Safety and feasibility of fasting in combination with platinum-based chemotherapyReport as inadecuate

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BMC Cancer

, 16:360

Medical and radiation oncology


BackgroundShort-term starvation prior to chemotherapy administration protects mice against toxicity. We undertook dose-escalation of fasting prior to platinum-based chemotherapy to determine safety and feasibility in cancer patients.

Methods3 cohorts fasted before chemotherapy for 24, 48 and 72 h divided as 48 pre-chemo and 24 post-chemo and recorded all calories consumed. Feasibility was defined as ≥ 3-6 subjects in each cohort consuming ≤ 200 kcal per 24 h during the fast period without excess toxicity. Oxidative stress was evaluated in leukocytes using the COMET assay. Insulin, glucose, ketones, insulin-like growth factor-1 IGF-1 and IGF binding proteins IGFBPs were measured as biomarkers of the fasting state.

ResultsThe median age of our 20 subjects was 61, and 85 % were women. Feasibility criteria were met. Fasting-related toxicities were limited to ≤ grade 2, most commonly fatigue, headache, and dizziness. The COMET assay indicated reduced DNA damage in leukocytes from subjects who fasted for ≥48 h p = 0.08. There was a non-significant trend toward less grade 3 or 4 neutropenia in the 48 and 72 h cohorts compared to 24 h cohort p = 0.17. IGF-1 levels decreased by 30, 33 and 8 % in the 24, 48 and 72 h fasting cohorts respectively after the first fasting period.

ConclusionFasting for 72 h around chemotherapy administration is safe and feasible for cancer patients. Biomarkers such as IGF-1 may facilitate assessment of differences in chemotherapy toxicity in subgroups achieving the physiologic fasting state. An onging randomized trial is studying the effect of 72 h of fasting.

Trial registrationNCT00936364, registered propectively on July 9, 2009.

KeywordsFasting Chemotherapy Neutropenia Oxidative stress Insulin-like growth factor Valter Longo and David I. Quinn are co-senior authors, having supervising responsibility for the laboratory and the clinical aspects of the data, respectively.

Electronic supplementary materialThe online version of this article doi:10.1186-s12885-016-2370-6 contains supplementary material, which is available to authorized users.

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