10–0 — terminal state to death

Tatyana’s score spoke for itself. The Karnofsky Scale is widely used in oncology to determine whether aggressive treatment is still appropriate or whether it is time to transition to palliative care. And although her case seemed hopeless, there was still something—however fragile—to hold onto.

Tatyana’s Cancer

Brain tumors are classified by their origin, degree of malignancy, and growth pattern. There are primary tumors, such as gliomas and meningiomas, and secondary tumors—metastases from other organs such as the lungs, breast, colon, kidneys, or melanoma.

By malignancy, tumors are divided into four grades:

• Grade I — slow-growing and often curable (e.g., pilocytic astrocytoma).

• Grade II — relatively slow but prone to progression (e.g., diffuse astrocytoma).

• Grade III — malignant and aggressive (anaplastic astrocytoma).

• Grade IV — the most dangerous and rapidly progressing (glioblastoma).

Tatyana had a Grade III tumor — an anaplastic astrocytoma. After the Cancer Institute refused to treat her, it became clear that official medicine had no options left to offer. We understood that we were playing against the statistics—but we decided to try anyway.

At the time, scientific literature increasingly raised the question: could the development of brain tumors be linked to chronic infections? Viruses, bacteria, and even parasites were being discussed as potential co-participants in tumor biology through DNA damage, suppression of immune surveillance, and chronic inflammation.

Attention was focused on cytomegalovirus (CMV), a herpesvirus capable of persisting for life. CMV DNA and proteins had repeatedly been found in glioblastoma tissue.

It was suspected of:

• impairing DNA repair,

• stimulating tumor cell growth and blocking apoptosis,

• creating localized immune suppression around the tumor.

  
  

Similar roles were being discussed for other viruses: Epstein–Barr virus (EBV), human papillomavirus (HPV), HHV-6. These pathogens were known to interfere with cellular signaling pathways and promote the accumulation of mutations. Bacteria, including mycoplasma, and parasites such as Toxoplasma gondii were also mentioned as potential contributors to a pro-tumor microenvironment.

The basic hypothesis was simple and frighteningly logical:

1. Infection damages DNA.

2. Suppresses the immune system.

3. Creates an inflammatory microenvironment that supports tumor growth.

Igor proposed a standard course of chemotherapy with temozolomide (Temodal)—the most effective drug for glial tumors. We calculated the dosage and ordered the medication, but I couldn’t shake the feeling that something was missing.

I suggested adding antiviral therapy. The idea sounded risky—such combined approaches were not in use at the time, publications were scarce, and the evidence base looked more like a field for speculation than certainty. But intuition and logic suggested that if the tumor was associated with viral activity, then weakening that activity might help.

We decided to take a calculated, non-standard risk. To temozolomide we added an antiviral agent. It was Valacyclovir. The regimen was experimental but scientifically grounded.

Treatment began immediately. Tatyana received chemotherapy—to attack the tumor—and antiviral therapy—to deprive the tumor of one of its possible allies.

The first days were difficult. Her condition remained critical, and we didn’t know whether her body would have time to respond. But after several days, the first faint signs of improvement appeared: fewer seizures, some reaction to speech, reduced edema. And then more. Her Karnofsky score rose to 40… then 50… then 60 and 70.

Against all expectations, Tatyana began to return to life. After several months, we continued treatment at the Oncology Center in Astana. Her condition improved even further. One day we saw the number 100 on the Karnofsky scale.

MRI showed — the tumor had disappeared.

This case became symbolic for us. It showed that an unconventional, yet logical approach could not only prolong life but defeat disease. We continued helping other patients despite modest conditions. But soon the project was closed. Some people went back to Ukraine, others to Kazakhstan. I returned to the United States.

Tatyana lived for several more years. In Ukraine, however, she had no access to combined therapy. She received only chemotherapy. In 2016 the tumor returned—more aggressive and faster. Without antiviral treatment, without a comprehensive approach, her body could not withstand the recurrence. Her death was a painful reminder: we could have prolonged her life. We knew how. But we couldn’t.

I still remember her—with gratitude and sorrow. Her smile, her courage, her clear gaze. And the quiet lesson she left behind: sometimes you must go against the system if you truly want to help.

Years later, I began seeing publications from other countries explicitly noting that adding antiviral therapy could improve outcomes in certain brain tumors. We were not alone—we were simply early.

Tatyana’s case became a cornerstone of my interest in the role of chronic infections in oncology and neuropathology. It gave me conviction: the fight against viruses may hold the key to prolonging life.