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This investigational quadrate combination therapy, developed by Mahmoud Ramadan Mohamed Elkazzaz, is being evaluated for the treatment of early breast cancer. The regimen consists of all-trans retinoic acid (ATRA), mifepristone (an antiprogesterone), tamoxifen (a selective estrogen receptor modulator), and cannabidiol (acting as a selective CYP26 inhibitor). The therapeutic rationale is based on preventing the induction of therapy-resistant cytokeratin 5 (CK5)-expressing cancer stem cells, which are often expanded by progesterone or standard hormonal treatments. In this protocol, mifepristone counteracts the progesterone-mediated induction of CK5+ cells, while cannabidiol is included to inhibit CYP26 enzymes, thereby preventing the degradation of retinoic acid and potentially enhancing its anti-tumor activity. Additionally, cannabidiol acts as an atypical inhibitor of CYP2D6 to modulate the metabolic profile of the combination.
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