Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer

Abstract

Triple-negative breast cancer (TNBC) is more aggressive and metastatic than other breast cancer types. Cytotoxic chemotherapy is presently the predominant systemic therapy for TNBC patients. This case report highlights the influence of metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT) in an overweight 29-year-old woman with stage IV (T4N3M1) triple-negative invasive ductal carcinoma of the breast. The patient presented with an observable mass in her left breast detected during a physical examination in December 2015. Magnetic resonance imaging revealed a Breast Imaging Reporting and Data System Category 5 tumor and multiple lymphadenomegaly in the left axilla. A Tru-Cut biopsy led to the diagnosis of a triple-negative nuclear grade 2 invasive ductal carcinoma. The patient was admitted to ChemoThermia Oncology Center, Istanbul, Turkey in October 2016, and a whole body (18F)-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) scan revealed a 77 mm x 55 mm primary tumor in her left breast, multiple left pectoral and axillary lymph nodes, multiple widespread liver masses, and an upper left nodular abdominal lesion. The patient received a treatment protocol consisting of MSCT, KD, HT, and HBOT. A follow-up whole body 18F-FDG PET-CT scan in February 2017 showed a complete therapeutic response with no evidence of abnormal FDG uptake. The patient continued to receive this treatment protocol and in April 2017 underwent a mastectomy, which revealed a complete pathological response consistent with the response indicated by her PET-CT imaging. This single case study presents evidence of a complete clinical, radiological, and pathological response following a six-month treatment period using a combination of MSCT and a novel metabolic therapy in a patient with stage IV TNBC.

Aggressive skeletal muscle metastasis from cervical cancer invading into the spinal canal: A case report

“…Biochemically, the local production of lactic acid, with a relative lack of oxygen on occasion, could prevent tumor cell survival and proliferation. On the other hand, we can postulate that the abundance of vascularization and rich oxygen levels (when at rest), and rapid fluctuations during exercise, for which the tumor cell is unable to adapt to, could also be anti‐tumorigenic, as shown in hyperbaric oxygen experiments …”

“…On the other hand, we can postulate that the abundance of vascularization and rich oxygen levels (when at rest), and rapid fluctuations during exercise, for which the tumor cell is unable to adapt to, could also be anti-tumorigenic, as shown in hyperbaric oxygen experiments. 4,5 Protease inhibitors located in the skeletal muscle cell basement membrane may play a vital role in preventing invasion of tumor cells as well. Immune-mediated antitumor activity by lymphocytes and natural killer cells within the skeletal muscle are other postulated theories that may help reduce the incidence of metastasis.…”

Consideration of Ketogenic Metabolic Therapy as a Complementary or Alternative Approach for Managing Breast Cancer

“…Ketogenic metabolic therapy (KMT) is emerging as an effective complementary or alternative therapeutic strategy for managing a broad range of malignant cancers including breast cancer (151)(152)(153)(154)(155)(156)(157)(158)(159)(160). Calorie restriction and low-carbohydrate high-fat ketogenic diets (KD) reduce the glucose needed to propell the Warburg effect while also elevating ketone bodies (34).…”

“…Reduction of carbohydrate intake after breast cancer diagnosis in women reduces risk of recurrence (198). Evidence shows that therapeutic ketosis can act synergistically with several drugs and procedures to enhance cancer management while improving both progressionfree and overall survival (34, 154,199,200). For example, hyperbaric oxygen therapy (HBOT) increases oxidative stress on tumor cells especially when used alongside therapies that reduce blood glucose and elevate blood ketones (201).…”

Fasting, Fats, and Physics: Combining Ketogenic and Radiation Therapy against Cancer

“…This would support the use of both ketogenic therapy and HBO prior to an RT session as a complementary treatment approach. A recent case report of a poly-metastasized breast cancer patient in which a combination of HBO, KD, STF, glucose deprivation, hyperthermia and chemotherapy was used over 6 months reported a complete clinical, radiological, and pathological response and provides a proof-of-principle example for such integrative treatment concepts [111]. …”