(P21-005-24) Impact of a Ketogenic Diet as an Adjuvant Therapy in Adults With Brain Metastases

Objectives: To explore whether an individualized well-formulated ketogenic diet (WFKD) or American Institute of Cancer Research (AICR) diet can be implemented in patients with brain metastases (BM) scheduled to receive stereotactic radiosurgery (SRS), and to test whether WFKD or AICR dietary approach can modulate the inflammatory markers.

Methods: We are actively enrolling adults aged 18 to 75 years with BM who are scheduled to receive SRS as part of the standard-of-care clinical treatment to be randomized to a 16-week WFKD (n=4) or AICR (n=4) diet. Eight patients have completed the trial to date. Extensive dietary coaching was provided and daily tracking of capillary beta-hydroxybutyrate (BHB) and glucose levels was used to personalize the diet, measure adherence, and glycemic control. The following assessments were made at baseline and 16-wk: body mass and composition (dual-energy x-ray absorptiometry), MRI scans, and a blood collection for determination of serum IL-8.

Results: Capillary βHB indicated the KD group achieved nutritional ketosis (Week 8 mean: 0.55 mM; Week 16 mean: 0.62 mM).  Both diet groups lost weight (-7.1% ; p = 0.016) and body fat  (-2.6%; p = 0.007), with no significant effect on lean body mass (4:1 fat:lean mass ratio loss). Serum IL-8  decreased over time for both diets (p=0.001), with a trend for a greater decrease in the KD group (p= 0.094, respectively). In the KD group, all patients had stable disease findings and no white matter changes on MRI. One patient in the AICR group experienced disease progression following SRS. A separate patient in the AICR group experienced white matter changes 6 months following SRS. All patients had follow-up imaging reviewed, and there were no significant increases in edema or radionecrosis findings.

Conclusions: A WFKD may be a feasible adjunct therapy for adults diagnosed with BM receiving SRS treatment. Preliminary data indicate that body composition measures improved in both diet groups. Enrollment is ongoing which will allow for more robust comparisons between diets on metabolic and inflammatory responses as well as disease progression.

Funding Sources: The funding organization for this study is Kroger.