Figure 13.

A new metabolic strategy for personalized cancer diagnosis and therapy. Here, we outline a general experimental strategy for personalized cancer medicine. Briefly, cancer cells of a particular tumor type are selected for study. Then, these cancer cells are cultured in the absence and presence of high-energy metabolites, such as ketones and/or lactate. This should allow the investigator to generate a new gene signature based on transcriptional profiling (exon-array). This signature could then be used to select the patients that are undergoing this type of tumor metabolism, and correlate tumor metabolism with clinical outcome, such as recurrence and metastasis. High-risk patients could then be identified at diagnosis and treated with new therapies that are designed to target oxidative mitochondrial metabolism, such as metformin which is a specific inhibitor of mitochondrial complex I.