World Cancer Day: How integrative oncology improves cancer treatment tolerance
As integrative oncology gains attention, a protocol-driven model offers a clear message which is that metabolic and dietary therapies may enhance cancer care but only when anchored firmly to evidence-based treatment, ethics, and rigorous science.
At a time when alternative and integrative cancer therapies are increasingly discussed often controversially, Dr Mandeep Singh Malhotra, senior oncologist and co-founder of Art of Healing Cancer, draws a firm, non-negotiable line. In an in-depth conversation, he explains why evidence-based standard cancer treatment must always come first, and how integrative metabolic strategies can be safely and ethically layered on to improve treatment tolerance and outcomes. Speaking with the clarity of a clinician and the caution of a researcher, Dr Malhotra outlines a protocol-driven, IRB-approved model of integrative oncology that rejects shortcuts, delays, and unscientific claims.
STANDARD OF CARE CAN NEVER BE DELAYED
Dr Malhotra is unequivocal on the most contentious issue in integrative oncology.
“An integrative approach is never prioritised over evidence-based standard of care,” he stresses. “The standard of care has to be started without delay. On no account do we begin integrative therapy first and then look at standard treatment later.”
He is equally firm about patients seeking alternatives to avoid chemotherapy, radiation, or surgery.
“If any patient comes to us wanting to avoid standard treatment and only pursue integrative therapy, we do not entertain such requests. That approach is not just detrimental, it can be life-threatening.”
This clarity, he says, is foundational to ethical integrative oncology.
FROM AD HOC ADVICE TO STRINGENT SOPs
Contrary to the perception that dietary or metabolic therapies are informal add-ons, Dr Malhotra describes a system that is, by his own admission, “more stringent than prescribing a drug.”
“This is not an ad hoc recommendation. We have developed standard operating protocols and we collect data under Institutional Review Board approvals.”
Every patient undergoing a metabolic or dietary intervention is systematically monitored. Glycaemic levels, ketone levels, body mass index, muscle mass, and weight changes are meticulously recorded.
“When we look at a ketogenic or low-glycaemic diet, we tabulate everything. Nothing is left to assumption.”
THE SCIENCE BEHIND THE METABOLIC APPROACH
Central to this model is the Glucose Ketone Index (GKI), a concept popularised by Professor Thomas Seyfried and his team.
“The GKI index is critical,” Dr Malhotra explains. “When we are able to achieve the desired GKI, we have started seeing better response rates to cytotoxic drugs and even improved toxicity profiles.”
These observations, while still being systematically studied, have encouraged deeper exploration into cancer metabolism, particularly how tumours utilise glucose and glutamine as primary fuels.
“If we can modify these metabolic pathways through diet and nutraceuticals, chemotherapy may work better in selected patients.”
IRB OVERSIGHT, CONSENT, AND ETHICS
Addressing concerns around ethics and alternative medicine, Dr Malhotra emphasises governance and transparency.
“All these interventions are done with proper informed consent and under Institutional Review Board supervision.”
At CK Birla Hospital, he notes, the IRB not only oversees but actively suggests protocol modifications in the patient’s best interest.
He also places the approach within an Indian regulatory context.
“Dietary metabolic therapy can fall under the AYUSH concept. That does not make it unethical but it must be supervised, documented, and evidence-driven.”
WHY NUTRITION IS NOT ‘JUST A DIET’
One of the most striking insights from the interview is the sheer complexity involved.
“Every meal is calculated calories, protein content, timing, metabolic response. We monitor glucose, ketones, muscle mass. Sometimes this becomes difficult even for staff and patients.”
Nutraceuticals, he adds, require oncology-nutrition coordination.
“Some antioxidants must be given after the beta half-life of chemotherapy. Pro-oxidants like high-dose vitamin C must be timed during it. This cannot happen without oncologists and nutritionists working hand in hand.”
CASE STUDY: IMPROVING TOLERANCE IN A HIGH-RISK PATIENT
Dr Malhotra illustrates the approach with a compelling case of a 70-year-old man with advanced oral cancer (Stage IVA) and multiple comorbidities, including lung fibrosis.
“Conventionally, this would require radical surgery, jaw reconstruction, followed by chemoradiation with often poor outcomes.”
Instead, the team adopted a carefully integrated metabolic strategy alongside low-dose chemotherapy and targeted therapy.
“The patient tolerated chemotherapy remarkably well, had fewer side effects, and eventually underwent a limited local surgery.”
Final histopathology revealed no bone involvement. Today, the patient eats, speaks, and lives normally.
“For someone of his age and comorbidity burden, this is a very positive outcome.”
PRECISION ONCOLOGY AND THE FUTURE
Looking ahead, Dr Malhotra sees metabolic therapy converging with precision oncology.
“We can now map disease biology, whether a cancer is glucose-driven, protein-driven, or resistant due to specific pathways.”
The long-term goal, he says, is not replacement but optimisation.
