TABLE 2.
Treatment efficacy and side effects of intermittent fasting during chemotherapy in patients with cancer1
| Author | Subjects | Treatment and design | Treatment efficacy | GI adverse effects | Neurological adverse effects | Quality of life |
|---|---|---|---|---|---|---|
| Short-term fasting | ||||||
| Bauersfeld et al., 2018 (40) | n = 34 females with gynecologic cancers, various forms of chemotherapy | A. Group A: STF (36 h before, 24 h after)/ControlB. Group B: control/STFrandomized crossover trial, 6 cycles of chemotherapy | A. ↑ FACT-G, FACIT F, FACIT-F TOI during fasting cycles. ↑QOL during fasting and decreased during control cyclesB. Ø between cycles Ø difference between fasting cycles | |||
| de Groot et al., 2015 (41) | n = 13 HER2-negative stage II/III breast cancer (histologically confirmed) receiving neoadjuvant TAC (docetaxel/doxorubicin/cyclophosphamide) | A. STF (24 h before and after)B. Control (follow healthy nutrition guidelines with a minimum of 2 pieces of fruit per day) | Within-group change γ-H2AX intensity↑CD45 + CD13- myeloid cells (30 min) in control only*↑CD45 + CD3 + lymphocytes (7 d) in control only*Treatment-related side effects in STF↑ FT4*↑ Erythrocyte counts (D7, D21) *↑ Thrombocyte (D7) * | Ø differences between groups in grade I/II or III/IV grade toxicities using the CTCAE | Ø differences between groups in grade I/II or III/IV grade toxicities using the CTCAE | |
| Dorff et al., 2016 (29) | n = 20 males and females with cancer diagnosis prescribed platinum-based chemotherapy w/out radiation, curative or palliative | A. 24 h STF (n = 6)B. 48 h STF (n = 7)C. 72 h STF (48 h before/24 h after) (n = 7)Nonrandomized, no control | For all groups after chemotherapy: 2 pathological complete response, 6 partial radiographic response, 3 stable diseaseØ difference in olive moments (indicating DNA damage) based on Comet assay | ↓ grade I/II nausea and vomiting (test for trend)**Toxicity graded using CTCAE | ||
| Riedinger et al., 2020 (30) | n = 20 females with gynecologic cancers with ≥6 cycles of chemotherapy Multiagent chemotherapy (bevacizumab, carboplatin, cisplatin, docetaxel, doxorubicin, gemcitabine, and paclitaxel), ≥2 participants neoadjuvant therapy | A. STF (24 h before and after)B. ControlRandomized control trial | Ø difference in complete or partial response between groups**↑ Platelet count in the STF group at week 18** | Ø difference in treatment-related toxicities via CTCAE** | Ø difference in treatment-related toxicities via CTCAE** | Ø difference between groups in mean NCCN-FACT FOSI-18 score **↑ QOL# in fasting group from first to last cycle in the fasting group compared to control |
| Zorn et al., 2020 (36) | n = 30; females with gynecologic cancers, all stages, neo or adjuvant chemotherapy | A. mSTF or KD + mSTFB. ControlCrossover, 2–3 cycles of CTX of intervention and control | Treatment-related side effects in STF↓MCH*↓MCV*↓Sodium*↑Uric acid*↓ fT3*↑Ft4* | mSTF and KD + mSTF had↓frequent grade I/II stomatitis*↓headaches* *↓total toxicities* measured by CTCAE | Ø score difference between group on EORTC QLQ-C30, EORTC QLQ-CIPN20 or FACIT-F | |
| Fasting mimicking diet | ||||||
| de Groot et al., 2020 (22) | n = 129 patients with HER-2 negative stage II/III breast cancer, neoadjuvant FEC-T or AC-T chemotherapy | A. FMD (n = 65)B. Control (n = 64)Diet was 3 d prior to and the day of treatment. Randomized control trial | Ø difference in toxicity of treatment↑ radiological complete or partial response in pts following FMD*Miller and Payne 4/5 pathological response more likely in those compliant (per-protocol) FMDCD45 + CD3 + lymphocytes (7 d) ↑ in control and ↓ in FMD compliant (per protocol)* | Ø score difference between group on EORTC QLQ-C30 | ||
| Lugtenberg et al., 2020 (37) | n = 129 patients with HER-2 negative stage II/III breast cancer | A. FMD (n = 65)B. Control (n = 64)Diet was 3 d prior to and the day of treatment. Randomized control trial | Ø differences between groupsPer-protocol analysis: less fatigue, nausea, and insomnia in those adherent to FMD* | Ø in QLQ-C30 or QLQ-BR23 between groupsPer-protocol analysis: improved physical, role, emotional, cognitive, and social functioning in those adherent to FMD*↓fatigue & dyspnea # in the FMD complaint 6 mo after treatment | ||
Ø no change, *Significant change within group, P <0.05; **significant difference between groups at endpoint, no time interaction, P <0.05; #significant group × time interaction, P <0.05. AC-T, Adriamuycin Cyclophosphamine Taxol regimen; CIPN, Chemotherapy-induced peripeheral neuropathy; CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; CTX, Cyclophosphamide; EORTC, European Organisation for Research and Treatment of Cancer; FACIT-F, Functional assessment of chronic illiness therapy fatigue; FACIT-G, Functional assessment of chronic illiness therapy general; FEC-T, Fluorouracil-Epirubicin-Cyclophosphamide-Docetaxel; FMD, fasting mimicking diet; KD + STF, ketogenic diet combined with short-term fasting (KD 6 d prior to STF); MCH, Mean corpuscular hemoglobin; MCV, mean corpuscular volume; mSTF, modified short-term fasting (<25% of energy needs); NCCN - FACIT FOSI 18, National comprehensive cancer network functional treatment of cancer therapy, Ovarian cancer symptom index; QOL, quality of life; QLQ, Quality of life questionaire; STF, short-term fasting; TAC, Taxotere-Adriamycin-Cytoxan regimen; TOI, Trial outcome index.