Ctni-15. Clinical Effect of Ketogenic Diet Combined With Standard Therapy Including Bevacizumab for Malignant Glioma

INTRODUCTION Glioma exhibit an upregulated glucose-dependent metabolic pathway. Based on our previous study, we conducted a clinical study to evaluate the feasibility of combining standard therapy with a ketogenic diet in patients with malignant glioma. MATERIALS AND METHODS The ketogenic diet protocol consisted of restricting carbohydrate intake to 10 g/day during the first week, 20 g/day for the subsequent two months, and 30 g/day from the third month onward. During the ketogenic diet therapy, body weight, blood ketone levels, blood glucose levels, and cholesterol levels were measured. RESULTS A total of 10 patients were enrolled, with an average age of 39 years. Five patients had newly diagnosed gliomas, and five had recurrent disease. The median duration of ketogenic diet adherence was 189 days. All patients received the vascular endothelial growth factor inhibitor bevacizumab in combination with the ketogenic diet. The mean peak blood ketone level was 4305 μmol/L. Adverse events included abdominal pain (1 case), taste disturbance (1 case), skin disorders (1 case), vomiting (1 case), and diarrhea (1 case). Tumor response outcomes of one year after ketogenic diet were as follows: complete response in 1 cases, partial response in 3 cases, stable disease in 4 cases, and progressive disease in 2 cases. Nine patients discontinued the Ketogenic diet, while one patient continued it over 5 years. Five cases are alive and 5 cases are dead. The median progression-free survival after the ketogenic diet was 369 days. CONCLUSION The combination of a ketogenic diet with standard therapy, including a vascular endothelial growth factor inhibitor, was safely administered to the patients with malignant glioma. Some cases showed promising efficacy, and further analysis with a larger sample size is necessary.