Starvation, Detoxification, and Multidrug Resistance in Cancer Therapy

Drug Resist Updat. Feb-Apr 2012;15(1-2):114-22. doi: 10.1016/j.drup.2012.01.004. Epub 2012 Mar 4.

Abstract

The selection of chemotherapy drugs is based on the cytotoxicity to specific tumor cell types and the relatively low toxicity to normal cells and tissues. However, the toxicity to normal cells poses a major clinical challenge, particularly when malignant cells have acquired resistance to chemotherapy. This drug resistance of cancer cells results from multiple factors including individual variation, genetic heterogeneity within a tumor, and cellular evolution. Much progress in the understanding of tumor cell resistance has been made in the past 35 years, owing to milestone discoveries such as the identification and characterization of ABC transporters. Nonetheless, the complexity of the genetic and epigenetic rewiring of cancer cells makes drug resistance an equally complex phenomenon that is difficult to overcome. In this review, we discuss how the remarkable changes in the levels of glucose, IGF-I, IGFBP-1 and in other proteins caused by fasting have the potential to improve the efficacy of chemotherapy against tumors by protecting normal cells and tissues and possibly by diminishing multidrug resistance in malignant cells.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • ATP-Binding Cassette Transporters / antagonists & inhibitors
  • ATP-Binding Cassette Transporters / metabolism
  • Animals
  • Antineoplastic Agents / pharmacokinetics
  • Antineoplastic Agents / therapeutic use*
  • Blood Glucose / analysis
  • Drug Resistance, Multiple
  • Drug Resistance, Neoplasm / drug effects*
  • Fasting / metabolism*
  • Humans
  • Inactivation, Metabolic
  • Insulin-Like Growth Factor Binding Protein 1 / metabolism
  • Insulin-Like Growth Factor I / metabolism
  • Mice
  • Neoplasms / metabolism
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Neoplasms / therapy*

Substances

  • ATP-Binding Cassette Transporters
  • Antineoplastic Agents
  • Blood Glucose
  • IGFBP1 protein, human
  • Insulin-Like Growth Factor Binding Protein 1
  • Insulin-Like Growth Factor I