EFEKTIVITAS DIET KETOGENIK SEBAGAI TERAPI ADJUVAN PADA PENYAKIT GLIOBLASTOMA

Authors

  • Ni Luh Kesyang Putri Dharma Patni Program Studi Kedokteran, Fakultas Kedokteran, Universitas Pendidikan Ganesha, Bali, Indonesia
  • I Komang Harry Supradnyan Program Studi Kedokteran, Fakultas Kedokteran, Universitas Pendidikan Ganesha, Bali, Indonesia
  • Ida Ayu Diah Purnama Sari Departemen Kulit dan Kelamin, RSUD Kabupaten Buleleng, Bali, Indonesia2

DOI:

https://doi.org/10.31004/prepotif.v9i3.53761

Keywords:

Glioblastoma, Diet Ketogenik, Terapi Adjuvan

Abstract

Glioblastoma Multiforme (GBM) merupakan tumor otak primer paling agresif dengan prognosis yang buruk meskipun telah menjalani standar perawatan bedah, radiasi, dan kemoterapi. Penelitian ini bertujuan untuk menganalisis efektivitas diet ketogenik (KD) sebagai terapi adjuvan metabolik dalam meningkatkan luaran klinis pasien GBM. Metode yang digunakan adalah literature review terhadap sepuluh studi klinis utama dan literatur pendukung yang relevan. Hasil analisis menunjukkan bahwa KD secara efektif menginduksi ketosis terapeutik yang mampu mengeksploitasi kerentanan metabolik sel tumor melalui pembatasan glukosa. Pasien yang patuh mempertahankan Glucose Ketone Index (GKI) di bawah 2,0 menunjukkan peningkatan signifikan pada Overall Survival (OS) dan Progression-Free Survival (PFS). Dari sisi keamanan, intervensi ini dinilai layak dan aman dengan manfaat tambahan berupa perlindungan fungsi neurokognitif dan stabilitas kualitas hidup pasien. Kesimpulannya, diet ketogenik merupakan strategi terapi adjuvan yang efektif dan rasional untuk memperkuat efikasi pengobatan standar pada glioblastoma derajat tinggi.

References

Amaral, L. J., Gresham, G., Kim, S., Tighiouart, M., Nelson, T. A., Welborn, A., Lockshon, L., Noorvash, B., Rudnick, J. D., Irwin, S. A., Freedland, S. J., & Hu, J. (2025). A phase 1 safety and feasibility trial of a ketogenic diet plus standard of care for patients with recently diagnosed glioblastoma. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-06675-6

Bowers, L. W., Rossi, E. L., O’Flanagan, C. H., De Graffenried, L. A., & Hursting, S. D. (2015). The role of the insulin/IGF system in cancer: Lessons learned from clinical trials and the energy balance-cancer link. In Frontiers in Endocrinology (Vol. 6, Issue MAY). Frontiers Media S.A. https://doi.org/10.3389/fendo.2015.00077

Cairns, J., Ung, C. Y., Da Rocha, E. L., Zhang, C., Correia, C., Weinshilboum, R., Wang, L., & Li, H. (2016). A network-based phenotype mapping approach to identify genes that modulate drug response phenotypes. Scientific Reports, 6. https://doi.org/10.1038/srep37003

Diwanji, T. P., Engelman, A., Snider, J. W., & Mohindra, P. (2017). Epidemiology, diagnosis, and optimal management of glioma in adolescents and young adults. Adolescent Health, Medicine and Therapeutics, Volume 8, 99–113. https://doi.org/10.2147/ahmt.s53391

Duraj, T., Kalamian, M., Zuccoli, G., Maroon, J. C., D’Agostino, D. P., Scheck, A. C., Poff, A., Winter, S. F., Hu, J., Klement, R. J., Hickson, A., Lee, D. C., Cooper, I., Kofler, B., Schwartz, K. A., Phillips, M. C. L., Champ, C. E., Zupec-Kania, B., Tan-Shalaby, J., … Seyfried, T. N. (2024). Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma. BMC Medicine, 22(1). https://doi.org/10.1186/s12916-024-03775-4

Dyńka, D., Kowalcze, K., & Paziewska, A. (2022). The Role of Ketogenic Diet in the Treatment of Neurological Diseases. In Nutrients (Vol. 14, Issue 23). MDPI. https://doi.org/10.3390/nu14235003

Elsakka, A. M. A., Bary, M. A., Abdelzaher, E., Elnaggar, M., Kalamian, M., Mukherjee, P., & Seyfried, T. N. (2018). Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up. Frontiers in Nutrition, 5. https://doi.org/10.3389/fnut.2018.00020

Esemen, Y., Awan, M., Parwez, R., Baig, A., Rahman, S., Masala, I., Franchini, S., & Giakoumettis, D. (2022). Molecular Pathogenesis of Glioblastoma in Adults and Future Perspectives: A Systematic Review. In International Journal of Molecular Sciences (Vol. 23, Issue 5). MDPI. https://doi.org/10.3390/ijms23052607

