Abstract: Warburg effect provides a substantial theoretical basis for cancer ketogenic therapy (CKT). Previous basic and clinical studies have reported that CKT effectively inhibit cancer growth, enhance chemo-radiotherapy efficacy, improve quality of life and prolong survival time. However, different cancers respond to CKT differently, the underlying mechanism of this heterogeneity remains unclear. CKT can be used independently or combined with other anti-cancer therapies. At present, the studies of CKT mainly conducted in cancer cell lines and corresponding cancer-carried animals, but not in patients. Although some clinical case reports have been known, well-designed clinical trials were still lacking. In order to impel cancer treatment and upgrade its current status, we should put more efforts on metabolic regulation therapy such as CKT, speed up translational medicine research, and reinforce CKT randomized controlled trial to identify the cause of the difference in sensitivity to CKT and its mechanism. It will provide insights into seeking the new biomarkers for CKT candidates, build up the molecular diagnosis methods for predicting the CKT sensitivity and explore the new targets for enhancing CKT efficacy to further optimize precise CKT and greatly improve efficacy of cancer therapy.