Ketogenic Diets as an Adjuvant Therapy in Glioblastoma

Not Applicable

Completed

• Conditions: Glioblastoma; Glioblastoma Multiforme; Glioblastoma, Adult
• Interventions: Other: MKD; Other: MCT

• Registration Number: NCT03075514
• Lead Sponsor: University of Liverpool

Brief Summary

Glioblastoma (GB) is the commonest form of brain cancer in adults. Despite current treatment options including surgery, radiotherapy and chemotherapy, overall survival is poor. Therefore, other treatment options are being explored and there is increasing interest in the possibility of using the ketogenic diet (KD), alongside current treatment options.

The KD is a high fat, low carbohydrate diet. This encourages the body to use fat (broken down to ketones) as its primary energy source, instead of carbohydrate (broken down to glucose, a type of sugar). KDs have been considered for use in patients with GB as this type of cancer is thought to use glucose as its main energy supply, which is of short supply in this diet. Animal studies have shown KDs may make GB more responsive to radiotherapy and chemotherapy and could improve survival by slowing the cancer's growth. However, clinical studies are needed in humans to assess any possible benefits.

This trial will see patients randomly assigned to one of two types of KDs; the modified ketogenic diet (MKD) and the medium chain triglyceride ketogenic diet (MCT). Both diets follow the same high fat, low carbohydrate principles, with the MCT diet requiring the patient to take some of the fat as a supplement drink instead of as food. Patients will follow the diet for 12 weeks initially. The trial will look to enroll newly diagnosed GB patients, from The Walton Centre NHS Foundation Trust over a 12 month period.

The aim of the trial is to investigate protocol feasibility and patient impact by comparing two KDs in an NHS setting, with a view to informing future phase III clinical trials.

Detailed Description

A prospective, non-blinded, randomized, pilot study will be undertaken in patients with glioblastoma (GB). Patients will be randomized to the modified ketogenic diet (MKD) or the medium chain triglyceride ketogenic diet (MCT) for a 12 week period (primary completion). If patients wish to remain on diet, they will be offered dietetic support for a total of 12 months (secondary completion).

The trial will be open to all Walton Centre Foundation Trust patients with a newly diagnosed GB, who have undergone surgical resection or biopsy within the last four months and who are going on to receive/ are currently receiving/ have completed oncological treatments (radiotherapy or chemotherapy or chemoradiotherapy). Patients will be referred via neuro-oncology multi-disciplinary meetings and neurosurgical clinics, post histology. The diet will be offered alongside standard care, commencing within four months of surgery.

Both diets are high in fat and low in carbohydrate, but contain different types and amounts of fats. The MKD is 80% fat (predominately long chain fatty acids) and 5% carbohydrate, whilst the MCT diet is 75% fat (30% of which is medium chain fatty acids) and 10% carbohydrate.

A permuted block randomization method will be adopted, using 'sealedenvelope' randomization system. This will be set up and administered by the statistician, who is not involved with the recruiting of patients.

Patients will receive regular input from the trial dietitian. This includes clinical consultations at baseline, dietary initiation, week 6, week 12 and every 3 months thereafter and telephone consultations at weeks 1, 3 and 9. Patients will receive dietary and ketone monitoring education.

Assessments and monitoring undertaken at each consultation include anthropometry, biochemistry, compliance, tolerance, acceptability, quality of life and ketosis.

Informed consent will be obtained prior to enrollment and the patient may withdraw at any time.

An information study is also embedded into KEATING, to aid understanding of the patients' recruitment experience and viewpoints, by interviewing a sub-sample of patients and their relatives/ carers. This will enable the design of bespoke strategies to optimise recruitment to future trials related to ketogenic diets and gliomas

Study Timeline

• Study First Submitted: 2017-02-28
• Study First Submitted QC: 2017-03-03
• Study First Posted: 2017-03-09
• Study Start: 2017-04-01
• Primary Completion: 2019-03-05
• Study Completion: 2019-03-05
• Status Verified: 2019-04
• Last Update Submitted: 2019-04-02
• Last Update Posted: 2019-04-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 12

Inclusion Criteria

• Age ≥16 years
• Patient at The Walton Centre NHS Foundation Trust
• Performance status ≤2
• Confirmed histological diagnosis of glioblastoma
• Undergone surgical resection or biopsy and will go onto receive/ is receiving/ has received oncological treatments

Exclusion Criteria

• Having prior use of KD
• Kidney dysfunction
• Liver dysfunction
• Gall bladder dysfunction
• Metabolic disorder
• Eating disorder
• Diabetes (requiring medication)
• Body mass index ≤ 18.5kg/m2
• Weight loss medications
• Currently pregnant or breast feeding
• Performance status ≥3

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Modified ketogenic diet (MKD)	MKD	MKD: 80% fat and 5% carbohydrate (% of total energy requirements per day).
Medium chain triglyceride (MCT) diet	MCT	MCT: 75% fat (30% of which is medium chain fatty acids taken as a supplement) and 5% carbohydrate (% of total energy requirements per day).

Primary Outcome Measures

Name	Time	Method
To assess retention and drop out rates	12 weeks	The time to dietary discontinuation

Secondary Outcome Measures

Name	Time	Method
Long term retention	2 years	Time to dietary discontinuation after week 12
Estimation of recruitment rates	12 months	Actual recruitment compared to proposed recruitment
Enrollment of patients	12 months	Number of patients initiated on diet post oncological treatments.
Dietary adjustments required to achieve ketosis	2 years	Number of dietary adjustments to macronutrient composition of MCT and MKD diets required to achieve ketosis.
Self reported dietary compliance	2 years	Self reported by compliance rate
Dietetic time required for interventions	2 years	Dietetic time spent on clinical and non clinical activities relating to the trial.
Protocol refinements required	2 years	Number of deviations from the protocol including reasons for deviations.
Gastrointestinal side effects	2 years	Number of reported gastrointestinal side effects assessed through EORTC QLQ C30 questionnaire and Common Terminology Criteria for Adverse Events.
Sample size estimates for future trials	2 years	Number of participants required for future phase III clinical trials
Food acceptability	2 years	Change in food acceptability assessed through food acceptability questionnaire
Completeness of data	2 years	Number of complete data sets for all trial outcomes
Calculated dietary compliance	2 years	Analysed by comparing macronutrient content assessed via 3 day food diaries to advised macronutrient content.
MCT compliance	2 years	Dose of MCT taken compared to dose advised.
Ketosis levels	2 years	Self reported urinary ketone levels twice daily for first 6 weeks then once per week thereafter and blood ketone and glucose levels weekly.
Quality of life	2 years	Change in quality of life assessed through EORTC QLQ C30 and BN 20 questionnaires
Anthropometric changes	2 years	Changes to anthropometry (weight, body mass index, fat mass, muscle circumference, hand grip strength) during the duration of the diet.
Changes to biochemical markers	2 years	Changes to biochemical markers (renal, bone, LFT, lipid profiles) during the duration of the diet.

Trial Locations

Locations (1)

Univeristy of Liverpool/ The Walton Centre NHS Foundation Trust; 🇬🇧 Liverpool, Merseyside, United Kingdom