Dieta cetogénica cáncer (tabla 2)

Dieta cetogénica y cáncer (volver al texto)

Tabla 2 estudios clínicos

Estudios clínicos en el contexto de la dieta cetogénica y el cáncer.

CáncerTamaño del grupo de estudio (n)Intervención dietética (n)Finalización del estudio (n)Combinado con terapia tumoral (n)Duración del estudioCambios metabólicosResultado principalEfecto en la calidad de vidaÁrbitro.
Glioblastoma1CR-KD 20 g KetoCal® 4: 1 + 10 g de grasa, 32 g de proteína, 10 g de CHO, 600 kcal / día (1)1/1S T14 días CR-KD;
5 meses CR
↓ glucosa
↑ cetosis
↓ peso corporal
después de dos meses: respuesta completa;
diez semanas después de la suspensión de CR: el tumor recidivó
no especificado[77]
Glioblastoma20KD 60 g CHO / día (20)20/8S T6 + semanas↔ glucosa
↑ cetosis
↓ peso corporal
tendencia a una SSP más prolongada en individuos con cetosis estable (n = 8);
1 respuesta completa,
5 PR
3 dejaron de KD porque sintieron que la restricción de CHO
↓ QoL
[52]
Glioblastoma2CR-KD 3: 1, 20% CR / día (2)1/2No3 meses↔ glucosa
↑ cetosis
↓ peso corporal
TP en ambos pacientesno especificado[76]
Glioblastoma32KD 50% kcal de grasa, 25% kcal de CHO, 1,5 g / kg de proteína (17),
CD (15)
17/9,
15/8
55 mg POH3 meses↔ glucosa
↑ cetosis
↔ peso corporal
Grupo KD: 78% PR, 11% SD, 11% TP;
Grupo CD: 25% PR, 25% SD, 50% TP;
↓ área del tumor en el grupo KD en comparación con el valor inicial, no en el grupo CD
no especificado[20]
Glioblastoma1CR-KD 4: 1, 900 kcal / día (1)1/1CT + RT + varios medicamentos + TOHB9 meses↓ glucosa
↑ cetosis
↓ peso corporal
TR significativa, el paciente continuó un KD con 1500 kcal / día + terapia; después de 20 meses: más TRno especificado[75]
Glioblastoma53KD 30-50 g CHO / día (5), CR-KD (1)6/6RT (4/6)3 a 12 meses↓ glucosa
↑ cetosis
↓ peso corporal
5 TP; el paciente en CR-KD no mostró recurrencia tumoral 12 meses después de la RTno especificado[90]
Glioblastoma y gliomatosis cerebri9KD 4: 1 (5),
CD (4)
2/5,
4/4
ST (4/5, 4/4)2-31 meses↑ cetosisKD estricto: 1 SD, 1 TP; cetonas detectables en el cerebro
intermitente KD: 3 TP
CD: 2 SD, 2 TP
no especificado[131]
Glioma172KD modificado 70% kcal de grasa, 20 g CHO / día (6)4/6S T3 meses↑ cetosis
↔ peso corporal
KD modificado fue bien tolerado;
sin datos sobre TP
buena calidad de vida autoinformada[80]
Glioma8MAD 20 g CHO / día (8)7/8ST (3/8)2-24 meses↓ peso corporal↑ seizure control in brain tumor patients; at 13.2 months of follow-up all patients were alivenot specified[73]
Advanced stage malignant astrocytoma2 childrenKD 70% kcal fat, 30% kcal CHO + protein (2)2/2ST8 weeks↓ glucose
↑ ketosis
↑ body weight
2 complete responses;
↓ glucose uptake at tumor site by an average of 21.8%; both patients remained in remission 5 and 4 years after diagnosis, respectively
substantial ↑ QoL of patient 1 + significant ↑ in mood and skill learning[74]
Invasive rectal cancer359KD >= 40% kcal fat and <100 g/day glycemic load (48)48/48RT (18/48)not specifiednot specifiedKD ↓ the risk of cancer specific death; minimal difference in the risk of cancer specific death between KD and KD + RT; KD + RT ↓ the risk of cancer specific death compared to other deathsnot specified[196]
Breast cancer1strict KD + high dose vitamin D3, not further specified (1)1/1no3 weeksnot specifiedchanges in biological markers of breast cancer (↓ HER2 and ↑ PgR expression)not specified[72]
Triple-negative breast cancer1KD, not further specified (1)1/1MSCT + HT + BHOT6 months↑ ketosis
↓ body weight
clinical, radiological and pathological complete responseself-reported ↑ QoL[69]
Liver metastases from colorectal cancer12LTPN (6), GTPN (6)6/6,
6/6
no3 hnot specified↔ FDG uptake in liver metastasis after LTPN compared to GTPNnot specified[197]
Gastro-intestinal tract27LTPN (9),
GTPN (9), oral CD (9)
9/9,
9/9,
9/9
no14 days↔ glucose
↔ body weight
number of replicating cells: GTPN 32.2% ↑, LTPN 24.3% ↓, CD 15% ↑not specified[86]
Intra-abdominal desmoid tumor1LTPN (1)1/1no5 months↓ glucose
↑ ketosis
↔ body weight
↔ tumor volumenot specified[71]
Pancreato-biliary cancer30KD 1–2:1 (20),
CD (10)
10/20,
9/10
no10 + days↑ ketosis
↓ fat mass, preserved lean mass
KD significantly ↑ energy intake, meal compliance and meal satisfaction rate after surgery; no data on TPnot specified[87]
Lung and pancreatic cancer9KD 4:1 (9)3/9ST5–6 weeks↔ glucose
↑ ketosis
suboptimal compliance to KD;
