INNV-01. KETOGENIC METABOLIC THERAPY SIGNIFICANTLY IMPROVES RADIOGRAPHIC AND CLINICAL RESPONSE TO SALVAGE TEMAZOLAMIDE IN PATIENTS WITH RECURRENT HIGH GRADE GLIOMAS

摘要

Ketogenic Metabolic Therapy (KMT), by the proposed Warburg effect, has been shown in animal studies to augment responses to chemotherapy in laboratory models of high grade gliomas. Anecdotal responses in human patients have also been reported. We advised patients in our clinic to adhere to a low-carbohydrate, high-fat diet to obtain a state of nutritional ketosis while undergoing temazolamide (TMZ) chemotherapy for recurrent high-grade gliomas. A registered dietitian, specifically trained in KMT was utilized as a consultant for all of these patients. Blood ketone levels were checked frequently to assure ketone levels above 0.5 mmol/L. Nine patients have documented a near-continuous state of ketosis for at least 3 months while on TMZ therapy and have shown significant radiographic resolution of recurrent disease based on serial high resolution MRI surveillance imaging. All of these patients had shown progressive recurrent disease on serial MRI imaging prior to initiation of KMT. 4 of the 9 patients obtained a complete response, while the other 5 experienced a partial response. None of the patients failed to show any improvement in their imaging follow-up while on KMT. Three of the 9 patients also had salvage radiation therapy to some local area of recurrence prior to initiating KMT. There were no adverse effects related to the KMT diet. Most patients stated that they felt an overall improvement in quality of life while on the diet and embraced the diet as a means of feeling more in control of their disease. The diet was well tolerated and not felt to be a hardship or burdensome after an initial learning curve transition period was overcome. Based on these highly positive preliminary results, we suggest that KMT be included in larger prospective randomized trials for up-front and recurrent high-grade glioma trials to augment standard and experimental therapies.