Metabolomics in Thoracic Oncology from Biomarker Discovery to Therapeutic Targeting: A Narrative Review
5 affiliations
- 1Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- 2Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- 3Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- 4Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- 5Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
Abstract
Thoracic malignancies show context-dependent metabolic plasticity that influences growth, immune evasion, and treatment response. This review examines how metabolomics, stable-isotope tracing, and metabolic flux analysis complement molecular profiling in lung, esophageal, pleural, and thymic cancers. We distinguish metabolite abundance from isotope enrichment and quantitative flux, and review analytical platforms, computational workflows, histology-specific programs, immunometabolism, biomarkers, and therapy. Lung squamous cell carcinoma often depends on glycolysis, lung adenocarcinoma shows substrate and spatial heterogeneity, and molecular subsets of small cell lung cancer have preclinical vulnerabilities in arginine metabolism and guanosine nucleotide synthesis. Hypoxia and metabolite exchange among malignant, stromal, and immune cells may shape therapeutic resistance. Biofluid and tissue studies support early detection and monitoring, but most circulating signatures and findings in rare thoracic tumors remain exploratory. Translation is limited by confounding, incomplete metabolite identification, small cohorts, and limited external validation. Trials of unselected metabolic inhibitors have largely failed. Two biomarker-selected strategies have advanced: arginine deprivation in non-epithelioid pleural mesothelioma, a population enriched for argininosuccinate synthetase 1 (ASS1) deficiency, and PRMT5 inhibition in tumors with MTAP deletion. These results suggest that success may depend on selecting patients by a demonstrated metabolic dependency rather than by the plausibility of the target. Progress requires harmonized multicenter workflows, paired tissue and biofluid sampling, rigorous validation, and integration with spatial, single-cell, multi-omic, and clinical data.
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BibTeX
@article{mahmoud2026metabolomics,
title = {{Metabolomics in Thoracic Oncology from Biomarker Discovery to Therapeutic Targeting: A Narrative Review}},
author = {Mohamed A. Mahmoud and Gaurav Sharma and Inderpal S. Sarkaria and Matthew R. Porembka and Ralph J. DeBerardinis and Kemp H. Kernstine},
journal = {Cancers},
year = {2026},
month = nov,
doi = {10.3390/cancers18213582},
url = {https://www.mdpi.com/2072-6694/18/21/3582},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Metabolomics in Thoracic Oncology from Biomarker Discovery to Therapeutic Targeting: A Narrative Review
AU - Mohamed A. Mahmoud
AU - Gaurav Sharma
AU - Inderpal S. Sarkaria
AU - Matthew R. Porembka
AU - Ralph J. DeBerardinis
AU - Kemp H. Kernstine
PY - 2026
DA - 2026/11/07
JO - Cancers
DO - 10.3390/cancers18213582
UR - https://www.mdpi.com/2072-6694/18/21/3582
AB - Thoracic malignancies show context-dependent metabolic plasticity that influences growth, immune evasion, and treatment response. This review examines how metabolomics, stable-isotope tracing, and metabolic flux analysis complement molecular profiling in lung, esophageal, pleural, and thymic cancers. We distinguish metabolite abundance from isotope enrichment and quantitative flux, and review analytical platforms, computational workflows, histology-specific programs, immunometabolism, biomarkers, and therapy. Lung squamous cell carcinoma often depends on glycolysis, lung adenocarcinoma shows substrate and spatial heterogeneity, and molecular subsets of small cell lung cancer have preclinical vulnerabilities in arginine metabolism and guanosine nucleotide synthesis. Hypoxia and metabolite exchange among malignant, stromal, and immune cells may shape therapeutic resistance. Biofluid and tissue studies support early detection and monitoring, but most circulating signatures and findings in rare thoracic tumors remain exploratory. Translation is limited by confounding, incomplete metabolite identification, small cohorts, and limited external validation. Trials of unselected metabolic inhibitors have largely failed. Two biomarker-selected strategies have advanced: arginine deprivation in non-epithelioid pleural mesothelioma, a population enriched for argininosuccinate synthetase 1 (ASS1) deficiency, and PRMT5 inhibition in tumors with MTAP deletion. These results suggest that success may depend on selecting patients by a demonstrated metabolic dependency rather than by the plausibility of the target. Progress requires harmonized multicenter workflows, paired tissue and biofluid sampling, rigorous validation, and integration with spatial, single-cell, multi-omic, and clinical data.
SN - 2072-6694
ER -