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BMC Cancer. 2016 Jun 10;16:360. doi: 10.1186/s12885-016-2370-6.

Safety and feasibility of fasting in combination with platinum-based chemotherapy.

Author information

1
USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA.
2
Department of Preventive Medicine, USC Keck School of Medicine, 1441 Eastlake Ave, #4427, Los Angeles, 90033, CA, United States.
3
USC Keck School of Medicine, Department of Obstetrics and Gynecology, 1441 Eastlake Ave, #3440, Los Angeles, 90033, CA, United States.
4
Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States.
5
Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States. vlongo@usc.edu.
6
USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA. diquinn@usc.edu.

Abstract

BACKGROUND:

Short-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.

METHODS:

3 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.

RESULTS:

The 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.

CONCLUSION:

Fasting 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 REGISTRATION:

NCT00936364 , registered propectively on July 9, 2009.

KEYWORDS:

Chemotherapy; Fasting; Insulin-like growth factor; Neutropenia; Oxidative stress

PMID:
27282289
PMCID:
PMC4901417
DOI:
10.1186/s12885-016-2370-6
[Indexed for MEDLINE]
Free PMC Article

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