Foods for Osteosarcoma!

Introduction

Foods for Osteosarcoma should be personalized for each individual and also must adapt when cancer treatment or tumor genetic change. The personalization and adaptation must consider all the active ingredients or bioactives contained in different foods with respect to cancer tissue biology, genetics, treatments, lifestyle conditions and diet preferences. Hence while nutrition is one of the very important decisions for a cancer patient and individual at risk of cancer to make – how to choose foods to eat is not an easy task.

Osteosarcoma, a primary malignant tumor of the bones, is a rare cancer with about 1,000 new cases diagnosed in the United States and a worldwide incidence of 3.4 cases per million people per year. About half of these are in children, teens, and young adults between the ages of 10 and 30 years. Osteosarcoma most often affects long bones, such as those in the arms and legs and it usually occurs near the ends of the bones and near your knee where the fastest growth is taking place (in case of teenagers). Osteosarcoma occurs slightly more often in boys (post-adolescence), due to their longer period of skeletal growth. Symptoms of Osteosarcoma include bone pain or tenderness, a mass or lump, swelling, limping, limited movement (if affects joints), broken bone. The 5-year survival rates for osteosarcoma are >65% if localized but if it has spread to other parts of the body, the survival rate drops to 30-50%. Management of high-grade osteosarcoma includes more emphasis on chemotherapy and limb salvage and can be supported by the right nutrition (foods and natural supplements) aligned to the cancer and treatment context.

For Osteosarcoma does it matter what vegetables, fruits, nuts, seeds one eats?

A very common nutrition question asked by cancer patients and individuals at-genetic risk of cancer is – for cancers like Osteosarcoma does it matter what foods I eat and which I do not? Or if I follow a plant-based diet is that enough for cancer like Osteosarcoma?

For example does it matter if vegetable Cabbage is consumed more compared to Yautia? Does it make any difference if fruit Passion Fruit is preferred over Java Plum? Also if similar choices are made for nuts/seeds like Common Walnut over European Chestnut and for pulses like Gram Bean over Lima Bean. And if what I eat matters – then how does one identify foods which are recommended for Osteosarcoma and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Osteosarcoma!

Food recommendations may not be the same for everyone and can be different even for the same diagnosis and genetic risk.

All foods (vegetables, fruits, nuts, seeds, pulses, oils etc.) and nutritional supplements are made up of more than one active molecular ingredient or bio-actives in different proportions and quantities. Each active ingredient has a unique mechanism of action – which can be activation or inhibition of different biochemical pathways. Simply stated foods and supplements which are recommended are those which do not cause an increase of molecular drivers of cancer but reduce them. Else those foods should not be recommended. Foods contain multiple active ingredients – hence when evaluating foods and supplements you need to consider the impact of all active ingredients cumulatively rather than individually.

For example Passion Fruit contains active ingredients Curcumin, Isoliquiritigenin, Apigenin, Lupeol, Psoralen. And Java Plum contains active ingredients Curcumin, Isoliquiritigenin, Apigenin, Lycopene, Lupeol and possibly others.

A common mistake made when deciding and choosing foods to eat for Osteosarcoma – is to evaluate only selected active ingredients contained in foods and ignore the rest. Because different active ingredients contained in foods may have opposing effects on cancer drivers – you cannot cherry pick active ingredients in foods and supplements for making a nutrition decision for Osteosarcoma.

YES – FOOD CHOICES MATTER FOR CANCER. NUTRITION DECISIONS MUST CONSIDER ALL ACTIVE INGREDIENTS OF FOODS.

Skills Needed for Nutrition Personalization for Osteosarcoma?

Personalized nutrition for cancers like Osteosarcoma consists of recommended foods / supplements; not recommended foods / supplements with example recipes which prioritize use of recommended foods. An example of personalized nutrition can be seen at this link.

Deciding which foods are recommended or not is extremely complicated, requiring expertise in Osteosarcoma biology, food science, genetics, biochemistry along with good understanding of how cancer treatments work and associated vulnerabilities by which the treatments could stop being effective.

MINIMUM KNOWLEDGE EXPERTISE NEEDED FOR NUTRITION PERSONALIZATION FOR CANCER ARE: CANCER BIOLOGY, FOOD SCIENCE, CANCER TREATMENTS AND GENETICS.

