Fasting and cancer treatment in humans: A case series report

Abstract

Short-term fasting (48 hours) was shown to be effective in protecting normal cells and mice but not cancer cells against high dose chemotherapy, termed Differential Stress Resistance (DSR), but the feasibility and effect of fasting in cancer patients undergoing chemotherapy is unknown. Here we describe 10 cases in which patients diagnosed with a variety of malignancies had voluntarily fasted prior to (48-140 hours) and/or following (5-56 hours) chemotherapy. None of these patients, who received an average of 4 cycles of various chemotherapy drugs in combination with fasting, reported significant side effects caused by the fasting itself other than hunger and lightheadedness. Chemotherapy associated toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) of the National Cancer Institute (NCI). The six patients who underwent chemotherapy with or without fasting reported a reduction in fatigue, weakness, and gastrointestinal side effects while fasting. In those patients whose cancer progression could be assessed, fasting did not prevent the chemotherapy-induced reduction of tumor volume or tumor markers. Although the 10 cases presented here suggest that fasting in combination with chemotherapy is feasible, safe, and has the potential to ameliorate side effects caused by chemotherapies, they are not meant to establish practice guidelines for patients undergoing chemotherapy. Only controlled-randomized clinical trials will determine the effect of fasting on clinical outcomes including quality of life and therapeutic index.

Keywords: Cancer; Chemotherapy; IGF-I; Side-effect; Toxicity; fasting.

Conflict of interest statement

The authors of this manuscript have no conflict of interest to declare.

Figures

Figure 1.. Self-reported side-effects after chemotherapy with or without fasting.

Data represent average of CTCAE grade from matching fasting and non-fasting cycles (Ad Lib). 6 patients received either chemotherapy-alone or chemo-fasting treatments. Self-reported side effects from the closest two cycles were compared one another. Statistic analysis was performed only from matching cycles. Data presented as standard error of the mean (SEM). P value was calculated with unpaired, two tail t test. (*, P

Figure 2.. Laboratory values of blood cell counts for case 1.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct; (H) Body weight. Filled triangle indicates day of chemotherapy; open square indicates fasting. Normal ranges of laboratory values are indicate by dash lines; (I) Self-reported side-effects after chemotherapy for case 1. Data represent the average of 2 cycles of chemo-alone vs the average of 2 cycles of chemo-fasting treatments.

Figure 3.. Self-reported side-effects after chemotherapy for case 2.

Data represent the average of 3 cycles of chemo-alone vs the average of 5 cycles of chemo-fasting treatments.

Figure 4.. Laboratory values of blood cell counts for case 3.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct; (H) Prostate specific antigen (PSA) level. The patient was enrolled in abiraterone acetate (CYP17 inhibitor) trial for 90 days indicated by vertical dash lines. The patient also received G-CSF (Neulasta) on the day of chemotherapy except during the treatment with abiraterone acetate. Filled triangle indicates day of chemotherapy; open square indicates fasting, arrow indicates testosterone application (cream 1%). Normal ranges of laboratory values are indicated by horizontal dash lines; (I) Self-reported side-effects after chemotherapy for case 3. Data represent the average of 5 cycles of chemo-alone vs the average of 7 cycles of chemo-fasting treatments.

Figure 5.. Laboratory values of blood cell counts for case 4.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct; Filled triangle indicates day of chemotherapy; open square indicates fasting. Normal ranges of laboratory values are indicated by dash lines; (H) Self-reported side-effects after chemotherapy for case 4. Data represent the average of 5 cycles of chemo-alone vs 1 cycle of chemo-fasting treatment.

Figure 6.. Self-reported side-effects after chemotherapy for case 5.

Data represent 1 cycle of chemotherapy-alone (first cycle) vs the average of 5 cycles of chemo-fasting treatments.

Figure 7.. Laboratory values of blood cell counts for case 6.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct; Filled triangle indicates day of chemotherapy; open square indicates fasting. Normal ranges of laboratory values are indicated by dash lines. The patient received red blood cell transfusion (3 units) on day 71 and also received G-CSF (Neulasta) as indicated.

Figure 8.. Laboratory values of blood cell counts for case 7.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct; (H) Prostate specific antigen (PSA) level. Filled triangle indicates day of chemotherapy; open square indicates fasting, arrow indicates abiraterone administration. Normal ranges of laboratory values are indicate by dash lines. The patient also received G-CSF (Neulasta) as indicated; (I) Self-reported side-effects after chemotherapy for case 7. Data represent the average of 8 cycles of chemo-fasting treatments.

Figure 9.. Self-reported side-effects after chemotherapy for case 8.

Data represent the average of 4 cycles of chemo-fasting treatments.

Figure 10.. Self-reported side-effects after chemotherapy for case 9.

Data represent the average of 4 cycles of chemo-fasting treatments.

Figure 11.. Laboratory values of blood cell counts for case 10.

(A) Neutrophils; (B) Lymphocytes; (C) White blood cells, WBC; (D) Platelets; (E) Red blood cells, RBC (F) Hemoglobin, Hgb; (G) Hematocrit, Hct. Filled triangle indicates day of chemotherapy; open square indicates fasting. Normal ranges of laboratory values are indicated by dash lines. The patient also received G-CSF (Neulasta) as indicated. (H) Self-reported side-effects after chemotherapy for case 10. Data represent the average of 6 cycles of chemo-fasting treatments.