Lifestyle Factors

The JLA Neuro-Oncology Priority Setting Partnership (link) identified the question of “Do lifestyle factors (e.g. sleep, stress, diet) influence tumour growth in people with brain or spinal cord tumours.”. This area is therefore now a priority area for clinical research. Patients want to be partners in their clinical management and often seek information about whether changes in lifestyle factors will have beneficial effects on tumour growth, survival or quality of life.

The web is full of unsubstantiated claims of benefit of different therapies that can be confusing and potentially harmful. Lifestyle factors have not been adequately assessed.

Diet

Some research has been done on the effect of the ketogenic diet in cancer (low carbohydrate, high fat diet). The ketogenic diet has been used in drug-resistant childhood epilepsy and epilepsy is one of the most common symptoms people with brain tumours have to cope with. .Brain tumour cells have altered energy metabolism. The ketogenic diet triggers a shift from glucose utilisation to fatty acid oxidation and ketone production, which healthy brain cells can adapt to but tumour cells struggle. Preclinical studies of malignant brain tumours indicate that a ketogenic diet targets angiogenesis and inflammation and may enhance the effectiveness of radiotherapy and possibly chemotherapy.

The ketogenic diet can be unpalatable and can be associated with harms, especially if not closely monitored by a dietician. In the UK, there are some very limited ketogenic therapy services for children, linked to epilepsy teams. Support for adults is not developed within NHS oncology teams. In USA, there are currently three centres conducting clinical trials on ketogenic therapy as an adjunctive component alongside chemotherapy and radiation in newly diagnosed GBM and one studying the effect on refractory and end stage GBM. Another USA team is looking at the use of ketogenic therapy and intermittent fasting in GBM management after the initial surgery, radiotherapy and chemotherapy has been completed. These are listed on ClinicalTrials.Gov. There are no UK trials currently underway of the ketogenic diet in glioma.

A Cochrane Systematic Review of Evidence in brain tumours is underway.

Some UK charities are supportive of developing the evidence around the ketogenic diet further (Matthew Friends Astro Brain tumour Fund and the Brain Tumour Research Campaign) to examine the potential for a UK trial.

The NCRI will hold an “Incubator Day” in 2016, to examine the current stage of research and advise on best design of any future study in the area.

If interested in supporting this research area, please contact the NCRI Brain Supportive & Palliative Care Group and leave details of your interest. (email: S&PC@neuro-oncology.org.uk)