In preclinical research, short-term fasting (STF) protects tumor-bearing mice against the toxic effects of chemotherapy, improves the CD8+ effector T-cell intratumor infiltration, while enhancing the chemotherapy efficacy. Short-term use of a "fasting-mimicking diet" (FMD) caused a major increase in the efficacy of cancer treatment in mice comparable to STF. In humans, the investigators recently performed a multicenter randomized phase II trial showing that patients with Human Epidermal growth factor Receptor 2 (HER2) negative breast cancer treated with neoadjuvant chemotherapy and FMD displayed a better radiological response and a better pathological response (90-100% vs \<90% tumor cell reduction) than patients treated with chemotherapy without FMD (de Groot, Nat Commun 2020; NCT02126449). Therefore these findings will be validated in a phase 3 trial with the underlying hypothesis that FMD during neoadjuvant chemotherapy for breast cancer improves clinical outcomes, potentially due to improved local immunity.
STF during neadjuvant chemotherapy aiming to improve the chemotherapy efficacy and decline the side effects in patients with stage II-III HR+, HER2- breast cancer
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Fasting mimicking diet by L-Nutra, a 4-day low caloric, low protein, vegetarian diet 3 days prior to and the day of neoadjuvant chemotherapy administration. The FMD will take place every 4 weeks, thus in total 5 times (2x during ddAC, 3x during Paclitaxel) during the neoadjuvant chemotherapy.
Noordwest Ziekenhuisgroep
Alkmaar, Netherlands
Rode Kruis ziekenhuis
Beverwijk, Netherlands
Alexander Monro Ziekenhuis
Bilthoven, Netherlands
Reinier de Graaf ziekenhuis
Delft, Netherlands
Deventer Ziekenhuis
Deventer, Netherlands
Ziekenhuis Gelderse Vallei
Ede, Netherlands
Leiden University Medical Center
Leiden, Netherlands
Pathological response rate (pCR). Both percentage of pCR and 90-100% tumor loss according to Miller & Payne
Time frame: 4.5 years
Objective response rate assessed by MRI (RECIST1.1) after 4 ddAC cycles and at the end of chemotherapy
Time frame: 4.5 years
Determine the effect of treatment on the 3 and 5 year Event-free survival (EFS) and Overall survival (OS)
Time frame: 7.5 and 9.5 years
Adverse events ≥grade 3 (maximum of total) difference between treatment arms during neoadjuvant chemotherapy (ddAC, paclitaxel and total).
Time frame: 4.5 years
Quality of Life assessed by online questionnaires (EORTC QLQ-C30, EORTC QLQ-BR23), burden of therapy (Distress Thermometer) and Illness Perceptions (B-IPQ)
Validated online questionnaires take place at baseline, after 4 ddAC cycles, before surgery and 6 months after surgery.
Time frame: 5 years
Cognition assessed by Amsterdam Cognition Scan (ACS) online battery consisting of 7 online neuropsychological tests
online questionnaires take place at baseline, before surgery and 6 months after surgery.
Time frame: 5 years
Determine the effect of FMD on local immunomodulation and tumor immunity
By analyzing the immune-composition and gene-expression profile using multispectral Vectra imaging and Nanostring analyses respectively, in tumor samples taken at baseline (diagnostic), after 4 cycles and resection specimen
Time frame: 6 years
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