Dr. Tan-Shalaby is a physician in the Department of Medicine, Section of Hematology and Oncology at the VA Pittsburgh Healthcare System and a clinical assistant professor at the University of Pittsburgh School of Medicine, both in Pennsylvania.
Author disclosure The author reports no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combination—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Duke University has initiated a randomized study (NCT00932672) of the Atkins diet and androgen deprivation therapy for patients with prostate cancer. Tel Aviv Sourasky Medical Center in Israel is recruiting previously treated chemoradiation patients with high-grade glial tumors for an open-label study (NCT01092247) of the efficacy of KD in preventing tumor growth and recurrence. St. Joseph’s Hospital and Medical Center (Phoenix, AZ) is recruiting newly diagnosed glioblastoma patients for a phase 1/2 prospective trial (NCT02046187) involving upfront resection followed by KD with radiotherapy and concurrent temozolomide, followed by adjuvant temozolomide chemotherapy. The primary endpoint is number of patients with AEs and the secondary endpoints are overall survival, time to progression, and QOL. The University of Iowa is recruiting patients with prostate cancer and non-small cell lung cancer for 2 phase 1 studies (NCT01419483 and NCT01419587, respectively) involving KD using Nutritia KetoCal 4:1 (Gaithersburg, MD).
Conclusion
Data from case reports and trials suggest KD use is safe and tolerable for patients with cancer. Although it would be ideal to conduct a larger trial using a randomized therapeutic approach, the current emphasis on drug-based trials is a formidable obstacle. Other major obstacles are patient initiative and adherence. For now, investigators must work with anecdotal data. Examination of gene expression patterns in mitochondria and mutations in ketolytic and glycolytic enzymes may prove useful in selecting potentially responsive patients. Combining this dietary approach with standard chemotherapeutic and radiotherapeutic options may help improve tumor response, and further research is desperately needed.
