Fasting-mimicking diet and breast cancer: hopes for treatment from Milan

A new path, based on a nutritional approach, is opening up in the fight against cancer. It's called Breakfast, in fact, the study launched last May at the National Cancer Institute of Milan (Int) and presented to the press in recent days, whose goal is to demonstrate the effectiveness of the cyclical fasting-mimicking diet, alone or in combination with the antidiabetic drug metformin, in patients between 18 and 75 years old diagnosed with triple-negative breast cancer, without metastases, undergoing chemotherapy before surgery. Waiting time for the first results: two years.

“The study, which involves 90 women, aims to increase the ability of chemotherapy to induce complete pathological responses, that is, the absence of invasive cancer both at the breast level and in the lymph nodes removed during surgery, thus resulting in the elimination of vital cancer cells, which is associated with a significantly higher probability of definitive cure of the patient from cancer,” says Claudio Vernieri, oncologist at the breast unit of the department of Medical Oncology and Hematology at Int and group leader of the program “Metabolic Reprogramming in Solid Tumors” at Ifom-Institute, Firc Foundation of Molecular Oncology in Milan. “We have set as our main goal the increase of complete pathological responses from 45%, which is the historical literature data with chemotherapy alone, to 65% with the proposed experimental approaches. It is an ambitious goal, but the preclinical data are so strong that they indicate this could be a revolutionary path.”

The experimental diet consists of fresh foods from the Mediterranean tradition with low carbohydrate and protein content, with a caloric intake of about 1,800 Kcal divided over five days. It is repeated every 21 days for eight cycles, in parallel with chemotherapy. The foods consist essentially of vegetables, mainly salad, zucchini and green leafy vegetables, olive oil, and nuts. No carrots, pumpkin, or potatoes due to their carbohydrate content, as well as proteins of any kind, i.e., meat, fish, cheese, and legumes.

“This dietary regimen is able to produce profound changes in the metabolism of sugars, amino acids, and fatty acids, thus targeting the metabolism of the cancer cell,” continues Vernieri.  “Contrary to what one might think, it is a well-tolerated dietary regimen, as we have also seen in previous studies, so much so that it allows for normal work activities, obviously if they are not too physically demanding. Furthermore, we have created a close network with patients from whom we receive a daily report via email or SMS every evening and we are available at any time, including weekends, to resolve any doubts or health problems. This type of support increases compliance and minimizes the risk of side effects.”

One arm of the Breakfast study involves the administration of metformin. “A possible antitumor activity of metformin has been known for some time, probably due to its ability to reduce blood levels of certain hormones that promote tumor growth,” says Saverio Minucci, director of the “New Drugs” program at the European Institute of Oncology in Milan. “Recently we have shown in a study published in the journal Cancer Cell how the combination of metformin with a hypoglycemic diet can lead to a strong enhancement of its antitumor activity with a direct action on cancer cells.”  

Thus concludes Filippo de Braud, director of the department and division of Medical Oncology and Hematology at Int: “The diet we are using is an experimental therapy, completely innovative, which arises from the combination of solid preclinical and clinical studies on tumor metabolism and from our Institute's tradition of considering nutritional approaches as potentially therapeutic. We have already been using it for some time in our research, with different objectives. The DigesT study, for example, was activated to evaluate the changes induced by the restrictive diet in the case of breast cancer and melanoma, while the Fame study is studying the effectiveness of the antidiabetic drug metformin, with or without restrictive diet, in combination with chemotherapy in patients with metastatic lung cancer characterized by a specific alteration.”

Triple-negative, whose name is due to the fact that it does not express either hormone receptors or the Her2 oncoprotein, which can guide targeted anticancer treatments, represents 15-20% of breast cancer forms, certainly the most aggressive, with a higher recurrence rate within the first five years after diagnosis and still unsatisfactory therapies in the context of metastatic disease.

Nicola Miglino

Original Article: http://www.nutrientiesupplementi.it/attualita/item/1111-mima-digiuno-e-ca-mammario-da-milano-nuove-s...