Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety study

Abstract

Background: High-grade glioma cells consume mainly glucose and cannot compensate for glucose restriction. Apoptosis may potentially occur under carbohydrate restriction by a ketogenic diet (KD). We explored the feasibility and safety of KD during standard treatment of chemoradiation in patients with glioblastoma multiforme. Methods: A full liquid KD induced ketosis within 2 weeks before start of chemoradiation. After 6 weeks, the KD was modified with solid foods and medium-chain-triglyceride emulsions and used for an additional 6 weeks while maintaining ketosis. During the total study period (14 weeks), feasibility, safety, coping (both patient and partner), quality of life (QoL), neurological functioning and impairment were measured. Overall survival was analyzed with actuarial estimates. Results: Eleven patients started the study protocol, nine reached ketosis and six (67%) completed the study. Severe adverse effects did not occur. The majority of coping scores ranged from 3 to 6 on a 10-point scale at all timepoints; QoL, neurological functioning, and impairment did not essentially change over time; overall survival ranged between 9.8 and 19.0 months. Conclusion: KD was feasible and safe as an adjuvant to standard chemoradiation treatment of glioblastoma multiforme. A supportive partner and intensive counseling were essential for coping. Future research should identify possible beneficial effects on overall survival. Clinical trial registration: Netherlands Trial Registry: NTR5167 (registration date 29-01-2015),

The effect of a ketogenic diet and synergy with rapamycin in a mouse model of breast cancer

“…Rapamycin was selected for the current animal study because it a) has the potential to be a successful anti-cancer drug when administered at doses known to be normo-glycemic in mice b) it may yet have utility in humans and c) has been an FDA approved drug since 1999 [12]. The principle of combining a ketogenic diet with other forms of anti-cancer chemotherapies for widely metastatic disease has been reported to have potential additive effects in mice [13,14], as well as in limited human studies [4,[15][16][17][18]. As above, rapamycin is not expected to induce hyperglycemia in our mouse model and we wished to determine if a KD would exert its cytotoxic effects even in the absence of hyperglycemia.…”

The Effect of a Ketogenic Diet and Synergy with Rapamycin in a Mouse Model of Breast Cancer

“…Rapamycin was selected for the current animal study because it a) has the potential to be a successful anti-cancer drug when administered at doses known to be normo-glycemic in mice b) it may yet have utility in humans and c) has been an FDA approved drug since 1999 [11]. The principle of combining a ketogenic diet with other forms of anti-cancer chemotherapies for widely metastatic disease has been reported to have additive effects in mice [12] [13] [14], as well as in limited human studies [4] [15] [16] [17]. As above, rapamycin is not expected to induce hyperglycemia in our mouse model and we wished to determine if a KD would exert its cytotoxic effects even in the absence of hyperglycemia.…”

Impact of carbohydrate-reduced nutrition in septic patients on ICU: study protocol for a prospective randomised controlled trial

“… 19 20 Also, ketogenic/low-carb nutritional regimes have recently been investigated in clinical studies enrolling overweight patients with type II diabetes 21 and patients suffering from glioblastoma. 22 These studies reported no adverse side effects, providing additional evidence that ketogenic/low-carb diets are feasible and safe.…”