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  • Dr. Robert A. Nagourney, MD

Cancer as a Metabolic Disorder

I received an inquiry via Twitter “Has anyone thought about using a sugar medium (similar to PET scans) to deliver chemo drugs?”

Although no one would use PET scans nor the PET reagents as therapy, the question is actually profound.

There is a growing recognition that cancer is not a genetic disease but instead a metabolic disorder.

One could not attend a lecture at the American Association of Cancer Research without there being reference to Otto Warburg’s 1956 paper “On the Origin of Cancer Cells” that described the metabolic basis of human malignancy.

Despite our myopic focus on cancer genomics, there is a growing recognition that cancer represents dysregulated energy metabolism. The high utilization of glucose, a hallmark of malignantly transformed cells, (and the target of PET scan diagnostics), in part reflects the process of aerobic glycolysis, whereby cells provided ample oxygen nonetheless eschew the efficiency of mitochondrial oxidative phosphorylation in favor of seemingly inefficient lactate production.

Into this new realm of biochemically driven developments, a growing number of therapeutic agents that target glucose metabolism are finding their way into the clinic. To the dismay of some, the mutations that our molecular biologists identify are increasingly found to represent intermediates of cellular metabolism, forcing many to go back to relearn biochemistry.

Thus, the avidity for glucose represented by uptake of the PET scan reagent F18 fluorodeoxyglucose by tumor cells, is a diagnostic application of what, in the future, may provide meaningful therapeutic opportunities.

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