The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study

• Published in: BMC cancer Vol. 15; no. 1; p. 652
• Main Authors: de Groot, Stefanie, Vreeswijk, Maaike PG, Welters, Marij JP, Gravesteijn, Gido, Boei, Jan JWA, Jochems, Anouk, Houtsma, Daniel, Putter, Hein, van der Hoeven, Jacobus JM, Nortier, Johan WR, Pijl, Hanno, Kroep, Judith R
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.10.2015; BioMed Central
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - metabolism; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Calories; Care and treatment; Chemotherapy; Cloning; Comparative analysis; Complications and side effects; DNA Damage; Fasting; Female; Growth factors; Health aspects; Histones - metabolism; Human subjects; Humans; Insulin; Laboratories; Leukocytes, Mononuclear - metabolism; Metabolism; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Patients; Pilot Projects; Receptor, ErbB-2 - deficiency; Time Factors; Toxicity; Treatment Outcome
• DOI: 10.1186/s12885-015-1663-5
• ISSN: 1471-2407

Preclinical evidence shows that short-term fasting (STF) protects healthy cells against side effects of chemotherapy and makes cancer cells more vulnerable to it. This pilot study examines the feasibility of STF and its effects on tolerance of chemotherapy in a homogeneous patient group with early breast cancer (BC). Eligible patients had HER2-negative, stage II/III BC. Women receiving (neo)-adjuvant TAC (docetaxel/doxorubicin/cyclophosphamide) were randomized to fast 24 h before and after commencing chemotherapy, or to eat according to the guidelines for healthy nutrition. Toxicity in the two groups was compared. Chemotherapy-induced DNA damage in peripheral blood mononuclear cells (PBMCs) was quantified by the level of γ-H2AX analyzed by flow cytometry. Thirteen patients were included of whom seven were randomized to the STF arm. STF was well tolerated. Mean erythrocyte- and thrombocyte counts 7 days post-chemotherapy were significantly higher (P = 0.007, 95 % CI 0.106-0.638 and P = 0.00007, 95 % CI 38.7-104, respectively) in the STF group compared to the non-STF group. Non-hematological toxicity did not differ between the groups. Levels of γ-H2AX were significantly increased 30 min post-chemotherapy in CD45 + CD3- cells in non-STF, but not in STF patients. STF during chemotherapy was well tolerated and reduced hematological toxicity of TAC in HER2-negative BC patients. Moreover, STF may reduce a transient increase in, and/or induce a faster recovery of DNA damage in PBMCs after chemotherapy. Larger studies, investigating a longer fasting period, are required to generate more insight into the possible benefits of STF during chemotherapy. ClinicalTrials.gov: NCT01304251 , March 2011.