{"entity":{"id":"ergo2","kind":"trial","name":"ERGO2: ketogenic diet and fasting during re-irradiation of recurrent glioma","aka":[],"tldr":"The only randomised trial of a ketogenic diet in brain tumours found no benefit. Patients could follow the diet and their ketone levels rose, but progression came just as quickly.","summary":"50 patients were randomised 1:1. The intervention was feasible and safe: glucose fell and ketones rose as intended, and the diet was well tolerated over nine days. Progression-free survival at 6 months, the primary endpoint, did not differ (20% vs 16%; median PFS 3.2 vs 3.4 months), nor did overall survival (median 11.1 vs 10.5 months). The trial is small and the dietary exposure brief, so it cannot exclude a benefit from sustained ketosis; equally, longer feasibility studies (KETOCAN, modified Atkins with standard chemoradiation) show adherence declining by three months. Together they define the current state: ketogenic diets in glioma are feasible, unproven, and widely promoted to patients as if they were not.","status":"negative","asOf":"2026-09-08","links":[{"label":"ClinicalTrials.gov NCT01754350","url":"https://clinicaltrials.gov/study/NCT01754350"},{"label":"Voss et al. (Int J Radiat Oncol Biol Phys 2020)","url":"https://doi.org/10.1016/j.ijrobp.2020.06.021"}],"tags":[],"related":["idea-nl-ketogenic-gbm-definitive-trial"],"cancers":["glioblastoma"],"sections":["nutrition-lifestyle"],"technologies":["ketogenic-diet-glioblastoma","metabolic-therapy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["warburg-effect-diet-claims","warburg-effect","pfs"],"trials":[],"people":[],"bottlenecks":["b-misinformation","b-negative-results"],"keyPapers":["paper-voss-int-j-radiat-oncol-biol-phys"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01754350","phase":"2","setting":"Recurrent glioblastoma and other malignant gliomas undergoing re-irradiation: 6-day calorie-restricted ketogenic diet plus 3-day fasting during radiotherapy vs standard diet","sponsor":"Goethe University Frankfurt","result":"6-month PFS 20% vs 16%; median OS 11.1 vs 10.5 months; no benefit.","started":"2013-05","yearReported":2020,"enrolled":50,"enrolledBasis":"registry","outcomes":[{"endpoint":"Progression-free survival at 6 months","primary":true,"unit":"%","arms":[{"name":"Ketogenic diet + fasting","n":25,"value":20},{"name":"Standard diet","n":25,"value":16}],"source":"https://doi.org/10.1016/j.ijrobp.2020.06.021"}],"replication":"No adequately powered trial exists. Feasibility studies concordant on tolerability, silent on efficacy."},"route":"/trials/ergo2/","neighbours":{"idea":[{"id":"idea-nl-ketogenic-gbm-definitive-trial","kind":"idea","name":"One definitive ketogenic diet trial in glioblastoma, then stop","route":"/ideas/idea-nl-ketogenic-gbm-definitive-trial/"}],"cancer":[{"id":"glioblastoma","kind":"cancer","name":"Glioma & glioblastoma","route":"/cancers/glioblastoma/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"}],"technology":[{"id":"ketogenic-diet-glioblastoma","kind":"technology","name":"Ketogenic diets in glioblastoma","route":"/technologies/ketogenic-diet-glioblastoma/"},{"id":"metabolic-therapy","kind":"technology","name":"Metabolic therapy: starving the tumour of a nutrient","route":"/technologies/metabolic-therapy/"}],"term":[{"id":"metabolic-theory-of-cancer","kind":"term","name":"Metabolic theory of cancer: from Warburg to oncometabolites","route":"/terms/metabolic-theory-of-cancer/"},{"id":"pfs","kind":"term","name":"Progression-free survival (PFS)","route":"/terms/pfs/"},{"id":"warburg-effect","kind":"term","name":"Warburg effect","route":"/terms/warburg-effect/"},{"id":"warburg-effect-diet-claims","kind":"term","name":"Warburg-effect diet claims ('sugar feeds cancer')","route":"/terms/warburg-effect-diet-claims/"}],"bottleneck":[{"id":"b-negative-results","kind":"bottleneck","name":"Failures are hidden","route":"/bottlenecks/b-negative-results/"},{"id":"b-misinformation","kind":"bottleneck","name":"Misinformation and unproven therapies","route":"/bottlenecks/b-misinformation/"}],"paper":[{"id":"paper-voss-int-j-radiat-oncol-biol-phys","kind":"paper","name":"ERGO2: A Prospective, Randomized Trial of Calorie-Restricted Ketogenic Diet and Fasting in Addition to Reirradiation for Malignant Glioma","route":"/key-papers/paper-voss-int-j-radiat-oncol-biol-phys/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"}]}}