Expert review: Clinical trials have shown that fasting can aid breast cancer treatment, enhance the effect severity of chemotherapy, reduce side effects.

In modern society, with the development of society and economy, people's quality of life has been steadily rising, and people's health and life expectancy have also been significantly increased.at present, health concepts such as exercise, fitness and balanced diet have become a consensus. These scientific health concepts also guide us to actively pursue a healthy lifestyle.fasting is not a healthy lifestyle, but it exists in many religions. As a criterion of faith, it can reflect on oneself, or teach believers to control greed and pursue a higher level of life.in addition, fasting is sometimes an expression of political will, such as Mahatma Gandhi's hunger strike to promote Indian independence movement.it is worth noting that in recent years, scientific research has shown that fasting can sometimes promote the treatment of certain diseases, such as diabetes and cancer.however, most of these studies are limited to animal models, and there are few clinical trials to confirm whether fasting really benefits the treatment of these diseases.recently, researchers from the Department of medical oncology, Leiden University Medical Center, the Netherlands, published a clinical research paper entitled: fast mimicking die as an adjunct to neoadjuvant chemotherapy for breast cancer in the multicenter randomized phase 2 direct trial.this is the first randomized controlled study to evaluate the side effects of simulated restricted diet on cancer patients and the efficacy of chemotherapy. 131 patients with HER2 negative stage II / III breast cancer were randomly selected and divided into two groups: the conventional diet group and the simulated fasting group. After chemotherapy in the two groups, the researchers found that the effect of simulated fasting group was better and significantly reduced DNA damage of T lymphocytes induced by chemotherapy.a large number of preclinical evidences show that short-term fasting can protect healthy cells from various stress sources including chemotherapy, and make cancer cells more sensitive to chemotherapy or other therapies.fundamentally, fasting forces healthy cells to change from proliferative state to maintenance and repair state. On the contrary, cancer cells seem unable to enter this protective state due to special physiological conditions. Moreover, fasting also deprives cancer cells of nutrition and growth factors, increasing cell death after chemotherapy.cytokines such as insulin-like growth factor-1 (IGF-1), insulin and glucose can promote the growth and tissue apoptosis. The decrease of their plasma levels will have a significant impact on the physiological status of cancer cells.studies have shown that it takes at least 48 hours of fasting to cause a significant decrease in plasma IGF-1, insulin and glucose levels.in this regard, a simulated restricted diet (FMD) with very low calories and low protein has been developed. It can not only affect the metabolism of various hunger reaction markers, but also reduce the burden of fasting.in this study, the researchers conducted a multicenter, open label, randomized phase II clinical trial.the team randomly selected 131 HER2 negative patients with stage II / III breast cancer who had no diabetes and had a body mass index of more than 18 kg / m2.after signing informed consent and physical examination, 129 patients were randomly and equally assigned to two groups - the conventional diet group and the fasting simulation group.before chemotherapy, the two groups received conventional diet or fasting simulated diet for 3 days. the researchers found that although the fasting simulation group did not use dexamethasone and FEC / AC, there were no more grade III / IV adverse events compared with the patients in the conventional diet group, indicating that FMD can also play a similar role in preventing the side effects of chemotherapy with dexamethasone. more importantly, FMD protects these cells from chemotherapy-induced DNA damage, compared with patients in the conventional diet group. in addition, complete or partial remission after chemotherapy was more common in the fasting simulation group (or 3.168, P
=
0.039). Miller & amp; Payne 4 / 5 pathological reaction showed that 90% - 100% of tumor cell loss was more likely to occur in the fasting simulation group (or 4.109, P
=
0.016). in conclusion, different from previous preclinical studies, this study conducted a multicenter randomized phase II clinical trial in 129 HER2 negative stage II / III breast cancer patients, and verified that fasting before chemotherapy can enhance the effect of chemotherapy and reduce the side effects of chemotherapy. these positive findings will encourage the scientific community to further explore the application of fasting in cancer treatment. on April 20, 2020, Miao Changhong team of Fudan University published a research paper entitled: fast inhibitors aeroglycolysis and promotion in color cancer via the fdft1 mediated Akt / mTOR / HIF1 α pathway suppression in nature communications. this study elaborated the detailed molecular mechanism of fasting inhibiting colorectal cancer. Fdft1 is a key downstream target of fasting. Fasting can up regulate the expression of fdft1 and inhibit Akt / mTOR / HIF1 α signal transduction, thus inhibiting aerobic glycolysis and proliferation of colorectal cancer cells. It also indicates that fasting and inhibiting mTOR pathway are potential methods for the treatment of colorectal cancer. it is reported that this is the first time that Chinese clinical anesthesiologists published a paper on tumor anesthesia in nature communications. BioWorld invited director Miao Changhong to review the research work on the adjuvant treatment of breast cancer by fasting. expert comments: Miao Changhong (director of anesthesia department, Zhongshan Hospital Affiliated to Fudan University), this is the first randomized controlled study to evaluate the side effects and chemotherapy efficacy of simulated restricted diet on cancer patients. this study suggests that simulated restricted diet can significantly enhance the imaging and pathological tumor remission of patients with HER2 negative early breast cancer. ITT analysis showed that compared with the control group, the number of patients with complete or partial remission on imaging was increased, while the number of patients with stable or progressive imaging was decreased. protocol analysis showed that the simulated restricted diet had a beneficial effect on pathological response. the longer the cycle of simulated restriction diet, the higher the Miller & amp; Payne pathological reaction score (4 / 5) (tumor cell loss rate > 90%). it shows that the periodic simulated diet restriction is safe and effective as an adjuvant method of chemotherapy for early breast cancer. these findings, together with preclinical data, encourage us to further explore the benefits of fasting / simulated diet restriction in cancer patients. what is insufficient is that the sample size of this study is still relatively small, so we look forward to the results of clinical trials with larger samples in the future. in addition, we should be cautious in interpreting the results of this study, and there is a risk of selection bias in some analyses. in addition, how will diet restriction and simulated restriction diet affect new cancer therapies, such as immunotherapy? Can restricted diet and simulated restricted diet combined with other therapies affect tumor free survival in patients with metastatic tumors? These need more well-designed, high-quality randomized controlled trials to confirm. nevertheless, this study opens a new window for new treatment methods and concepts of cancer! Special reminder: short term fasting has certain potential health benefits, but it should not be carried out blindly in order to prevent damage to health. More importantly, fasting can not replace normal treatment. This paper only interprets the latest scientific research progress and does not constitute any treatment suggestions. paper links: