Nicole

Food as Medicine: Targeted Nutrient Deprivation (TND) Therapy for Cancer

(This will be a shorter post than my usual, along the lines of a request for a startup. )

Since what may have been the first instance in the 1990s, the suggestion of starving off cancer tumors by restricting dietary intake of fatty and amino acids has been an eyebrow raising proposition for treating cancer.

The study author also recommends using drugs to block the body’s production of those acids and states that the approach is in its early phase. But such a simple sounding proposition seems revolutionary in a world where there are around 18M new cancer cases per year and 9.5M people pass from cancer-related deaths.

Science

There are a number of startups that are approaching disease care through diet prescription, from Epicured which delivers low-FODMAP meals to help manage digestive diseases, to Virta which focuses on using ketogenic diets to reverse type 2 diabetes.

Generally the way we have seen companies approach prescribed diets for cancer thus far is such: they approach a few cancers with a body of pre-clinical diet research around a few therapeutic targets – generally some type of specific amino acid. The idea is that starving off tumors quickly is best enabled by precisely removing the nutrients they feed off of, in a way that is nutritionally sustainable to the patient. Sometimes this is also delivered alongside of a chemotherapy as a means of increasing the chemotherapies effectiveness.

For other cancers, it seems that intermittent fasting becomes even more relevant when it replicates the effects of drugs like Rapamycin which may be one of the few drugs to have any effect on some less common cancers like Chordoma. (for example: IMF induced mTOR inhibition/modulation that had very similar effects to Rapamycin)

It’s notable that people have previously also tried ketogentic diets for glioblastoma and the results have been tenuous.

To be clear, mouse trials are infamously shaky indications of performance of treatments in humans. This is one of the natural risks of investing in the therapeutics space. We have a long way to go in terms of fully understanding these treatments but I’m excited to see what these trials reveal, and are looking for teams with especially thoughtful clinical trial design.

Where We’re Going / Venture Model

There are a few specific companies already working on exactly this. Two companies that are currently working on this are:

  • Filtricine (founded 2017, raised 5.3M seed) – Replacement meals that cut off the supply of target nutrients to cancer cells when consumed as the sole source of nutrition along with modified dialysis.
    • Prostate cancer – first human clinical study (trial)
  • Faeth therapeutics (founded 2019, raised $20M seed round) – “Precision nutrition” programs engineered to starve off cancerous tumor by targeting non-essential amino acids and by more broadly enabling precision nutrition derived from the tumor’s genotype and the organ from which the cancer originates.
    • They are studying pancreatic, colorectal, endometrial, and clear cell ovarian cancer. In the future they’re also looking to trial insulin-suppressing diets
    • The metastatic pancreatic cancer trial combines a reduced amino acid diet with a gemcitabine and nab-paclitaxel chemotherapy regimen is in development.
    • Metastatic colorectal cancer (trial)

Some other companies are tackling this from other angles. Journey Foods, for example, is creating software to better understand product formulation and suggestion ingredients. More broadly, I think it’s essential that food as medicine companies are either proving out novel research via clinical trials, or are running their own tight feedback loops with their products to understand when their diets and nutritional recommendations improve the lives of their patients.

It’s also worth reading Nikhil Krishnan’s Food as Medicine post on the subject which encompasses broader data that food interventions for at-risk populations work, and practical thoughts on tracking outcomes within billing systems and broader implementation.

Conclusion

Tangentially, there are a number of additional areas of study that I hope will be progressed as more clinical studies are completed with food as medicine for cancer treatment. The number of auto-immune disorders for women especially is climbing and go vastly under-diagnosed, microbiome gut health is becoming better understood but still has a long way to go in terms of actionability, and nutrition broadly seems poised to finally benefit from the great personalized healthcare revolution as we get more longitudinal data on metabolism, and as consumers are enabled to understand their own metabolic data through wearables like Levels. Ideally, the more we map metabolic pathways, the better we can become at targeting specific parts of them through dietary interventions and others to disable cancers.

Although there’s much work to be done and more data to be gathered, the investment in greater research in the space is deeply exciting. We’re excited to find a team working in the space to invest in, and welcome outreach if you’re working on something in the area!

As always — feel free to tweet or message me questions, thoughts, disagreements, or pitches on twitter or at nicolewilliams@compound.vc. Thanks to Cooper Clawson for your help and guidance.

Background research: