Dr. Jeff Geschwind is an interventional oncologist widely recognized as a world expert on liver cancer. He currently holds the position of Medical Director for Oncology, Image-Guided Therapy, and the Imaging Core Lab at NAMSA. In addition, he serves as a Medical Advisor to HistoSonics and provides consulting services to Philips Healthcare and Cage Pharma, a company he founded in 2009 to develop cancer drugs targeting tumor metabolism. Jeff Geschwind has led or co-led more than 50 clinical trials and previously chaired the Department of Radiology and Biomedical Imaging at Yale University School of Medicine after directing Interventional Radiology at Johns Hopkins University School of Medicine for nearly 15 years. His studies on the ways tumors produce and utilize energy have helped shape new approaches to depriving cancer cells of essential resources. These strategies include treatments designed to disrupt the metabolic processes that cancer cells rely on for growth. Dr. Geschwind earned his MD from Boston University School of Medicine and holds several patents tied to his cancer research.
A tumor, also known as a neoplasm, develops when abnormal cells multiply and form a solid mass of tissue. These growths can occur in various parts of the body, such as the organs, bones, skin, and glands. Tumors come in many forms and are classified according to factors such as their size, location, and growth characteristics. However, they are generally divided into two main categories: benign tumors, which are noncancerous, and malignant tumors, which are cancerous and may require medical intervention.
Cancer specialists use several treatment methods to manage malignant tumors, tailoring their approach to each patient’s condition. Common treatments include chemotherapy, radiation, immunotherapy, and targeted drugs. When appropriate, surgery may also be performed to remove the tumor from the body.
Another approach involves limiting the nutrients and energy cancer cells need to survive and multiply. Understanding this strategy begins with exploring how tumors obtain and process energy to support their growth.
Tumor metabolism describes the intricate biochemical processes that cancer cells alter to meet their increased demands for energy and the materials needed to build new cells. Researchers have long recognized that cancer cells can multiply rapidly and spread to distant parts of the body through a process called metastasis. Supporting these activities requires a steady supply of energy and essential nutrients.
Cancer metabolism involves several specialized mechanisms, such as the Warburg effect, glutamate dependence, and the uptake of macronutrients from surrounding sources. The Warburg effect, often referred to as aerobic glycolysis, occurs when cancer cells favor glycolysis to produce energy. During this process, glucose is broken down into smaller compounds, ultimately generating lactate.
Although glycolysis usually plays a major role when oxygen availability is limited, cancer cells often rely on this pathway even when sufficient oxygen is present. This metabolic adaptation helps them produce energy and generate essential compounds that support rapid cell division and tumor growth.
Glutamine dependence is another key feature of cancer metabolism. Alongside glucose, cancer cells use glutamine, an amino acid, to obtain the carbon and nitrogen needed for essential cellular processes. This nutrient also supports rapid cell proliferation and helps cancer cells manage oxidative stress, allowing them to maintain their growth.
Macronutrient scavenging is another metabolic adaptation that helps tumors survive when nutrients are scarce. Through this mechanism, cancer cells obtain essential substances, including fats and proteins, from their surrounding environment. This process is also linked to autophagy, a cellular recycling mechanism in which tumor cells break down their own organelles and cytoplasmic components to recover materials that can be reused for energy and other vital functions.
As medical professionals and researchers deepen their knowledge of tumor metabolism, they can identify ways to disrupt the processes cancer cells use to obtain energy and sustain their growth. Cancer starvation is an evolving treatment strategy that aims to interfere with the metabolic pathways tumors depend on to develop and multiply.
Antimetabolic treatments use medications to interfere with specific metabolic activities in cancer cells, including processes associated with the Warburg effect. Another approach involves angiogenesis inhibitors, which block the formation of new blood vessels that tumors need to receive oxygen and nutrients. By restricting this blood supply, these therapies can help slow tumor development and, in some cases, limit further growth.
Modified fat cells are also being investigated as a potential way to limit the nutrients available to tumors. Preclinical research at the University of California, San Francisco, suggests that gene-edited fat cells placed near tumors may absorb fatty acids and glucose that cancer cells rely on for glycolysis and other essential processes involved in growth.
About Jeff Geschwind
Dr. Jeff Geschwind, MD, is a renowned interventional oncologist specializing in liver cancer. He currently leads Oncology, Image-Guided Therapy, and the Imaging Core Lab as Medical Director at NAMSA. He previously chaired the Department of Radiology and Biomedical Imaging at Yale University School of Medicine and directed Interventional Radiology at Johns Hopkins University School of Medicine. He founded Cage Pharma in 2009 to develop cancer drugs targeting tumor metabolism and has led more than 50 clinical trials. He earned his MD from Boston University School of Medicine.