ESMO E-Learning: Metabolomics in Cancer, With a Focus on Breast Cancer

Learning Objectives

  • To provide an update on altered cancer metabolism
  • To provide an outline of the essential principles of metabolomics in cancer
  • To provide a rationale for a range of potential applications in oncology  
Title Duration Content CME Points CME Test
Metabolomics in Cancer, With a Focus on Breast Cancer 47 min. 45 slides 1 Take Test
Angelo Di Leo
Angelo Di Leo
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Christopher Hart
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Metabolomics refers to the study of the presence, concentration and relative ratios of metabolites to interpret cellular processes, linking them to pathways and looking at the correlation with clinical states or behaviour. Metabolic pathways are significantly altered in cancer cells, leading to detectable downstream changes in the metabolites produced. The host immune response can also vary considerably. Combined, this offers a picture of both the tumour Phenotype and the host’s local and systemic response. Metabolomics includes variations in enzymatic activity, pathway interactions and cellular crosstalk that cannot be predicted or appreciated by looking at upstream molecules.

In this E-Learning Module, one of the few research groups dedicated to the research area of metabolomics outlines the essential principles of metabolomics as an ‘omics’ science, provides an update on altered metabolism in cancer, techniques for metabolomic data analysis, metabolite patterns and potential clinical applications.
Anti-metabolites have been used for a long time in the treatment of cancer, exploiting the rapidly-dividing nature of many cancer cells by targeting cell division and proliferation. Here, the authors provide an invaluable update on anti-metabolites and other agents that affect metabolism and may have a potential use in the treatment of cancer.

The authors also discuss the pattern of metabolites, representing the metabolomic signature or fingerprint. Many metabolites correlate with the presence of cancer but few are used in clinical practice as tumour markers. The enhanced glucose uptake exploited in FDG PET scans by using radiolabeled glucose is one example of the application of metabolites in the clinic.

In addition to covering metabolomic techniques and principles of data analysis, the module provides some examples of the potential clinical applications of metabolomics, specifically in breast cancer. While it is an interesting area of research which shows promise for the future, currently there are no approved treatment methodologies based on this field and it is unlikely that it will become a sole method of assessment. However, with further development, in combination with other techniques, it has the potential to lead to significant progress in understanding the complex behaviour and characteristics of cancer, and aiding in risk assessment.

The authors conclude the module by describing the challenges that keep metabolomics in the research domain. This includes difficulties in sample handling, intra- and interpatient variability, the absence of a standard reference that can take all background variables into account, and the need for complicated machinery with sophisticated techniques that would be difficult to move into standard hospital settings or commercial laboratories. In addition, it would be difficult to prove superiority over current risk assessment without a long prospective randomised trial, which is unfeasible. 

Last update: 23 September 2015

The authors have reported no conflicts of interest.