While emerging evidence, including preclinical studies, early-phase trials, and limited clinical series, suggests that KD may help overcome treatment resistance by suppressing the PI3K/Akt/mTOR pathway, reducing insulin-like growth factor-1 (IGF-1) signaling, and enhancing cancer cell susceptibility to chemotherapy and targeted therapies, robust data from large, randomized controlled trials (RCTs) remain sparse. This evidence concerns the gene IGF1 and cancer.