Table Of ContentRajesh N. Gacche
Dietary
Research
and Cancer
Dietary Research and Cancer
Rajesh N. Gacche
Dietary Research and Cancer
RajeshN.Gacche
TumorBiologyLaboratory,DepartmentofBiotechnology
SavitribaiPhulePuneUniversity
Pune,Maharashtra,India
ISBN978-981-16-6049-8 ISBN978-981-16-6050-4 (eBook)
https://doi.org/10.1007/978-981-16-6050-4
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Dedicated to my parents, who besides
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‘School’andmademylifemeaningful......!!!
Foreword
Great strides of appreciable efforts have been made in decreasing the progression
of cancer; however, the global incidence and cancer-related mortality are still
substantially increasing across the world. We still have to understand more about
the molecular drivers of cancer progression. Sizable volume of research also pin-
pointsatthepathophysiologyofcancerwithindividual’slifestyle,physicalactivity,
dietaryhabitsandmindset.Owingtotheessentialroleplayedbythesecontributing
factors, many National Health Programmes and world reputed organizations have
takeninitiativesinprovidingguidance,supportandevidence-basedstrategiesforthe
cancer survivors, health service providers and populations for reducing the cancer
risk.Infact,suchendeavoursforprovidingevidence-basedstrategicapproachesare
more authentic when there is a collaborative network of experts from the area of
cancer biology, epidemiology, prevention, public health, policy makers and health
serviceproviders,especiallyoncologistsandmedicalprofessionals.
The advances in cancer biology research have clearly demonstrated that the
progression of tumour growth is closely associated with the supply of nutrients
thatareusuallyderivedfromthedietaryinclusionsofthehost.Theseunderstandings
vii
viii Foreword
furtherpavedthewayformodifyingtheindividual’sdietthatmayalterthenutrient
availabilityinthetumourmicroenvironmentandmaytargetthemetabolicvulnera-
bilitiesofthecancercellsandmightalsoenhancetheefficacyofcancerchemother-
apy drugs. Thus, dietary interventions at present represent a promising strategic
approachforintegratedmanagementofcancer.
Tailoringdietaryapproacheshasremainedoneoftheimportanttreatmentoptions
forthemanagementofobesity.Theevolvingliteraturelinksobesitywiththeonsetof
diabetes.Thecurrentmolecularunderstandingsshedlightondiabetes-relatedfactors
which are associated with risk, progression, mortality and treatment of cancer. At
present,diabetesseemstobeaneglectedriskfactorfortheneoplastictransformation
and only limited literature is available on their correlation, and perhaps the lack of
mechanistic understanding in such comorbid conditions may contribute to higher
mortality rates. Owing to glucose addiction of cancer cells, the future research
settings have an opportunity to understand the prevalence of hyperglycaemia–
cancer.Dietaryinterventionsarealsoknowntomodulatethediabetes-relatedcyto-
kinessuchasadiponectin,resistinandleptin.Therecentfindingshaveunravelledthe
roleofresistininthedevelopmentofinsulinresistanceunderobesecondition,andit
is also linked with a variety of human ailments including cancer. There is equal
scientific opportunity for understanding the effect of different dietary patterns on
resistinregulationasrecentreportssuggestthatthesecretionofresistininrodentsis
stronglyinfluencedbygeneticsaswellasdietaryinterventions.
Besides the physiological functions of cholesterol, the dietary sources that con-
tain high amounts of cholesterol have been attributed with a variety of human
degenerative diseases and disorders like obesity, cardiovascular disease, diabetes
andcancer.Moreprecisely,aseriesofclinicalobservationsrevealedthedynamicsof
bloodcholesterollevelsincancerpatients.Thescientificendeavourstowardsunder-
standing how the cholesterol is being inscrutably hijacked for the development of
malignancy, progression, survival, stemness and metastasis of cancerous cells will
beof immenseimportance for modifyingthedietarypatterns andalso for tailoring
noveltherapeuticapproachesforthetreatmentofcancer.Ofnote,thedysregulation
ofthecholesterolmetabolismhasbeenshowntohampervarioustreatmentstrategies
indifferenttypesofhumancancers.
Thebook“DietaryResearchinCancer”byProf.RajeshGaccheisalandscapeof
information related to “Diet-Cancer” discourse touching multiple facets of diet-
related mechanisms in the pathophysiology of cancer progression. Besides the
dietary research in a variety of cancers, Prof. Gacche has also taken due care of
providingdiet-relatedinformationtocancersurvivors.Thedietaryrecommendations
from worldwide cancer-related organizations have been presented in this book,
which perhaps will be a ready reference booklet for cancer patients. The book can
be an exhaustive resource for the researchers working in the mainstream of “Diet-
Nutrition-Cancer”. Several recent advances like the effect of dietary interventions/
patterns on cancer stem cells, oncogenic and tumour suppressor miRNAs, cancer
epigenetics, anticancer drugs targets, etc. have been precisely consolidated in this
book by citing current literature. Prof. Gacche has also made anattempt topresent
Foreword ix
clinical evidence-based answers to avarietyofdiet-related questions andillusions.
More precisely, the chapters on fasting/calorie restrictions in concert with chemo-
therapyefficiency andcancerpreventionclearlyoutlinesthecurrentstateaffairsin
cancerprogressionanddiet.
I am sure that this book will be a ready reference in providing resourceful
informationtotheresearchers,healthcareprofessionals,oncologists,policymakers,
cancer survivors, nursing staff and even to general public for maintaining a diet-
relatedhealthyprofilewhichperhapswillbeavalueadditiontowardsthemanage-
mentofcancer-associatedcomplication.IconveymybestwishestoProf.Gacchefor
hisfutureendeavours.
