Short-term fasting accompanying chemotherapy as a supportive therapy in gynecological cancer: protocol for a multicenter randomized controlled clinical trial

Abstract

Background/objectives A few preliminary studies have documented the safety and feasibility of repeated short-term fasting in patients undergoing chemotherapy. However, there is a lack of data from larger randomized trials on the effects of short-term fasting on quality of life, reduction of side effects during chemotherapy, and a possible reduction of tumor progression. Moreover, no data is available on the effectiveness of fasting approaches compared to so-called healthy diets. We aim to investigate whether the potentially beneficial effects of short-term fasting can be confirmed in a larger randomized trial and can compare favorably to a plant-based wholefood diet. Methods This is a multicenter, randomized, controlled, two-armed interventional study with a parallel group assignment. One hundred fifty patients, including 120 breast cancer patients and 30 patients with ovarian cancer, are to be randomized to one of two nutritional interventions accompanying chemotherapy: (1) repeated short-term fasting with a maximum energy supply of 350–400 kcal on fasting days or (2) repeated short-term normocaloric plant-based diet with restriction of refined carbohydrates. The primary outcome is disease-related quality of life, as assessed by the functional assessment of the chronic illness therapy measurement system. Secondary outcomes include changes in the Hospital Anxiety and Depression Score and as well as frequency and severity of chemotherapy-induced side effects based on the Common Terminology Criteria of Adverse Events. Explorative analysis in a subpopulation will compare histological complete remissions in patients with neoadjuvant treatments. Discussion/planned outcomes Preclinical data and a small number of clinical studies suggest that repeated short-term fasting may reduce the side effects of chemotherapy, enhance quality of life, and eventually slow down tumor progression. Experimental research suggests that the effects of fasting may partly be caused by the restriction of animal protein and refined carbohydrates. This study is the first confirmatory, randomized controlled, clinical study, comparing the effects of short-term fasting to a short-term, plant-based, low-sugar diet during chemotherapy on quality of life and histological tumor remission. Trial registration ClinicalTrials.gov NCT03162289. Registered on 22 May 2017

Traditional and Medical Applications of Fasting

“…Physicians should be aware that many of their patients already adopt some type of fasting, including prolonged ones with the aim to "detoxify" their body. This is especially commonplace in oncological patients who undergo chemotherapy [117,118], very often without telling their physicians. Anecdotal reports of two-or three-day water fasts before chemotherapy [119] underline the need for the medical community to gain control over this practice and carefully discuss the pros and cons with their patients.…”

Fasten – ein potentes Therapeutikum der Moderne

“…Da jedoch in fortgeschritten Erkrankungsstadien ein Gewichtsverlust mit einer negativen Prognose korreliert, ist eine kontinuierliche Kalorienrestrik tion mit der daraus resultierenden Gewichtsabnahme bei Krebspatienten oft kontraindiziert. Kurzzeitiges, die Chemotherapie begleitendes Fasten, verursacht jedoch keinen signifikanten Gewichtsverlust und wird derzeit als klinisch praktikable Induktion der differenziellen Stressresistenz experimentell wie klinisch wissenschaftlich evaluiert [21,44,45]. Die experimentellen Studien zeigten bisher konsistent, dass ein chemotherapiebegleitendes Kurzzeitfasten sowohl Nebenwirkungen deutlich vermindert als auch die Ansprechraten auf die Chemotherapie verbessert [46,47].…”

Fasten – ein potentes Therapeutikum der Moderne

“…Da jedoch in fortgeschritten Erkrankungsstadien ein Gewichtsverlust mit einer negativen Prognose korreliert, ist eine kontinuierliche Kalorienrestriktion mit der daraus resultierenden Gewichtsabnahme bei Krebspatienten oft kontraindiziert. Kurzzeitiges, die Chemotherapie begleitendes Fasten, verursacht jedoch keinen signifikanten Gewichtsverlust und wird derzeit als klinisch praktikable Induktion der differenziellen Stressresistenz experimentell wie klinisch wissenschaftlich evaluiert [21,44,45]. Die experimentellen Studien zeigten bisher konsistent, dass ein chemotherapiebegleitendes Kurzzeitfasten sowohl Nebenwirkungen deutlich vermindert als auch die Ansprechraten auf die Chemotherapie verbessert [46,47].…”