Characteristics of cancers like Osteosarcoma

All cancers like Osteosarcoma can be characterized by a unique set of biochemical pathways – the signature pathways of Osteosarcoma. Biochemical pathways like Cell Cycle Checkpoints, Cell Cycle, Extracellular Matrix Remodelling, Focal Adhesion are part of the signature definition of Osteosarcoma. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Osteosarcoma need to be cognizant of the associated signature biochemical pathways for each cancer patient and individual at genetic risk. Therefore different treatments with different mechanisms of actions are effective for different patients. Similarly and for the same reasons foods and supplements need to be personalized for each individual. Hence some foods and supplements are recommended for Osteosarcoma when taking cancer treatment Dacarbazine, and some foods and supplements are not recommended.

Sources like cBioPortal and many others provide population representative patient anonymized data from clinical trials for all cancer indications. This data consists of clinical trial study details like sample size / number of patients, age groups, gender, ethnicity, treatments, tumor site and any genetic mutations.

DNMT3A, PPM1D, TET2, TP53 and CHEK2 are the top ranked reported genes for Osteosarcoma. DNMT3A is reported in 21.6 % of the representative patients across all clinical trials. And PPM1D is reported in 9.7 %. The combined population patient data cover ages from 1 to 93. 29.2 % of the patient data are identified as men. The Osteosarcoma biology along with reported genetics together define the population represented signature biochemical pathways for this cancer. If the individual cancer tumor genetics or genes contributing to the risk are also known then that should also be used for nutrition personalization.

NUTRITION CHOICES SHOULD MATCH WITH EACH INDIVIDUAL’S CANCER SIGNATURE.

Food and Supplements for Osteosarcoma

For Cancer Patients

Cancer patients on treatment or on palliative care need to make decisions on food and supplements – for the needed dietary calories, for managing any treatment side effects and also for improved cancer management. All plant-based foods are not equal and choosing and prioritizing foods which are personalized and customized to ongoing cancer treatment is important and complicated. Here are some examples providing guidelines for making nutrition decisions.

Choose Vegetable CABBAGE or YAUTIA?

Vegetable Cabbage contains many active ingredients or bioactives such as Quercetin, Curcumin, Isoliquiritigenin, Apigenin, Lycopene. These active ingredients manipulate various biochemical pathways like Cell Cycle, Inflammation, P53 Signaling and Angiogenesis and others. Cabbage is recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine. This is because Cabbage modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Dacarbazine.

Some of the active ingredients or bioactives in vegetable Yautia are Curcumin, Isoliquiritigenin, Apigenin, Lycopene, Lupeol. These active ingredients manipulate various biochemical pathways like DNA Repair and Oxidative Stress and others. Yautia is not recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE CABBAGE IS RECOMMENDED OVER YAUTIA FOR Osteosarcoma AND TREATMENT Dacarbazine.

Choose Fruit JAVA PLUM or PASSION FRUIT?

Fruit Java Plum contains many active ingredients or bioactives such as Curcumin, Isoliquiritigenin, Apigenin, Lycopene, Lupeol. These active ingredients manipulate various biochemical pathways like Cell Cycle, Inflammation, DNA Repair and TWEAK Signaling and others. Java Plum is recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine. This is because Java Plum modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Dacarbazine.

Some of the active ingredients or bioactives in fruit Passion Fruit are Curcumin, Isoliquiritigenin, Apigenin, Lupeol, Psoralen. These active ingredients manipulate various biochemical pathways like DNA Repair, Oxidative Stress and TWEAK Signaling and others. Passion Fruit is not recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT JAVA PLUM IS RECOMMENDED OVER PASSION FRUIT FOR Osteosarcoma AND TREATMENT Dacarbazine.

Choose Nut COMMON WALNUT or EUROPEAN CHESTNUT?

Common Walnut contains many active ingredients or bioactives such as Quercetin, Curcumin, Isoliquiritigenin, Lupeol, Ellagic Acid. These active ingredients manipulate various biochemical pathways like DNA Repair, Cell Cycle, P53 Signaling and TWEAK Signaling and others. Common Walnut is recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine. This is because Common Walnut modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Dacarbazine.

