生酮饮食与化学免疫治疗相结合的经验:一个病例报告和文献综述。

Daniel Sims, Agnes K Liman, Victoria Leung, Andrew Hwang, Jeffrey Means, Andrew D Liman
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摘要

背景:文献报道高脂肪、中等蛋白质、低碳水化合物生酮饮食是癌症患者的一种治疗选择。病例介绍:一名69岁的退伍军人最初被诊断为III期结直肠癌,尽管手术后完成了辅助FOLFOX(氟尿嘧啶、亚叶酸钙和奥沙利铂),但仍进展为肝脏、胰腺和大网膜淋巴结受累。患者接受FOLFIRI(氟尿嘧啶、亚叶酸钙和盐酸伊立替康)和贝伐单抗治疗,病情进展后接受恩可非尼和西妥昔单抗治疗。随后,他接受了派姆单抗治疗,但病情继续恶化。患者随后在生酮饮食的同时给予trifluridine/tipiracil和bevacizumab治疗。正电子发射断层扫描和癌胚抗原水平显示疾病稳定10个月。随着病情进展,患者改用伊匹卢单抗和纳武单抗,并继续坚持生酮饮食。在过去的一年里,患者的病情一直保持稳定。用葡萄糖酮指数测定酮症程度。患者在同时进行生酮饮食和治疗期间仍有良好的生活质量。结论:该病例支持生酮饮食与化疗和免疫治疗的耐受性,应考虑作为标准癌症治疗的辅助手段。本文就生酮饮食的细胞机制、与化疗和免疫治疗的疗效及关系等方面的最新文献作一综述。我们即将在弗雷斯诺的退伍军人事务加州中部医疗保健系统推出生酮饮食方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
What We Have Learned About Combining a Ketogenic Diet and Chemoimmunotherapy: a Case Report and Review of Literature.

Background: A high-fat, moderate-protein, low-carbohydrate ketogenic diet has been reported in the literature as a treatment option for patients with cancer.

Case presentation: A 69-year-old veteran was initially diagnosed with stage III colorectal cancer and progressed to having liver, pancreatic, and omental lymph node involvement despite completing adjuvant FOLFOX (fluorouracil, leucovorin calcium, and oxaliplatin) after surgery. The patient was treated with FOLFIRI (fluorouracil, leucovorin calcium, and irinotecan hydrochloride) and bevacizumab, followed by encorafenib and cetuximab on progression. Subsequently, he received pembrolizumab but continued to progress. The patient was later placed on trifluridine/tipiracil and bevacizumab concurrent with a ketogenic diet. Positron emission tomography and carcinoembryonic antigen levels indicated disease stabilization for 10 months. On progression, the patient was transitioned to ipilumimab and nivolumab and continued to adhere to the ketogenic diet. The patient's disease has continued to remain stable for the past 1 year. His degree of ketosis was determined using the glucose ketone index. The patient continues to have a good quality of life during concurrent ketogenic diet and therapy.

Conclusions: This case supports the tolerability of the ketogenic diet along with chemotherapy and immunotherapy and should be considered as an adjunct to standard cancer treatment. In this report, we reviewed the latest literature about cellular mechanism of the ketogenic diet and the efficacy and relationship with chemotherapy and immunotherapy. We are about to open a ketogenic diet protocol at the Veterans Affairs Central California Health Care System in Fresno.

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