Treatment of advanced glioma with an energy restricted ketogenic diet: Case report and literature summary.

Abstract

Listen

Translate article

e13047 Background: We initiated a pilot study to evaluate an energy restricted ketogenic diet (ERKD) as treatment for patients with glioblastoma multiforme (GBM) whose brain tumor had progressed with standard therapy. Methods: This reports documents our experience using an ERKD with an IRB approved, clinical trials #NCTO1535911 registered treatment protocol and briefly summarizes the 5 published case reports that document favorable responses with ERKD. Results: Our patient, a 55-year-old white male, presented with a left sided visual field cut, decreased analytical mental skills, a slow methodical wide based gait and a right posterior brain mass with a histological diagnosis of GBM. After documented progression following surgery, radiation therapy and TMZ the patient was treated with ERKD. He was hospitalized to induce a decrease in glucose and an increase in ketones using Ketocal 20-25 Cal/Kg. Adherence and efficacy to the diet was monitored using AM and PM measurements of blood glucose and ketones. Initial treatment with Ketocal decreased his blood glucose so that his PM glucose was <80mg/dl and increased his PM ketones to >3mm(our protocol’s target concentrations). However, his AM glucose was still >80mg/dl and his AM ketones decreased to >2mM. Because of the low palatability of the Ketocal, the patient was switched to a ketogenic regular food diet with a 3:1 ratio of fat to proteins and carbohydrates. Out of the hospital and on this diet his PM ketones remained > 3mM and his AM > 2mM, but his AM and PM blood glucose increased to > 80mg/dl. After 4 weeks of treatment with the ERKD, the patient’s disease advanced; his vision, mobility and cognition decreased and MRI demonstrated tumor growth and he withdrew from the study. Five patients with advanced brain tumors and favorable responses to ERKD have been reported. The best response was a C.R. 5 years after diagnosis. In 4 of the 5 patients ERKD was combined with one of the standard modalities of treatment. At last report 3 of the 5 patients were C.R. and 2 had documented disease progression after stopping the ERKD. Conclusions: Investigation of ERKD in patients with malignant brain tumors using an approved, registered protocol under the guidance of a dietician is feasible.