[azalemeth]

"Cancer as a metabolic disease" has been known since the 1920s when Otto Warburg discovered that shift towards "aerobic glycolysis"; that is, glycolysis even in presence of adequate oxygen for fatty acid oxidation. It's the basis of some treatment and medical imaging approaches – e.g. 18-FDG PET images the extra uptake of glucose caused by cancers' voracious thirst for glucose.

I agree that interest in diet is an increasing vogue – and I would never recommend replacing a medical therapy with dietary modification, but some of the citations I linked to above indicated that it may potentiate the effect of some other chemotherapies, particularly those that themselves have a metabolic effect. I agree with you about the difficulty in funding such trials, and the difficulty in both monitoring patient compliance with them and obtaining a robust and reproducible readout of their effects. Cancer is a heterogenous disease of life, and its response to therapy is too.

[kozikow]

My mother is on Osimertinib for Adenocarcinoma with EGFR Exon 19del mutation. Oncologist only recommended Osimertinib without any additions. Oncologist won't recommend anything that hasn't been confirmed by Phase 3 study. Phase 3 studies in oncology seem to be rare for treatments you can't make money on like $10K per month Osimertinib therapy. There are many things that have been shown effective alongside EGFR TKI inhibitors with minimal side effects based on smaller studies, cell models, retrospective data analyses etc.

So far we added Metformin [1][2] (not as diabetic drug), Aspirin[3], Vitamin D, low glycemic index, no red meat, mediterranean diet, freshly made juices from vegetables and fruits with anti-angiogenic or confirmed anti-cancer properties (e.g. kale, brocolli, apples, carrots, celery, turmeric, red grapes, berries). Metformin has been confirmed with an endocrinologist.

One issue with things like Keto is that it is too extreme to convince a regular 50+ years old person to consider such approaches. And frankly, neither of us has medical training, so we are afraid of trying too-unconventional approaches. Some other medications or supplements I heard recommended, but we didn't decide to include yet are reservatol, simvastatin, altrexone, doxycycline, boswellia, quercetin, keto, intermittent fasting.

1. https://jamanetwork.com/journals/jamaoncology/article-abstra...

2. https://www.frontiersin.org/articles/10.3389/fonc.2020.01605...

3. https://www.lungcancerjournal.info/article/S0169-5002(20)305...