“Can dietary or nutraceutical interventions make chemotherapy work in patients where it otherwise wouldn’t? That’s the scientific question we are pursuing.”
At a time when alternative and integrative cancer therapies are increasingly discussed often controversially, Dr Mandeep Singh Malhotra, senior oncologist and co-founder of Art of Healing Cancer, draws a firm, non-negotiable line. In an in-depth conversation, he explains why evidence-based standard cancer treatment must always come first, and how integrative metabolic strategies can be safely and ethically layered on to improve treatment tolerance and outcomes. Speaking with the clarity of a clinician and the caution of a researcher, Dr Malhotra outlines a protocol-driven, IRB-approved model of integrative oncology that rejects shortcuts, delays, and unscientific claims.
STANDARD OF CARE CAN NEVER BE DELAYED
Dr Malhotra is unequivocal on the most contentious issue in integrative oncology.
“An integrative approach is never prioritised over evidence-based standard of care,” he stresses. “The standard of care has to be started without delay. On no account do we begin integrative therapy first and then look at standard treatment later.”
He is equally firm about patients seeking alternatives to avoid chemotherapy, radiation, or surgery.
“If any patient comes to us wanting to avoid standard treatment and only pursue integrative therapy, we do not entertain such requests. That approach is not just detrimental, it can be life-threatening.”
This clarity, he says, is foundational to ethical integrative oncology.
FROM AD HOC ADVICE TO STRINGENT SOPs
Contrary to the perception that dietary or metabolic therapies are informal add-ons, Dr Malhotra describes a system that is, by his own admission, “more stringent than prescribing a drug.”
“This is not an ad hoc recommendation. We have developed standard operating protocols and we collect data under Institutional Review Board approvals.”
Every patient undergoing a metabolic or dietary intervention is systematically monitored. Glycaemic levels, ketone levels, body mass index, muscle mass, and weight changes are meticulously recorded.
“When we look at a ketogenic or low-glycaemic diet, we tabulate everything. Nothing is left to assumption.”
THE SCIENCE BEHIND THE METABOLIC APPROACH
Central to this model is the Glucose Ketone Index (GKI), a concept popularised by Professor Thomas Seyfried and his team.
“The GKI index is critical,” Dr Malhotra explains. “When we are able to achieve the desired GKI, we have started seeing better response rates to cytotoxic drugs and even improved toxicity profiles.”
These observations, while still being systematically studied, have encouraged deeper exploration into cancer metabolism, particularly how tumours utilise glucose and glutamine as primary fuels.
“If we can modify these metabolic pathways through diet and nutraceuticals, chemotherapy may work better in selected patients.”
IRB OVERSIGHT, CONSENT, AND ETHICS
Addressing concerns around ethics and alternative medicine, Dr Malhotra emphasises governance and transparency.
“All these interventions are done with proper informed consent and under Institutional Review Board supervision.”
At CK Birla Hospital, he notes, the IRB not only oversees but actively suggests protocol modifications in the patient’s best interest.
He also places the approach within an Indian regulatory context.
“Dietary metabolic therapy can fall under the AYUSH concept. That does not make it unethical but it must be supervised, documented, and evidence-driven.”
WHY NUTRITION IS NOT ‘JUST A DIET’
One of the most striking insights from the interview is the sheer complexity involved.
“Every meal is calculated calories, protein content, timing, metabolic response. We monitor glucose, ketones, muscle mass. Sometimes this becomes difficult even for staff and patients.”
Nutraceuticals, he adds, require oncology-nutrition coordination.
“Some antioxidants must be given after the beta half-life of chemotherapy. Pro-oxidants like high-dose vitamin C must be timed during it. This cannot happen without oncologists and nutritionists working hand in hand.”
CASE STUDY: IMPROVING TOLERANCE IN A HIGH-RISK PATIENT
Dr Malhotra illustrates the approach with a compelling case of a 70-year-old man with advanced oral cancer (Stage IVA) and multiple comorbidities, including lung fibrosis.
“Conventionally, this would require radical surgery, jaw reconstruction, followed by chemoradiation with often poor outcomes.”
Instead, the team adopted a carefully integrated metabolic strategy alongside low-dose chemotherapy and targeted therapy.
“The patient tolerated chemotherapy remarkably well, had fewer side effects, and eventually underwent a limited local surgery.”
Final histopathology revealed no bone involvement. Today, the patient eats, speaks, and lives normally.
“For someone of his age and comorbidity burden, this is a very positive outcome.”
PRECISION ONCOLOGY AND THE FUTURE
Looking ahead, Dr Malhotra sees metabolic therapy converging with precision oncology.
“We can now map disease biology, whether a cancer is glucose-driven, protein-driven, or resistant due to specific pathways.”
The long-term goal, he says, is not replacement but optimisation.
“Can dietary or nutraceutical interventions make chemotherapy work in patients where it otherwise wouldn’t? That’s the scientific question we are pursuing.”