Gittleman, H., Boscia, A., Ostrom, Q. T., Truitt, G., Fritz, Y., Kruchko, C., & Barnholtz-Sloan, J. S. (2018). Survivorship in adults with malignant brain and other central nervous system tumor from 2000-2014. Neuro-Oncology, 20, VII6–VII16. https://doi.org/10.1093/neuonc/noy090

Gough, S. M., Casella, A., Ortega, K. J., & Hackam, A. S. (2021). Neuroprotection by the Ketogenic Diet: Evidence and Controversies. In Frontiers in Nutrition (Vol. 8). Frontiers Media S.A. https://doi.org/10.3389/fnut.2021.782657

Grochans, S., Cybulska, A. M., Simińska, D., Korbecki, J., Kojder, K., Chlubek, D., & Baranowska-Bosiacka, I. (2022). Epidemiology of Glioblastoma Multiforme–Literature Review. In Cancers (Vol. 14, Issue 10). MDPI. https://doi.org/10.3390/cancers14102412

Ji, C. C., Hu, Y. Y., Cheng, G., Liang, L., Gao, B., Ren, Y. P., Liu, J. T., Cao, X. L., Zheng, M. H., Li, S. Z., Wan, F., Han, H., & Fei, Z. (2020). A ketogenic diet attenuates proliferation and stemness of glioma stem like cells by altering metabolism resulting in increased ROS production. International Journal of Oncology, 56(2), 606–617. https://doi.org/10.3892/ijo.2019.4942

Kayode, T. O., Rotimi, E. D., Afolayan, A. O., & Kayode, A. A. A. (2020). Ketogenic diet: A nutritional remedy for some metabolic disorders. Journal of Education, Health and Sport, 10(8), 180–188. https://doi.org/10.12775/jehs.2020.10.08.021

Kiryttopoulos, A., Evangeliou, A. E., Katsanika, I., Boukovinas, I., Foroglou, N., Zountsas, B., Cheva, A., Nikolopoulos, V., Zaramboukas, T., Duraj, T., Seyfried, T. N., & Spilioti, M. (2024). Successful application of dietary ketogenic metabolic therapy in patients with glioblastoma: a clinical study. Frontiers in Nutrition, 11. https://doi.org/10.3389/fnut.2024.1489812

Lim-Fat, M. J., & Das, S. (2023). Unique molecular, clinical, and treatment aspects of gliomas in adolescents and young adults: a review. In Journal of Neurosurgery (Vol. 139, Issue 6, pp. 1619–1627). American Association of Neurological Surgeons. https://doi.org/10.3171/2023.4.JNS221800

Ludwig, D. S. (2020). The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. Journal of Nutrition, 150(6), 1354–1359. https://doi.org/10.1093/jn/nxz308

Malinowska, D., & Żendzian-Piotrowska, M. (2024). Ketogenic Diet: A Review of Composition Diversity, Mechanism of Action and Clinical Application. In Journal of Nutrition and Metabolism (Vol. 2024, Issue 1). John Wiley and Sons Ltd. https://doi.org/10.1155/2024/6666171

Maroon, J., Seyfried, T., Donohue, J., & Bost, J. (2015). The role of metabolic therapy in treating glioblastoma multiforme. Surgical Neurology International, 6(1). https://doi.org/10.4103/2152-7806.155259

Martin-McGill, K. J., Marson, A. G., Tudur Smith, C., Young, B., Mills, S. J., Cherry, M. G., & Jenkinson, M. D. (2020). Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study. Journal of Neuro-Oncology, 147(1), 213–227. https://doi.org/10.1007/s11060-020-03417-8

Mukherjee, P., Augur, Z. M., Li, M., Hill, C., Greenwood, B., Domin, M. A., Kondakci, G., Narain, N. R., Kiebish, M. A., Bronson, R. T., Arismendi-Morillo, G., Chinopoulos, C., & Seyfried, T. N. (2019). Therapeutic benefit of combining calorie-restricted ketogenic diet and glutamine targeting in late-stage experimental glioblastoma. Communications Biology, 2(1). https://doi.org/10.1038/s42003-019-0455-x

Naithani, D., & Karn, S. K. (2020). The Role of Ketone Bodies in Improving Neurological Function and Efficiency. Health Scope, 9(2). https://doi.org/10.5812/jhealthscope.86578

Phillips, M. C. L., Leyden, J., McManus, E. J., Lowyim, D. G., Ziad, F., Moon, B. G., Haji Mohd Yasin, N. A. B., Tan, A., Thotathil, Z., & Jameson, M. B. (2022). Feasibility and Safety of a Combined Metabolic Strategy in Glioblastoma Multiforme: A Prospective Case Series. Journal of Oncology, 2022. https://doi.org/10.1155/2022/4496734

Phillips, M. C. L., Thotathil, Z., Dass, P. H., Ziad, F., & Moon, B. G. (2024a). Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report. Oncology Letters, 27(5). https://doi.org/10.3892/ol.2024.14363

Phillips, M. C. L., Thotathil, Z., Dass, P. H., Ziad, F., & Moon, B. G. (2024b). Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report. Oncology Letters, 27(5). https://doi.org/10.3892/ol.2024.14363

