Fig. 2

Illustration of the Press-Pulse Therapeutic Strategy for Cancer Management. The “Press-Pulse” therapeutic strategy considers cancer as a singular systemic disease regardless of the specific tissue or organ system containing invasive or metastatic tumor cells. This strategy is designed to target the glucose and glutamine dependency of tumor cells, while enhancing the metabolic efficiency in normal cells. Press therapies are designed to reduce systemic glucose availability while elevating blood levels of ketone bodies, which tumor cells cannot effectively use for energy generation. This approach pits the metabolic demands of normal cells against those of the mutated tumor cells, which are less capable than normal cells in adapting to metabolic stress from nutrient deprivation. Ketone body supplements could further reduce glucose levels while enhancing the respiratory energy metabolism in normal cells. Stress management techniques together with exercise could further stress tumor cell metabolism while improving general health. The press therapies would be designed to work synergistically with acute pulse therapies to further target glucose and glutamine metabolism. HBOT will work together with the press therapies to selectively increase oxidative stress in tumor cells. The spacing between the various pulse therapies is designed to stress tumor cell metabolism while minimizing toxicity to normal body cells. This therapeutic strategy will target the fermentation metabolism common to most tumor cells, thus gradually degrading tumor burden. The progressive color change in the Vitruvian man drawing from red (diseased with darker red spots indicative of metastatic lesions), to yellow (reduced metastasis), to green (resolution) symbolizes a gradual metabolic management and resolution of cancer. The pill symbol is indicative of glycolysis targeting that could be delivered orally. The Rx symbol is indicative of glutamine targeting that could be delivered intravenously. Pulse therapies would terminate with evidence of management or resolution while press therapies could continue under modification or adjustment (arrow). Optimization of dosing, timing, and scheduling of the press-pulse therapeutic strategy will facilitate the eradication of tumor cells with minimal patient toxicity. This therapeutic strategy can be used as a framework for the design of clinical trials for the majority of cancers. HBOT, hyperbaric oxygen therapy; KD-R, calorie restricted ketogenic diet