Ketogenic Diet for Patients Receiving First Line Treatment for Metastatic Renal Cell Carcinoma

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the tolerance of one year of ketogenic diet associated with vitamin supplementation in patients treated for a metastatic renal cell carcinoma.

Detailed Description
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This research study is a pilot study evaluating the tolerance of a ketogenic diet associated with a standard of care in patient with metastatic renal cell carcinoma. The drugs involved in this study could be NIVOLUMAB + IPILIMUMAB, PEMBROLIZUMAB + AXITINIB, SUNITINIB or PAZOPANIB. Cancer cells are known to have an increased glycolytic activity that allows them to product energy from anaerobic degradation of glucose. A ketogenic diet places the body in ketosis state. It forces the body to burn fat instead of glucose. Fat metabolism occurs via the mitochondrial oxidative phosphorylation. By reducing sugar intake and regulating energy metabolism, the ketogenic diet could contribute to limit tumor progression. This diet will be introduced during one year, patient will be monitored closely with biological tests and radiological assessments every three month.

Official Title
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A Pilot Study Evaluating the Tolerability of a Ketogenic Diet With Vitamin Supplementation for Patients Receiving First Line Treatment for Metastatic Renal Cell Carcinoma

Conditions
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Metastatic Renal Cancer

Intervention / Treatment
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* Dietary Supplement: Ketogenic diet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject with histologically-confirmed renal cell carcinoma At least one CT-verified metastasis ≥ 10 mm, not previously irradiated First line treatment : PAZOPANIB, SUNITINIB, PEMBROLIZUMAB/AXITINIB or NIVOLUMAB/IPILIMUMAB No prior treatment for the metastatic renal cell carcinoma Men and women, aged ≥ 18 years OMS ≤ 1 Screening laboratory values must meet the following criteria and should be obtained prior to commencement of treatment: Hemoglobin ≥ 9 g/dL, neutrophils ≥ 1000 /mm3, platelets ≥ 100 000 /mm3, leukocytes ≥ 2000 /mm3 Total bilirubin ≤ 1,5 ULN, ASAT and ALAT ≤ 3 x ULN Creatinine clearance ≥ 30 mL/min, verified proteinuria above or equal to 1g/24 hours measured from 24 hours of urine if the urinary protein Corrected calcium ≤ ULN Patient must have signed and dated informed consent Patient must have an internet connection Exclusion Criteria: Any contraindication to a ketogenic diet : primary carnitine deficiency, fatty acid beta-oxidation and cytogenesis deficiencies, pyruvate carboxylate deficiency, porphyria Swallowing disorder Important surgical procedure within the 4 weeks before treatment Prior radiotherapy must have been completed at least 2 weeks prior to treatment Pregnant women or breastfeeding Subjects with previous malignancies (except non-melanoma skin cancer and the following endometrial in situ cancers) are excluded unless a complete remission was achieved at least 3 years prior to study entry and no additional therapy is required during the study period Subjects with brain metastases, uncontrolled compression of the spinal cord, carcinomatous meningitis, signs of cerebral or leptomeningeal involvement Uncontrolled blood pressure (SBP >150 mmH et DBP >100 mmHg) Any serious or uncontrolled medical disorder during the last 6 months : hepatic insufficiency, renal insufficiency, respiratory insufficiency Patients with any severe medical conditions within 6 month prior to inclusion such as : myocardial infarction, severe/instable angina pectoris, coronary artery bypass surgery, NYHA III or IV congestive heart failure, stroke or transient ischemic attack Patients with sere medical conditions within 3 month prior to inclusion such as : grade 3 or grade 4 gastrointestinal bleeding, peptic ulcer treatment resistant, esophagitis or ulcerated gastritis, infectious or inflammatory bowel disease, diverticulitis, thrombosis, pulmonary embolism or other uncontrolled thromboembolic event, unhealed bone fractures Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) Malabsorption syndrome Uncontrolled infection QT/QTc interval > 450 msec for men and > 470 msec for women Concomitant treatments : strong inducers of CYP3A4 (DEXAMETHASONE, PHENYTOINE, CARBAMAZEPINE, RIFAMPICINE, RIFABUTINE, RIFAPENTINE, PHENOBARBITAL, and ST. JOHN'S WORT) Social, psychological or medical condition that may interfere with participation in the study or its evaluation Patient deprived of liberty by judicial or administrative decision Patient with psychiatric treatment under duress Patient subject to legal protection measures Patient unable to give informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ketogenic diet<br>Ketogenic diet + standard of care | Dietary Supplement: Ketogenic diet<br>* Ketogenic diet 2:1<br>* Other names: First line treatment;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tolerance of one year of ketogenic diet 2:1 | Frequency of adverse events evaluation | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance of ketogenic diet | Pourcentage of compliant patients | 1 year | 
| Progression free survival according to RECIST 1.1 at 2 years | Assessed by RECIST 1.1 | 2 years | 
| Overall survival at 2 years | Assessed by RECIST 1.1 | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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metastatic renal cancer, ketogenic diet, immunotherapy, first line treatment, targeted therapy