Santos, J. G., Da Cruz, W. M. S., Schönthal, A. H., Salazar, M. D. alincourt, Fontes, C. A. P., Quirico-Santos, T., & Da Fonseca, C. O. (2018). Efficacy of a ketogenic diet with concomitant intranasal perillyl alcohol as a novel strategy for the therapy of recurrent glioblastoma. Oncology Letters, 15(1), 1263–1270. https://doi.org/10.3892/ol.2017.7362

Schwartz, K. A., Noel, M., Nikolai, M., Olson, L. K., Hord, N. G., Zakem, M., Clark, J., Elnabtity, M., Figueroa, B., & Chang, H. T. (2022). Long Term Survivals in Aggressive Primary Brain Malignancies Treated With an Adjuvant Ketogenic Diet. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.770796

Seyfried, T. N., Shivane, A. G., Kalamian, M., Maroon, J. C., Mukherjee, P., & Zuccoli, G. (2021). Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report. Frontiers in Nutrition, 8. https://doi.org/10.3389/fnut.2021.682243

Shabbir, I., Liu, K., Riaz, B., Rahim, M. F., Zhong, S., Aweya, J. J., & Cheong, K. L. (2025a). Investigating the Therapeutic Potential of the Ketogenic Diet in Modulating Neurodegenerative Pathophysiology: An Interdisciplinary Approach. In Nutrients (Vol. 17, Issue 7). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/nu17071268

Shabbir, I., Liu, K., Riaz, B., Rahim, M. F., Zhong, S., Aweya, J. J., & Cheong, K. L. (2025b). Investigating the Therapeutic Potential of the Ketogenic Diet in Modulating Neurodegenerative Pathophysiology: An Interdisciplinary Approach. In Nutrients (Vol. 17, Issue 7). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/nu17071268

Sipos, D., Raposa, B. L., Freihat, O., Simon, M., Mekis, N., Cornacchione, P., & Kovács, Á. (2025). Glioblastoma: Clinical Presentation, Multidisciplinary Management, and Long-Term Outcomes. In Cancers (Vol. 17, Issue 1). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/cancers17010146

Sperry, J., Condro, M. C., Guo, L., Braas, D., Vanderveer-Harris, N., Kim, K. K. O., Pope, W. B., Divakaruni, A. S., Lai, A., Christofk, H., Castro, M. G., Lowenstein, P. R., Le Belle, J. E., & Kornblum, H. I. (2020). Glioblastoma Utilizes Fatty Acids and Ketone Bodies for Growth Allowing Progression during Ketogenic Diet Therapy. IScience, 23(9). https://doi.org/10.1016/j.isci.2020.101453

van der Louw, E. J. T. M., Olieman, J. F., van den Bemt, P. M. L. A., Bromberg, J. E. C., Oomen-de Hoop, E., Neuteboom, R. F., Catsman-Berrevoets, C. E., & Vincent, A. J. P. E. (2019). Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety study. Therapeutic Advances in Medical Oncology, 11. https://doi.org/10.1177/1758835919853958

Varshneya, K., Carico, C., Ortega, A., & Patil, C. G. (2015). The Efficacy of Ketogenic Diet and Associated Hypoglycemia as an Adjuvant Therapy for High-Grade Gliomas: A Review of the Literature. Cureus. https://doi.org/10.7759/cureus.251

Wells, J., Swaminathan, A., Paseka, J., & Hanson, C. (2020). Efficacy and safety of a ketogenic diet in children and adolescents with refractory epilepsy—a review. In Nutrients (Vol. 12, Issue 6, pp. 1–19). MDPI AG. https://doi.org/10.3390/nu12061809

Winter, S. F., Loebel, F., & Dietrich, J. (2017). Role of ketogenic metabolic therapy in malignant glioma: A systematic review. Critical Reviews In Oncology/Hematology, 112, 41–58.

Wu, W., Klockow, J. L., Zhang, M., Lafortune, F., Chang, E., Jin, L., Wu, Y., & Daldrup-Link, H. E. (2021). Glioblastoma multiforme (GBM): An overview of current therapies and mechanisms of resistance. Pharmacological Research, 171, 105780. https://doi.org/10.1016/j.phrs.2021.105780

Zhu, H., Bi, D., Zhang, Y., Kong, C., Du, J., Wu, X., Wei, Q., & Qin, H. (2022). Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. In Signal Transduction and Targeted Therapy (Vol. 7, Issue 1). Springer Nature. https://doi.org/10.1038/s41392-021-00831-w

Downloads

Published

2025-12-31

How to Cite

Patni, N. L. K. P. D., Supradnyan , I. K. H., & Sari, I. A. D. P. (2025). EFEKTIVITAS DIET KETOGENIK SEBAGAI TERAPI ADJUVAN PADA PENYAKIT GLIOBLASTOMA . PREPOTIF : JURNAL KESEHATAN MASYARAKAT, 9(3), 10380–10390. https://doi.org/10.31004/prepotif.v9i3.53761