Siddhartha Mukherjee in Stat 10:
In oncology we return, again and again, to first principles. The cell is our unit of life and of medicine. When a normal cell becomes malignant, it does not merely divide faster; it eats differently. It hoards glucose, reroutes amino acids, siphons lipids, and improvises when a pathway is blocked. We have learned to poison its DNA, to derail its signaling, to enlist T cells as sentinels. We have been slower to ask a simpler question that sits at the cell’s kitchen table: What if we change what a tumor can eat?
For a century, metabolism was oncology’s prologue. In the 1920s, Otto Warburg observed that many cancer cells consume glucose voraciously and convert much of that glucose to lactate even when oxygen is plentiful, a seemingly wasteful choice that became a metabolic signature of malignancy. That insight eventually receded into a footnote while genetics took the stage. But tumors are not static genotypes; they are shape-shifters that adapt to therapy by rewiring their fuel lines.
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