Description:
Preclinical studies provide strong support for the concept that fasting evokes resistance to
multiple forms of stress. Fasting reduces plasma levels of growth factors and modulates
intracellular nutrient sensing systems, thereby diverting energy from growth to maintenance.
Accordingly, the currently available preclinical evidence suggests that short-term fasting
protects normal cells against the perils of chemotherapy. In contrast, cancer cells are not
protected, as a result of their self-sufficiency in growth signals. This phenomenon is termed
Differential Stress Resistance (DSR). DSR reduces the severity of toxic side-effects of
chemotherapy and interestingly, it simultaneously renders cancer cells more vulnerable to
chemotherapeutics. Importantly, extensive preclinical evidence and preliminary clinical data
indicate that a specifically designed very low calorie, low amino acid substitution diet
("Fasting Mimicking Diet, FMD") has effects on cancer therapy that are very similar to those
of fasting. This study aims to evaluate the impact of the FMD on tolerance to and efficacy of
neoadjuvant chemotherapy in women with stage II or III breast cancer.
Title
- Brief Title: DIetary REstriction as an Adjunct to Neoadjuvant ChemoTherapy for HER2 Negative Breast Cancer
- Official Title: DIetary REstriction as an Adjunct to Neoadjuvant ChemoTherapy for HER2 Negative Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
NL44684.058.13
- SECONDARY ID:
BOOG2013-04
- SECONDARY ID:
p13.135
- NCT ID:
NCT02126449
Conditions
- Fasting Mimicking Diet
- Breast Cancer
- Neoadjuvant Chemotherapy
- Pathological Complete Response
Purpose
Preclinical studies provide strong support for the concept that fasting evokes resistance to
multiple forms of stress. Fasting reduces plasma levels of growth factors and modulates
intracellular nutrient sensing systems, thereby diverting energy from growth to maintenance.
Accordingly, the currently available preclinical evidence suggests that short-term fasting
protects normal cells against the perils of chemotherapy. In contrast, cancer cells are not
protected, as a result of their self-sufficiency in growth signals. This phenomenon is termed
Differential Stress Resistance (DSR). DSR reduces the severity of toxic side-effects of
chemotherapy and interestingly, it simultaneously renders cancer cells more vulnerable to
chemotherapeutics. Importantly, extensive preclinical evidence and preliminary clinical data
indicate that a specifically designed very low calorie, low amino acid substitution diet
("Fasting Mimicking Diet, FMD") has effects on cancer therapy that are very similar to those
of fasting. This study aims to evaluate the impact of the FMD on tolerance to and efficacy of
neoadjuvant chemotherapy in women with stage II or III breast cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Fasting mimicking diet | Experimental | Short term fasting using Fasting mimicking diet around neoadjuvant chemotherapy (AC>T) | |
regular diet | No Intervention | Standard neoadjuvant chemotherapy (AC>T) | |
Eligibility Criteria
Inclusion Criteria:
- Female patients with stage II or III (cT1cN+ or ≥T2 any cN, cM0) breast cancer
receiving neoadjuvant AC-T
- Measurable disease (breast and/or lymph nodes)
- HER2 negative core biopsy Age ≥18 years
- WHO performance status 0-2
- Adequate bone marrow function : white blood cells (WBCs) ≥3.0 x 109/l, neutrophils
≥1.5 x 109/l, platelets ≥100 x 109/l
- Adequate liver function: bilirubin ≤1.5 x upper limit of normal (UNL) range, ALAT
and/or ASAT ≤2.5 x UNL, Alkaline Phosphatase ≤5 x UNL
- Adequate renal function: the calculated creatinine clearance should be ≥50 mL/min
- Patients must be accessible for treatment and follow-up
- Written informed consent according to the local Ethics Committee requirements
- Willing to fill in quality of life questionnaires
- Able to read and write in Dutch
Exclusion Criteria:
- History of breast cancer (invasive or non-invasive)
- Previous malignancy within 5 years, with exception of a history of a previous basal
cell carcinoma of the skin or pre-invasive carcinoma of the cervix.
- Serious other diseases such as recent myocardial infarction, clinical signs of cardiac
failure or clinically significant arrhythmias
- Diabetes Mellitus
- Body mass index (BMI) < 19 kg/m2
- Pregnancy or lactating
- Significant food allergies which would make the subject unable to consume the food
provided (ex: nuts or soy)
- Any metabolic disorders that may affect gluconeogenesis or adaptation to short fasting
periods.
- Medical or psychological condition which in the opinion of the investigator would not
permit the patient to complete the study or sign meaningful informed consent
Maximum Eligible Age: | 70 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | The percentage of patients with grade III/IV toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events version (NCI CTCAE) v4.03. |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Phase II |
Secondary Outcome Measures
Measure: | Clinical response measured by MRI (RECIST1.1) after 4 cycles chemotherapy. |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | Grade I/II side effects of chemotherapy according to NCI CTCAE v4.03. |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | Metabolic (Glucose, insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein 3 (IGF-BP3), free thyroxin (FT4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH)) and inflammatory response (CRP) to chemotherapy. |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | DNA damage, apoptosis, immunology and nutrient sensing system activity in the tumor. |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | Patient's quality of life (using EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires), burden of therapy noted by a visual analogue scale (VAS) (Distress Thermometer) and differences of Illness Perceptions (B-IPQ). |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | Long term efficacy of treatment (DFS, OS). |
Time Frame: | 4years |
Safety Issue: | |
Description: | |
Measure: | Hormone receptor percentage, Ki67 and immunologic tumor profile and tumor/stroma ratio as predictive biomarker |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | SNPs used as biomarker to predict treatment outcome. |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2/Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Leiden University Medical Center |
Last Updated
October 24, 2019