Abstract
e13573 Background: Most aggressive cancers share a glycolytic phenotype associated with increased uptake of 18F-2-fluoro, 2-deoxyglucose (FDG) that may be detected by positron emission tomography (PET). We hypothesized that a carbohydrate restricted (CR) diet, by inhibiting insulin secretion, enlists plausible mechanisms to limit cancer growth. Methods: Patients with advanced incurable cancer were eligible if they had a positive FDG-PET scan, an ECOG performance status of 0-2 associated with normal organ function, no diabetes or recent weight loss, and a BMI >20 kg/m2. A supervised CR diet (5% of total kCal) was monitored weekly for macronutrient intake, body weight, serum electrolytes, betahydroxybutyrate concentrations [BHB], insulin, and insulin like growth factor-1 and 2 (IGF-1and IGF 2]. A FDG-PET scan was obtained before and after the CR diet. Results: Ten subjects completed 26-28 days of the CR diet without associated adverse effects. Mean caloric intake decreased by (35 + 6)% compared to baseline predictions of caloric requirements, and weight decreased by a median of 4% (range 0.0-6.1%.). One patient had advanced but indolent disease. Patients with non-progression (n=5), representing stable disease (SD) or partial remission (PR) on the post-CR diet FDG-PET scan exhibited three-fold higher dietary ketosis (p<0.02) when compared with patients with progressive disease (PD; n=4); but non-progression was not correlated with reduced calorie intake (p=0.65) or weight loss (p=0.35). Ketosis correlated inversely with serum insulin levels (r=0.62, p<0.001). Conclusions: A carbohydrate restricted diet is feasible in selected patients with advanced cancer, resulting in reduced serum insulin concentration and ketosis. Disease stabilization is correlated with the highest degrees of ketosis, supporting further evaluation of CR as a means of insulin secretory inhibition, and as a complementary approach in conjunction with standard and endocrine therapies. Energy deficit Pt. no. PET scan Ketosis on CR diet compared with baseline levels 0.35 3* SD 2.7 ± 1.2 0.42 2 PR 23.3 ± 14.2 0.29 5 SD 13.1 ± 18.5 0.53 7 SD 14.6 ± 11.8 0.07 8 SD 8.2 ± 2.8 0.45 10 SD 23.6 ± 8.2 0.33 1 PD 2.1 ± 1.9 0.28 4 PD 2.8 ± 1.2 0.31 6 PD 4.2 ± 2.8 0.60 9 PD 11.4 ± 4.5
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