Some of the active ingredients or bioactives in European Chestnut are Quercetin, Curcumin, Isoliquiritigenin, Apigenin, Lupeol. These active ingredients manipulate various biochemical pathways like DNA Repair, Oxidative Stress and TWEAK Signaling and others. European Chestnut is not recommended for Osteosarcoma when ongoing cancer treatment is Dacarbazine because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

COMMON WALNUT IS RECOMMENDED OVER EUROPEAN CHESTNUT FOR Osteosarcoma AND TREATMENT Dacarbazine.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Osteosarcoma or familial history is “What Should I Eat Differently from Before?” and how they should choose foods and supplements to manage risks of the disease. Since for cancer risk there is nothing actionable in terms of treatment – decisions of foods and supplements become important and one of the very few actionable things which can be done. All plant-based foods are not equal and based on identified genetics and pathway signature – the choices of food and supplements should be personalized.

Choose Vegetable GIANT BUTTERBUR or CHINESE BROCCOLI?

Vegetable Giant Butterbur contains many active ingredients or bioactives such as Apigenin, Curcumin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like Cell Cycle, P53 Signaling, DNA Repair and MYC Signaling and others. Giant Butterbur is recommended for risk of Osteosarcoma when associated genetic risk is CHEK2. This is because Giant Butterbur increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Chinese Broccoli are Apigenin, Curcumin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like Oxidative Stress and others. Chinese Broccoli is not recommended when risk of Osteosarcoma when associated genetic risk is CHEK2 because it increases the signature pathways of it.

VEGETABLE GIANT BUTTERBUR IS RECOMMENDED OVER CHINESE BROCCOLI FOR CHEK2 GENETIC RISK OF CANCER.

Choose Fruit NANCE or GRAPEFRUIT?

Fruit Nance contains many active ingredients or bioactives such as Apigenin, Curcumin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like Cell Cycle, P53 Signaling, DNA Repair and MYC Signaling and others. Nance is recommended for risk of Osteosarcoma when associated genetic risk is CHEK2. This is because Nance increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Grapefruit are Curcumin, Lupeol, Daidzein, Formononetin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like Oxidative Stress and others. Grapefruit is not recommended when risk of Osteosarcoma when associated genetic risk is CHEK2 because it increases the signature pathways of it.

FRUIT NANCE IS RECOMMENDED OVER GRAPEFRUIT FOR CHEK2 GENETIC RISK OF CANCER.

Choose Nut COMMON HAZELNUT or FLAXSEED?

Common Hazelnut contains many active ingredients or bioactives such as Curcumin, Lupeol, Daidzein, Formononetin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like DNA Repair, Cell Cycle, MAPK Signaling and MYC Signaling and others. Common Hazelnut is recommended for risk of Osteosarcoma when associated genetic risk is CHEK2. This is because Common Hazelnut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in Flaxseed are Apigenin, Curcumin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like JAK-STAT Signaling, Oxidative Stress and PI3K-AKT-MTOR Signaling and others. Flaxseed is not recommended when risk of Osteosarcoma when associated genetic risk is CHEK2 because it increases the signature pathways of it.

COMMON HAZELNUT IS RECOMMENDED OVER FLAXSEED FOR CHEK2 GENETIC RISK OF CANCER.

In Conclusion

Foods and Supplements chosen are important decisions for cancers like Osteosarcoma. Osteosarcoma patients and individuals with genetic-risk always have this question: “What foods and nutritional supplements are recommended for me and which are not?” There is a common belief which is a misconception that all plant-based foods could be beneficial or not but would not be harmful. Certain foods and supplements can interfere with cancer treatments or promote molecular pathway drivers of cancer.

There are different types of cancer indications like Osteosarcoma, each with different tumor genetics with further genomic variations across each individual. Further every cancer treatment and chemotherapy has a unique mechanism of action. Each food like Cabbage contains various bioactives in different quantities, which have an impact on different and distinct sets of biochemical pathways. The definition of personalized nutrition is individualized food recommendations for the cancer indication, treatments, genetics, lifestyle and other factors. Nutrition personalization decisions for cancer require knowledge of cancer biology, food science and an understanding of different chemotherapy treatments. Finally when there are treatment changes or new genomics is identified – the nutrition personalization needs re-evaluation.

The addon nutrition personalization solution makes the decision making easy and removes all the guesswork in answering the question, “What foods should I choose or not choose for Osteosarcoma?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.

References

• Mixed Kunga Msk 2022
• Pan-cancer analysis of whole genomes.
• Effects of isoliquiritigenin on ovarian cancer cells.
• Paederia foetida induces anticancer activity by modulating chromatin modification enzymes and altering pro-inflammatory cytokine gene expression in human prostate cancer cells.
• Misaghi A et al., SICOT J, 2018