Metastatic breast cancer, particularly estrogen receptor (ER) positive liver metastases, typically lacks a positive prognosis, quality of life, or effective treatment. But a new option now arises, with promising results.

Zeynep Madak-Erdogan, the Associate Director for Education at the Cancer Center at Illinois (CCIL), first-author Qianying Zuo, and their team have found that combining ketogenic diets with existing cancer therapies, specifically Fulvestrant, can improve therapeutic outcomes.

“We are looking into ways to improve the therapy’s effects on metastatic breast tumors through daily, available, accessible means, through food, exercise, or other ways that patients have within their locus of control. Hopefully we can improve both quality of life and outcomes for those with metastatic diseases,” said Madak-Erdogan.

Left to right: First-author Qianying Zuo and Associate Director for Education at the Cancer Center at Illinois (CCIL) Zeynep Madak-Erdogan

Ketogenic diets are low in carbohydrates and high in fat, with a history of clinical use. “It’s actually quite an old approach, so we know ketogenic diets work. How the diet works in a metastatic setting is the real question. What we found is that indeed these ketogenic diets will improve the ketone bodies,” said Madak-Erdogan.

Ketone bodies are molecules produced by the body when it breaks down fat. They are a backup energy source for the body. “By combining the therapy with the diet, we are creating an environment that has very high levels of ketone bodies. Tumor cells cannot use these as an energy source, and eventually this reduces the metastatic burden,” said Madak-Erdogan. With the ketogenic diet increasing levels of ketone bodies, tumor cell growth becomes more difficult. As Zuo said, “The ketogenic diet changes the way cancer cells use energy.”

“It’s a good approach because it’s not just another drug. If we can find and use such lifestyle interventions, hopefully it will help patients or survivors go through this process with more ease,” said Madak-Erdogan.

This research will help patients with ER-positive liver metastatic breast cancer, enhancing quality of life and improving survival rates. Healthcare providers and clinicians will also benefit from a new strategy to treat these cases.

“This research is just the beginning of exploring how metabolic strategies can be used alongside cancer treatments. We are excited about the potential to personalize treatment options based on a patient’s metabolic needs and to develop new therapeutic targets. This could open doors to more effective and less invasive cancer treatments, offering hope for people living with metastatic breast cancer,” said Zuo.

Editor’s notes:

Zeynep Madak-Erdogan is Sylvia D. Stroup Scholar of Nutrition and Cancer and an Associate Professor of Food Science & Human Nutrition. Madak-Erdogan is also an affiliate of the Carl R. Woese Institute for Genomic Biology. Studies in this paper were made possible by support from Prairie Dragon Paddlers. She can be reached at zmadake2@illinois.edu.

This research is reported in the paper “Co-targeting of metabolism using dietary and pharmacologic approaches reduces breast cancer metastatic burden” and is available online.

https://doi.org/10.1038/s41523-024-00715-6

This story was written by Florence Lin, CCIL Communications Intern.