ATCT-28: THE MODIFIED ATKINS DIET IN RECURRENT GLIOMA: A RETROSPECTIVE REVIEW

BACKGROUND: Glioblastoma (GBM) generates ATP via glycolysis even under oxygenation ("Warburg effect"). A strict ketogenic diet (KD) reduces glucose availability and increases ketone bodies. KD also reduces reactive oxygen species and downregulates signaling pathway genes associated with GBM growth (Scheck AC. 2012). Efficacy of KD as compared to standard diet is demonstrated in mouse GBM xenograft models (Abdelwahab MG. 2012). Rieger (Rieger J. 2014) demonstrated compliance in 17/20 recurrent GBM patients treated with a modified KD (up to 60 gm/day carbohydrate allowed). We report our experience with the modified Atkins diet (MAD) a high fat, carbohydrate-restricted (2-5% of total calories) diet in recurrent glioma patients. METHODS: Retrospective review of glioma patients treated with MAD at our institution. RESULTS: 13 patients aged 23-72 years with recurrent gliomas (7 GBM, 4 low grade, 2 anaplastic) were treated with MAD. IDH 1 was negative in 10/11 available tumor specimens. Diet was combined with chemotherapy or targeted agents in 9 patients. All created home meal plans. Two intermittently used a prepared food supplement to achieve diet guidelines. Time on diet ranged 1-21 mos.; 4 continue at 1.5 to 21 months. Two patients were noncompliant. Diet was discontinued because of disease progression in 4 (at 1-12 months). Two others discontinued the diet because of weight loss (1) and inconvenience (1). One experienced a serious adverse event (SAE) of renal calculus at 11 months. CONCLUSIONS: The MAD was tolerated in the majority of patients with recurrent glioma. There was one SAE. We are unable to correlate outcome with tumor IDH1 mutational status: IDH1 was negative in all but one tumor studied. The benefit of MAD and optimal combination with radiation and/or chemotherapy requires prospective study.