Glucose-containing carriers in cancer therapy (GLUCOSE-ONC): A multistream critical review and quantitative exposure...

Claims that glucose-containing anticancer infusions 'feed cancer' conflate a transient pharmaceutical carrier with chronic dysglycaemia and assume that glucose uptake equals tumour growth. We developed GLUCOSE-ONC, a multistream critical review separating direct systemic carrier comparisons, acute human glycaemia, parenteral nutrition as a high-exposure boundary, chronic dysglycaemia, and translational glucose-drug interactions. Four reproducible PubMed searches yielded 1,077 unique records; chronic dysglycaemia was handled as contextual evidence, and the clinically relevant set was curated with explicit causal-distance rules. Only one randomised systemic carrier comparison was identified: 5% glucose reduced gemcitabine vascular pain versus saline, but progression and survival were not measured. Dextrose-based hyperthermic intraperitoneal chemotherapy produced marked hyperglycaemia and inconsistent perioperative outcomes, but its large heated intraperitoneal exposure is not transportable to routine systemic carriers. Parenteral-nutrition trials, despite much larger and repeated nutrient exposure, showed mixed survival findings and no consistent neoplastic-acceleration pattern; infection and catheter effects contributed to net harm. Translational findings were bidirectional: high glucose induced resistance in some models but sensitised pancreatic and hepatocellular models, whereas glucose deprivation also induced resistance in selected endometrial and ovarian models. A 100-500 mL 5% dextrose bag contains 5-25 g; at 70 kg, 25 g over 2 h is 2.98 mg/kg/min, a transient flux subject to endogenous-production and disposal feedback. Standard glucose-containing infusion should not be conflated with chronic hyperglycaemia. Available evidence does not support the claim that transient carrier-level glucose exposure accelerates cancer progression, although direct outcome studies remain insufficient to prove exact equivalence.