Postoperative recurrence of pancreatic cancer controlled for 9 months solely by severe carbohydrate restriction: ketogenic diet

Carbohydrate restriction (ketogenic diet) is a cancer treatment that reduces energy production by oxidative phosphorylation in mitochondria of cancer cells and increases it through anaerobic glycolysis in cytoplasm. We report a patient in whom progression of pancreatic cancer recurrence was suppressed solely by a ketogenic diet for 9-month post-surgery. A 60-year-old female with a diagnosis of pancreatic cancer underwent pancreatoduodenectomy after 3 cycles of chemotherapy with gemcitabine plus nab-paclitaxel. Multiple pulmonary metastases were observed 22 months after the surgery. We administered gemcitabine plus nab-paclitaxel for 1 year. As the partial response continued for 1 year, we performed radiotherapy for the remnant pulmonary metastases followed by administration of S-1 for 6 months. Ten months after radiotherapy, CT showed exacerbation of the pulmonary metastases. As treatment, she requested severe carbohydrate restriction. After 9 months of the ketogenic diet, CT revealed stable disease. A ketogenic diet may have the therapeutic effect of suppressing tumor progression if strictly applied.