Ketogenic Diet in Patients With Untreated Low Tumor Burden Mantle Cell Lymphoma

Pilot Phase I Study of Ketogenic Diet in the Treatment of Patients With Untreated Mantle Cell Lymphoma With a Low Tumor Burden

This study evaluates adherence to a ketogenic diet in patients with low tumor burden, treatment-naïve mantle cell lymphoma.

Study Overview

• Status: Withdrawn
• Conditions: Mantle Cell Lymphoma; Ketogenic Dieting
• Intervention / Treatment: Other: Ketogenic Diet

Detailed Description

This is a single-arm feasibility study to evaluate adherence to a ketogenic diet in patients with low tumor burden, treatment-naïve mantle cell lymphoma.

Subjects will be evaluated for eligibility and baseline assessments prior to initiating the ketogenic diet during the screening period and/or prior to initiating the ketogenic diet on Day 1. Eligible subjects will receive study treatment which will consist of a daily ketogenic diet for up to 12 weeks (Day 1 through Day 84). Subjects will be monitored with weekly assessments of adherence to diet and effects on serum metabolic markers, tumor specimens, and body composition.

After discontinuing the ketogenic diet, subjects will be followed for 28 days.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amelyn Rodriguez, R.N.; Phone Number: 212-746-1362; Email: amr2017@med.cornell.edu
• Study Contact Backup: Name: Christine Tran, R.N.; Phone Number: 212-746-6738; Email: cht2328@med.cornell.edu

Study Locations

• United States
  • New York
    • New York, New York, United States, 10065
      • Weill Cornell Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Histologically confirmed diagnosis of mantle cell lymphoma
• Age ≥ 18 years
• No prior systemic therapy for lymphoma
• ECOG performance status ≤ 2

• Required initial laboratory parameters:

  • Absolute neutrophil count (ANC) ≥ 1000 cells/mm3
  • Platelet count ≥ 75,000 cells/mm3
  • Calculated creatinine clearance ≥ 30 ml/min by Cockcroft-Gault formula
  • Total bilirubin ≤ 2.0 x ULN
  • AST/SGOT or ALT/SGPT ≤ 3.0 x ULN
• Understand and voluntarily sign an ICF prior to any study related assessments and procedures are conducted

Exclusion Criteria:

• Patients with blastoid histology
• Patients with known or suspected central nervous system (CNS) involvement
• Patients with a clear indication for treatment of lymphoma, including those with a tumor larger than 6 cm, more than 3 lymph nodes more than 3 cm, or constitutional symptoms
• Active viral infection with HIV or hepatitis type B or C. Seropositive HBV patients are eligible if they are negative for HBV DNA by PCR and receive concomitant antiviral therapy during treatment and for additional six months after coming off study.
• Active uncontrolled systemic fungal, bacterial or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy and/or other treatment)
• Uncontrolled moderate to severe hypertriglyceridemia (TG>300 mg/dL).
• Strong family history of hypertriglyceridemia and coronary artery disease.
• Myocardial infarction within 6 months of cycle 1, day 1. [Subjects with a history of myocardial infarction between 6 and 12 months prior to cycle 1, day 1, who are asymptomatic and have had a negative cardiac risk assessment (treadmill stress test, nuclear medicine stress test, or stress echocardiogram) since the event, may participate].
• Symptomatic coronary artery disease (CAD), e.g., angina Canadian Class II-IV. In any patient in whom there is doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present.
• An ECG recorded at screening showing evidence of cardiac ischemia (ST depression of ≥ 2 mm, measured from isoelectric line to the ST segment). If in any doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present.
• Congestive heart failure (CHF) that meets New York Heart Association (NYHA) Class II to IV definitions and/or ejection fraction < 40% by multigated acquisition (MUGA) scan or < 50% by echocardiogram and/or magnetic resonance imaging (MRI).
• Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 3 months before the start of study medication.
• Patients requiring dual anti-platelets treatment for cardiac conditions or patients who are on anticoagulation for arterial or venous thrombosis.
• Patients with known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
• Type I diabetes
• Uncontrolled Type II diabetes mellitus (HbA1c> 7.5%).
• Type II diabetes requiring treatment with a sulfonylurea, meglitinide, or insulin.
• Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel that is likely to affect absorption, symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or gastric restrictions and bariatric surgery, such as gastric bypass.
• Active complaints of dysphagia or odynophagia
• Presence of a "feeding tube" (i.e. nasogastric tube, PEG, PEJ)
• Participation in a specialty diet (e.g. Atkins, Weight Watchers, Best Life, Nutrisystem, South Beach, Jenny Craig, Paleo Diet, Zone, etc) or weight loss plan within 28 days prior to Cycle 1 of treatment.
• Vegetarian or vegan eating habits.
• An allergy or intolerance to egg, gluten, tree nuts, or milk protein.
• History of serious or uncontrolled gout or hyperuricemia
• Diagnosis of a seizure disorder.
• Prior diagnosis of restless legs syndrome or a history of chronic muscle cramps, as defined as a period of at least 1 month where spontaneous cramping of the skeletal muscles occurred more than two-thirds of the days.
• Patients who are pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through at least 30 days after the last dose of trial treatment.
• History of nephrolithiasis or nephrolithiasis incidentally discovered during CT screening.
• Known selenium deficiency.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: All Subjects; Low tumor burden, treatment-naïve MCL	Other: Ketogenic Diet; Prepared ketogenic meals, 3 per day for up to 12 weeks (Day 1 through Day 84)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of subjects who adhere to ketogenic diet	Number of subjects who adhere to ketogenic diet as defined by serum betahydroxybutyrate > 1.0 mM at 7 out of 11 timepoints	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of subjects who achieve a partial or complete response	Number of subjects who achieve a partial or complete response based on radiographic imaging using Lugano criteria for lymphoma response	12 weeks
Number of subjects who exhibit a significant change in fasting serum metabolic markers	Fasting metabolic markers to be assessed for this outcome measure include insulin, glucose, and lipids	Baseline, 16 weeks
Number of subjects who exhibit a significant change in serum mediators of inflammation	Serum mediators of inflammation to be assessed for this outcome measure include high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-a, IL-1beta, and interferon (INF)-gamma.	Baseline, 16 weeks
Number of subjects who exhibit a significant change in blood cell populations	Blood cell populations will be assessed by performance of unbiased expression analysis (RNA-Seq) from blood cell populations, and High-Dimensional Single-Cell Mass Cytometry (CyTOF) analysis of peripheral blood cells	Baseline, 16 weeks
Change in body composition as measured by difference in ideal body weight and actual body weight at the end of study compared to baseline		Baseline, 16 weeks
Number of subjects who complete quality of life questionnaires at required timepoints	Quality of life questionnaire to be used for this outcome measure is EORTC-C30	16 weeks
Effect of ketogenic diet on gut microbiome	Change in proportion of most common gut bacteria identified by DNA analysis of stool samples	12 weeks
Rate of recruitment	Percentage of subjects screened for the trial who eventually enroll in the trial	1 year
Subject adherence to scheduled laboratory assessments	Percentage of laboratory assessments successfully attended by subjects	12 weeks
Subject adherence to meal assessments	Percentage of meal assessments successfully completed by subjects	12 weeks
Rate of attrition	Percentage of subjects enrolled who drop out before trial completion	12 weeks
Rate of daily ketosis	Percentage of days in ketosis as defined by positive ketones results on ketostix	12 weeks

Collaborators and Investigators

• Sponsor: Weill Medical College of Cornell University
• Investigators: Principal Investigator: Peter Martin, M.D., Weill Medical College of Cornell University

Publications and helpful links

Helpful Links

• WCM Joint Clinical Trials Office

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2023
• Primary Completion (Estimated): April 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: December 30, 2019
• First Submitted That Met QC Criteria: January 13, 2020
• First Posted (Actual): January 18, 2020

Study Record Updates

• Last Update Posted (Actual): August 28, 2023
• Last Update Submitted That Met QC Criteria: August 24, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Lymphoma; Lymphoma, Mantle-Cell
• Other Study ID Numbers: 19-05020213

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No