lung cancer: 1 TP + brain metastases,
1 unknown response pancreatic cancer:
1 biliary obstruction + sepsis
not specified[55]
Non-small cell lung cancer44mild KD, avoidance of high CHO foods (44)42/44MSCT + HT + BHOT6 monthsnot specifiedat 6 months: 95.4% survival, 61.4% overall response rate, 15.9% SD, 22.7% TP
after follow-up: mean OS of 42.9 months, PFS of 41.0 months
not specified[83]
Tuberous sclerosis complex5 (3 children)KD 3–4:1 (5)5/5no3 months-5.7 years↑ ketosisKD did not suppress tumor growth or induce tumor regressionnot specified[82]
Ovarian and endometrial cancer73KD 70% kcal fat, 30% kcal CHO + protein (37),
CD (36)
25/37, 20/26ST (7/25, 4/26)3 months↓ glucose
↑ ketosis
↓ fat mass, preserved lean mass
inverse association of BHB and IGF-1 levels;
↑ physical function,
↓ cravings for starch food and fast food fats; patients in the KD group without chemotherapy reported significantly ↑ energy at 12 weeks compared to baseline; no data on TP
KD does not diminish QoL, KD may even ↑ QoL[84][85]
Head and neck cancer12KD, not further specified (12)12/12not specified4 daysnot specified↓ mean lactate concentration in the tumor tissuenot specified[104]
Colorectal, breast, and head and neck cancer85fasting prior to RT + ketogenic breakfast (MCT drink + 10 g EAA) on RT days or full KD + 10 g EAA on RT days (22);
CD (63)
20/22;
61/63
RT (9/20; 30/61) or RT + CT (11/20; 31/61)35–40 days↑ ketosis colorectal + breast cancer: ↓ fat mass, preserved lean mass
head and neck cancer:
↑ body weight and lean mass
ongoing clinical phase I study: first results indicate significant favorable effects of the KD on cancer patients’ body compositionnot specified[88]
Malignant diseases*5KD via nasogastric tube, 70% kcal fat, 30% kcal CHO + protein suppl. with BHB salt (5)5/5not specified7 days↓ glucose
↑ ketosis
↑ body weight
cachectic patients ↑ body weight after 7 days;
patients maintained in a positive N balance;
no data on TP
not specified[70]
Advanced metastatic tumors*16LCHF < 70 g CHO/day (16)5/16noup to 3 months↓ glucose
↑ ketosis
↓ body weight
5 SD, patients reported ↑ emotional functioning and ↓ insomnia↔ QoL or ↓ QoL, which reflects advanced stage diseases[79]
Advanced malignancies*17MAD 20–40 g CHO/day (11)4/11noup to 4 months↔ glucose
↑ ketosis
↓ body weight
after 4 weeks: 5 TP, 6 SD or PR, those 6 dieted further to week 8: 1 TP, 5 SD;
4 continued the diet until week 16 and showed SD or TR; ↑ survival in 3 melanoma and 1 lung cancer patient
slightly ↑ QoL[78]
Any type*12KD 5% CHO/day (10)10/10no26–28 days↓ glucose
↑ ketosis
↓ body weight
5 SD, 1 PR, 4 TP; level of ketosis correlated with SD or PR; insulin levels correlated positively and negatively with glucose and BHB, respectivelynot specified[81]
Any type*6KD < 50 g CHO/day (6)6/6RT32–73 days↔ glucose
↑ ketosis
↓ fat mass, preserved lean mass
5 TR (early stage disease); 1 slight TP; KD administered during standard therapy is safe and might be helpful in preserving muscle mass↔ QoL, patients felt good on the diet and all continued a low CHO diet or KD after RT[8]
Any type*78full KD (7) and partial KD (6), not further specifiednot specifiednot specified10 monthsnot specifiedcorrelation between an improvement of the disease and fully adopting a KD;
KD ↓ TKTL1 levels
not specified[91]
Barra de desplazamiento para lectura completa

↑: aumentado, ↓: disminuido, ↔ no alterado, *: para tipos de cáncer, consulte la publicación original, BHB: β-hidroxibutirato, CD: dieta de control, CHO: carbohidratos, CR: restricción calórica, CR-KD: cetogénico restringido en calorías dieta, CT: quimioterapia, EAA: aminoácidos esenciales, GTPN: nutrición parenteral total basada en glucosa, TOHB: oxigenoterapia hiperbárica, HER2: receptor 2 del factor de crecimiento epidérmico humano, HT: hipertermia, KD: dieta cetogénica, LCHF: baja en carbohidratos dieta alta en grasas, LTPN: nutrición parenteral total basada en lípidos, DAM: dieta Atkins modificada, MSCT: quimioterapia con apoyo metabólico, SG: supervivencia general, SSP: supervivencia libre de progresión, PgR: receptor de progesterona, POH: alcohol perilílico, PR: parcial respuesta, QoL: calidad de vida, SD: enfermedad estable, ST: terapia estándar, TKTL1: transcetolasa-like-1, TP: progresión tumoral, TR: regresión tumoral.

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