World Cancer Day: How Integrative Oncology Enhances Treatment Tolerance
The Importance of Evidence-Based Standard Care in Integrative Oncology
In the evolving landscape of cancer treatment, where alternative and integrative therapies often spark debate, Dr. Mandeep Singh Malhotra, a senior oncologist and co-founder of Art of Healing Cancer, emphasizes a clear and unwavering stance. He asserts that evidence-based standard cancer treatment must always take precedence, with integrative metabolic strategies serving as complementary tools to enhance treatment tolerance and outcomes.
Dr. Malhotra is unequivocal about the most contentious issue in integrative oncology: “An integrative approach is never prioritized over evidence-based standard of care,” he states. “The standard of care has to be started without delay. On no account do we begin integrative therapy first and then look at standard treatment later.” This principle is foundational to ethical integrative oncology, ensuring that patients receive the most effective and scientifically validated treatments available.
From Ad Hoc Advice to Stringent SOPs
Contrary to the perception that dietary or metabolic therapies are informal add-ons, Dr. Malhotra describes a system that is, by his own admission, “more stringent than prescribing a drug.” His approach involves developing standard operating protocols (SOPs) and collecting data under Institutional Review Board (IRB) approvals. Every patient undergoing a metabolic or dietary intervention is systematically monitored, with meticulous tracking of glycaemic levels, ketone levels, body mass index, muscle mass, and weight changes.
“When we look at a ketogenic or low-glycaemic diet, we tabulate everything. Nothing is left to assumption,” he explains. This structured approach ensures that all interventions are grounded in scientific rigor and patient safety.
The Science Behind the Metabolic Approach
Central to this model is the Glucose Ketone Index (GKI), a concept popularized by Professor Thomas Seyfried and his team. “The GKI index is critical,” Dr. Malhotra explains. “When we are able to achieve the desired GKI, we have started seeing better response rates to cytotoxic drugs and even improved toxicity profiles.”
These observations, while still being systematically studied, have encouraged deeper exploration into cancer metabolism, particularly how tumors utilize glucose and glutamine as primary fuels. “If we can modify these metabolic pathways through diet and nutraceuticals, chemotherapy may work better in selected patients,” he adds.
IRB Oversight, Consent, and Ethics
Addressing concerns around ethics and alternative medicine, Dr. Malhotra emphasizes governance and transparency. “All these interventions are done with proper informed consent and under Institutional Review Board supervision,” he states. At CK Birla Hospital, the IRB not only oversees but actively suggests protocol modifications in the patient’s best interest.
He also places the approach within an Indian regulatory context. “Dietary metabolic therapy can fall under the AYUSH concept. That does not make it unethical, but it must be supervised, documented, and evidence-driven.”
Why Nutrition Is Not ‘Just a Diet’
One of the most striking insights from the interview is the sheer complexity involved in nutritional interventions. “Every meal is calculated calories, protein content, timing, metabolic response. We monitor glucose, ketones, muscle mass. Sometimes this becomes difficult even for staff and patients,” Dr. Malhotra notes.
Nutraceuticals, he adds, require oncology-nutrition coordination. “Some antioxidants must be given after the beta half-life of chemotherapy. Pro-oxidants like high-dose vitamin C must be timed during it. This cannot happen without oncologists and nutritionists working hand in hand.”
Case Study: Improving Tolerance in a High-Risk Patient
Dr. Malhotra illustrates the approach with a compelling case of a 70-year-old man with advanced oral cancer (Stage IVA) and multiple comorbidities, including lung fibrosis. “Conventionally, this would require radical surgery, jaw reconstruction, followed by chemoradiation with often poor outcomes,” he explains. Instead, the team adopted a carefully integrated metabolic strategy alongside low-dose chemotherapy and targeted therapy.
“The patient tolerated chemotherapy remarkably well, had fewer side effects, and eventually underwent a limited local surgery. Final histopathology revealed no bone involvement. Today, the patient eats, speaks, and lives normally. For someone of his age and comorbidity burden, this is a very positive outcome.”
Precision Oncology and the Future
Looking ahead, Dr. Malhotra sees metabolic therapy converging with precision oncology. “We can now map disease biology, whether a cancer is glucose-driven, protein-driven, or resistant due to specific pathways.” The long-term goal, he says, is not replacement but optimization.
“Can dietary or nutraceutical interventions make chemotherapy work in patients where it otherwise wouldn’t? That’s the scientific question we are pursuing,” he concludes.
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