Dieta cetogénica y cáncer (volver al texto)
Tabla 2 estudios clínicos
Estudios clínicos en el contexto de la dieta cetogénica y el cáncer.
| Cáncer | Tamaño del grupo de estudio (n) | Intervención dietética (n) | Finalización del estudio (n) | Combinado con terapia tumoral (n) | Duración del estudio | Cambios metabólicos | Resultado principal | Efecto en la calidad de vida | Árbitro. |
|---|---|---|---|---|---|---|---|---|---|
| Glioblastoma | 1 | CR-KD 20 g KetoCal® 4: 1 + 10 g de grasa, 32 g de proteína, 10 g de CHO, 600 kcal / día (1) | 1/1 | S T | 14 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] |
| Glioblastoma | 20 | KD 60 g CHO / día (20) | 20/8 | S T | 6 + 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] |
| Glioblastoma | 2 | CR-KD 3: 1, 20% CR / día (2) | 1/2 | No | 3 meses | ↔ glucosa ↑ cetosis ↓ peso corporal | TP en ambos pacientes | no especificado | [76] |
| Glioblastoma | 32 | KD 50% kcal de grasa, 25% kcal de CHO, 1,5 g / kg de proteína (17), CD (15) | 17/9, 15/8 | 55 mg POH | 3 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] |
| Glioblastoma | 1 | CR-KD 4: 1, 900 kcal / día (1) | 1/1 | CT + RT + varios medicamentos + TOHB | 9 meses | ↓ glucosa ↑ cetosis ↓ peso corporal | TR significativa, el paciente continuó un KD con 1500 kcal / día + terapia; después de 20 meses: más TR | no especificado | [75] |
| Glioblastoma | 53 | KD 30-50 g CHO / día (5), CR-KD (1) | 6/6 | RT (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 RT | no especificado | [90] |
| Glioblastoma y gliomatosis cerebri | 9 | KD 4: 1 (5), CD (4) | 2/5, 4/4 | ST (4/5, 4/4) | 2-31 meses | ↑ cetosis | KD estricto: 1 SD, 1 TP; cetonas detectables en el cerebro intermitente KD: 3 TP CD: 2 SD, 2 TP | no especificado | [131] |
| Glioma | 172 | KD modificado 70% kcal de grasa, 20 g CHO / día (6) | 4/6 | S T | 3 meses | ↑ cetosis ↔ peso corporal | KD modificado fue bien tolerado; sin datos sobre TP | buena calidad de vida autoinformada | [80] |
| Glioma | 8 | MAD 20 g CHO / día (8) | 7/8 | ST (3/8) | 2-24 meses | ↓ peso corporal | ↑ seizure control in brain tumor patients; at 13.2 months of follow-up all patients were alive | not specified | [73] |
| Advanced stage malignant astrocytoma | 2 children | KD 70% kcal fat, 30% kcal CHO + protein (2) | 2/2 | ST | 8 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 cancer | 359 | KD >= 40% kcal fat and <100 g/day glycemic load (48) | 48/48 | RT (18/48) | not specified | not specified | KD ↓ 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 deaths | not specified | [196] |
| Breast cancer | 1 | strict KD + high dose vitamin D3, not further specified (1) | 1/1 | no | 3 weeks | not specified | changes in biological markers of breast cancer (↓ HER2 and ↑ PgR expression) | not specified | [72] |
| Triple-negative breast cancer | 1 | KD, not further specified (1) | 1/1 | MSCT + HT + BHOT | 6 months | ↑ ketosis ↓ body weight | clinical, radiological and pathological complete response | self-reported ↑ QoL | [69] |
| Liver metastases from colorectal cancer | 12 | LTPN (6), GTPN (6) | 6/6, 6/6 | no | 3 h | not specified | ↔ FDG uptake in liver metastasis after LTPN compared to GTPN | not specified | [197] |
| Gastro-intestinal tract | 27 | LTPN (9), GTPN (9), oral CD (9) | 9/9, 9/9, 9/9 | no | 14 days | ↔ glucose ↔ body weight | number of replicating cells: GTPN 32.2% ↑, LTPN 24.3% ↓, CD 15% ↑ | not specified | [86] |
| Intra-abdominal desmoid tumor | 1 | LTPN (1) | 1/1 | no | 5 months | ↓ glucose ↑ ketosis ↔ body weight | ↔ tumor volume | not specified | [71] |
| Pancreato-biliary cancer | 30 | KD 1–2:1 (20), CD (10) | 10/20, 9/10 | no | 10 + days | ↑ ketosis ↓ fat mass, preserved lean mass | KD significantly ↑ energy intake, meal compliance and meal satisfaction rate after surgery; no data on TP | not specified | [87] |
| Lung and pancreatic cancer | 9 | KD 4:1 (9) | 3/9 | ST | 5–6 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 cancer | 44 | mild KD, avoidance of high CHO foods (44) | 42/44 | MSCT + HT + BHOT | 6 months | not specified | at 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 complex | 5 (3 children) | KD 3–4:1 (5) | 5/5 | no | 3 months-5.7 years | ↑ ketosis | KD did not suppress tumor growth or induce tumor regression | not specified | [82] |
| Ovarian and endometrial cancer | 73 | KD 70% kcal fat, 30% kcal CHO + protein (37), CD (36) | 25/37, 20/26 | ST (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 cancer | 12 | KD, not further specified (12) | 12/12 | not specified | 4 days | not specified | ↓ mean lactate concentration in the tumor tissue | not specified | [104] |
| Colorectal, breast, and head and neck cancer | 85 | fasting 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 composition | not specified | [88] |
| Malignant diseases* | 5 | KD via nasogastric tube, 70% kcal fat, 30% kcal CHO + protein suppl. with BHB salt (5) | 5/5 | not specified | 7 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* | 16 | LCHF < 70 g CHO/day (16) | 5/16 | no | up 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* | 17 | MAD 20–40 g CHO/day (11) | 4/11 | no | up 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* | 12 | KD 5% CHO/day (10) | 10/10 | no | 26–28 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, respectively | not specified | [81] |
| Any type* | 6 | KD < 50 g CHO/day (6) | 6/6 | RT | 32–73 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* | 78 | full KD (7) and partial KD (6), not further specified | not specified | not specified | 10 months | not specified | correlation between an improvement of the disease and fully adopting a KD; KD ↓ TKTL1 levels | not specified | [91] |
↑: 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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