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Modulating the Acidic Tumor Microenvironment to Enhance the Efficacy and Reduce the Toxicity of Cancer Treatment

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Tumor Microenvironment".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 1104

Special Issue Editors


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Guest Editor
Japanese Society on Inflammation and Metabolism in Cancer, 119 Nishioshikouji-cho, Nakagyoku, Kyoto 604-0842, Japan
Interests: cancer metabolism
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
Interests: melanoma; lung cancer; palliative care

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Guest Editor
1. Division of Molecular Medicine, Department of Internal Medicine, The University of New Mexico Health Sciences Center, Albuquerque, NM 87120, USA
2. Department of Pathology, The University of New Mexico Health Sciences Center, Albuquerque, NM 87120, USA
3. UNM Comprehensive Cancer Center, Albuquerque, NM 87131, USA
Interests: the biology and therapeutic utility of circulating tumor cells (CTCs); liquid biopsies; mechanisms of brain metastasis and dormancy in breast and melanoma cancers; molecular crosstalks between dormant bone-marrow (BM) cells and CTCs; roles of BM and BM cellular heterogeneity interplaying with metastasis and dormancy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cancer progression is closely associated with the acidic tumor microenvironment (TME), a hallmark of disturbed metabolic and thermodynamic order. The Warburg effect—characterized by aerobic glycolysis and lactate accumulation—leads to extracellular acidification, redox imbalance, and immune suppression. Alkalization therapy aims to restore this disrupted homeostasis by normalizing intra- and extracellular pH gradients, reactivating mitochondrial respiration, and reestablishing dissipative energy flow. Recent evidence indicates that modulation of TME acidity enhances the efficacy of immune checkpoint inhibitors, improves metabolic coordination, and suppresses tumor invasion and metastasis. This Special Issue, “Modulating the Acidic Tumor Microenvironment to Enhance the Efficacy and Reduce the Toxicity of Cancer Treatment,” seeks to integrate molecular, metabolic, and clinical perspectives to elucidate how pH restoration can reconstruct biological order and provide a foundation for science-based, personalized cancer therapy.

Prof. Dr. Hiromi Wada
Dr. Keisuke Shirai
Prof. Dr. Dario Marchetti
Guest Editors

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Keywords

  • Alkalization therapy
  • tumor microenvironment
  • Warburg effect
  • pH gradient
  • mitochondrial metabolism
  • redox balance
  • immune modulation
  • dissipative structure
  • personalized oncology
  • thermodynamic homeostasis

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Published Papers (1 paper)

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Review

16 pages, 1100 KB  
Review
Tumor Microenvironment Acidosis and Alkalization-Oriented Interventions in Advanced Solid Tumors: A Narrative Review and Science-Based Medicine Perspective on Long-Tail Survival
by Kazuyuki Suzuki, Shion Kachi and Hiromi Wada
Cancers 2026, 18(8), 1193; https://doi.org/10.3390/cancers18081193 - 8 Apr 2026
Viewed by 738
Abstract
Median overall survival remains a central endpoint in oncology, but it can obscure a clinically meaningful long tail of patients with advanced solid tumors who survive well beyond the median. One biological context in which this pattern may be relevant is tumor microenvironment [...] Read more.
Median overall survival remains a central endpoint in oncology, but it can obscure a clinically meaningful long tail of patients with advanced solid tumors who survive well beyond the median. One biological context in which this pattern may be relevant is tumor microenvironment (TME) acidosis. Driven by aerobic glycolysis, hypoxia, impaired perfusion, and proton-export programs, acidic TME is increasingly implicated in invasion, therapeutic resistance, and immune suppression. This narrative review examines TME acidosis as the primary biological framework and considers long-tail survival as a clinical lens through which its implications may be interpreted. We summarize the biological basis and heterogeneity of acidic TME, review current approaches to clinical and translational assessment of tumor acidity, including acidoCEST magnetic resonance imaging (MRI) and positron emission tomography (PET)-based approaches, and discuss the potential and limitations of alkalization-oriented interventions such as buffering and diet-based strategies. Particular attention is given to the distinction between direct measurements of tumor acidity and clinically feasible but indirect markers such as urinary pH, which should not be interpreted as a direct surrogate for local tumor extracellular pH. From a science-based medicine perspective, long-tail survival is treated here as a hypothesis-generating clinical signal rather than proof of causality. Overall, alkalization-oriented interventions appear biologically plausible and clinically testable, but current clinical evidence remains limited and context-dependent. Future progress will require mechanistically informed biomarkers, careful safety evaluation, and trial designs capable of detecting delayed separation of survival curves and tail-oriented patterns of benefit. Full article
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