NationalCentreforCellScience,Pune, ManojKumarBhat,PhD,FNASc
Maharashtra,India
Preface
Theclinicalreportofcancerdiagnosisisashockingnewsandperhapsfrompatient’s
pointofviewisa“DARKDAY”foranyaffectedindividualandhis/herfamilyand
relatives. Cancer is a chronic disease and the emotional and physical burden many
times be overshadowed by the financial burden incurred by the family of cancer
patients.Mostlyindevelopedcountries,amajorpartofthefinancialburdenisshared
bythestateagency.Butevenso,thereportsfromthedevelopedcountriesstatethat
cancerpatientsandfamilieshavetobearasignificantfinancialloadbesidesseveral
functional National policies and plans that are developed to circumvent this issue.
Therefore, the word “financial toxicity” has become familiar in the mainstream of
cancerchemotherapydrugsowingtotheprogressivehighpricesofnewerclassesof
effectiveanticancerdrugs.
Apart from the real classical disease-causative factors and physiological imbal-
ances, the other factors like social, cultural and economic also contribute signifi-
cantlytowardstheonsetandmanagementofavarietyofhumandiseasesincluding
cancer. Diet and nutritionhave remained an importantpart ofcancer management.
Availability of appropriate kinds of foods to cancer patients during and after the
cancer treatmenthasbeenproved tobehelpfulineffectivemanagement ofcancer.
Seriesofdietandnutrition-related questionsraisedbycancersurvivorsarewaiting
tobeaddressedscientifically.Dietandnutritionalrecommendationsandguidelines
suggestedbyworldwideagenciesareeitherinconsistentorlackthemechanisticand
rigorous clinical evidence. Patient-oriented and cancer-specific dietary recommen-
dationsarelimited. Moreover,theimpactofdietaryrecommendationsisnoteffec-
tive owing to moderate interest of clinical oncologists in diet and nutritional
interventions. The evolving preclinical and clinical research suggests that the sur-
vival of cancer patients is closely associated with dietary interventions, pattern of
diet and role of dietary ingredients in the pathophysiology of cancer progression.
Thecancer survivorshavealtered physiologyowingtotheseriousside effects and
off-targettoxicitiesofchemo-andradiotherapyregimes.Moreover,thetoxiceffects
of therapeutic regimes are more devastating and worst in malnourished or under-
nourished cancer survivors; therefore, the convincing dietary and nutrition guide-
lines before, during and after treatment needs to be formulated in concert with
xi
xii Preface
different typesofcancerandpathophysiologyofcancerprogression.Inthecurrent
state-of-the-art, while maintaining the healthy status of cancer patients through
healthy diet, it is important to consider whether the dietary interventions have any
roletoplayintheframeworkoftumour/cancermetabolismandtherebyaffectingthe
cancer landscape by modulating a variety of molecular underpinnings like cell
proliferating signalling pathways, epigenetic factors, metastasis, cancer stem cells,
tumoursuppressororoncogenicmiRNAs,andinteractionwithavarietyofantican-
cerdrugtargets. Theadvancesinpreclinicalandclinical researchhavecrossedthe
general notion of “eat healthy–be fit–reduce cancer risk” and a new paradigm of
evidence-basedpersonalizeddietaryinterventionsareevolving.Overall,thedietand
nutrition management is coming up as a complementary or adjuvant therapeutic
approachfor theeffective amelioration ofcancer.Till date, FDAhasnotapproved
anydietaryinterventionforcancerprevention.Oncologists,clinicians,dieticiansand
professional cancer care taker teams are expected to encourage evidence-based
dietary recommendations for cancer survivors. This book offers an updated infor-
mationanddiscourseaboutvariousdimensionsofdietaryresearchincancersuchas
comparative profile of dietary recommendations by National and International
agencies, frequently asked diet and nutrition-related questions by the cancer survi-
vorsandpossibleanswers,prosandconsofdietarypatterns,outcomeofdiet-related
clinical trials, emerging framework of molecular mechanisms and interactions of
dietary interventions and their applications in personalized diet, ground realities of
benefits and regulatory framework for functional foods, nutraceuticals and supple-
mentsincancerpreventionandupcomingfutureprospectusindiet-cancerresearch.
An elaborative discourse on cancer and fasting (including calorie restriction and
fasting mimicking diet)hasbeendescribed with possible answers toquestions like
can calorie restriction help fight cancer? Does it improve the therapeutic index of
anticancerdrugsandimmunosurveillance?Istherevalidclinicalevidenceoffasting/
calorie restriction/fasting mimicking diet-driven improvements in overall survival,
chemotherapy efficacy and drug toxicity? Looking forward, the most upcoming
discoursemaybetoinvestigatethedynamicinterplaybetweendietaryinterventions
and cancer microbiome. There is ample research opportunity to understand the
cancer-specific role of human microbiome. Moreover, the future research opportu-
nities in understanding the role of dietary intervention in improving cancer
immunosurveillance may be useful in integrating these nonpharmacological regi-
menswithcancerimmunetherapy.
Ihopetheinformationdescribedinthisbookmayserveasareferenceguideline
for oncologist, physicians, health cares, food industry, cancer care takers, nursing
and other stockholders while designing the treatment strategies for the effective
managementofcancer.
Pune,Maharashtra,India RajeshN.Gacche
