NT-31 * KETOGENIC DIET USED AS TREATEMENT FOR PRIMARY AGGRESSIVE BRAIN CANCERS: EXPERIENCE IN HUMANS

Abstract

BACKGROUND: A ketogenic diet (KD) has been proposed as an alternative therapy for treatment of malignant gliomas. Unlike normal brain, malignant brain tumors may not be able to efficiently metabolize ketones. The ketogenic diet exploits this metabolic difference as a possible therapeutic approach. This report reviews the past reported experiences in humans using a ketogenic diet to treat aggressive primary brain cancers and includes our experience treating 2 patients with an energy restricted ketogenic diet (ERKD). METHODS: Patients in this report include 5 detailed case reports, 2 new patients treated with an ERKD protocol and 19 recently reported patients from Germany. RESULTS: Patients were treated using different protocols. Two were monitored with twice daily measurements of blood glucose and ketones and daily weights while the remaining patients' ketones and glucose and weight measurements were intermittent and not at prescribed intervals. Prolonged remissions ranging from more than 5 years to 4 months were reported in detailed case reports. Only one of these patients was treated using the ketogenic diet as monotherapy. The best responses reported in more recent patient series were stable disease for approximately 6 weeks. Two patients with progressive disease after 12 weeks of diet therapy had tissue expression of at least one of 2 mitochondrial ketolytic enzymes succinyl CoA: 3-oxoacid CoA transferase (OXCT-1), β-3-hydroxybutyrate dehydrogenase 1 (BDH1). The 19 patients from Germany treated with a ketogenic diet demonstrated that the diet was safe with no major side effects. CONCLUSION: 1. Treatment with a ketogenic diet may be effective in controlling some patients with primary brain cancers, but additional protocol studies are needed; 2. Ketosis can be induce using customary foods and; 3. A ketogenic diet is safe without major side effects. TRIAL REGISTRATION: ClinicalTrials.gov# {type:clinical-trial,attrs:{text:NCT01535911,term_id:NCT01535911}}NCT01535911