Time Restricted Eating During Chemotherapy for Breast Cancer

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Breast cancer is the most common cancer in the United States however, little is known about how diet can affect cancer treatment. Pre-clinical murine studies report intermittent fasting increases effectiveness of chemotherapy and decreases treatment related adverse events. The proposed research will demonstrate that time restricted eating, a form of intermittent fasting, will improve treatment related outcomes, patient related outcomes, and limit treatment related weight gain and fat mass accretion.Time restricted eating combined with a mediterranean diet will also be feasible and improve cardiometabolic risk more than TRE alone or standard care.

Inclusion Criteria

Age 25-99 at time of consent
ECOG 0 or 1
Breast cancer to meet histologically confirmed Stage I-III.
Demonstrates adequate organ function (absolutely neutrophil count ≥ 1,500/μL).
All screening labs to be obtained within 30 days prior to registration.
Able to provide written informed consent and HIPAA authorization for release of personal health information, via an approved UIC Institutional Review Board (IRB) informed consent form and HIPAA authorization.
Women of childbearing potential must not be pregnant or breast-feeding. A negative serum or urine pregnancy test is required per institutional practice guidelines.
As determined at the discretion of the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study.

Exclusion Criteria

Women with metastatic disease or type 1 or 2 diabetes
Women with BMI ≥ 40kg/m2 and < 25kg/m2
Women who are pregnant. A negative serum or urine pregnancy test is required per institutional practice guidelines.
Night shift workers
Women with a history of eating disorders
Enrolled participants with a significant weight loss or weight gain within 3 months of the study (weight gain or loss >4kg)
Active infection requiring systemic therapy
Uncontrolled HIV/AIDS or active viral hepatitis
Pregnant or nursing
Any prior or concurrent malignancy whose natural history or treatment has the potential to interfere with the safety or efficacy assessment of this investigational regimen, as determined by the treating medical oncologist.
Any mental or medical condition that prevents the patient from giving informed consent or participating in the trial.
Other major comorbidity, as determined by study PI
Illicit drug use or excessive use of alcohol (i.e., > 2 drinks/day)
Currently participating in Weight Watcher's or another weight loss program
Myocardial infarction
Stroke
Congestive heart failure
Chronic hepatitis
Cirrhosis
Chronic pancreatitis
History of solid organ transplantation

Current standard of care during chemotherapy for breast cancer suggests enough daily

calories and protein to maintain body weight and avoid muscle loss. However, this

approach may be antiquated given weight gain is common during treatment and emerging

pre-clinical and clinical evidence suggest that fasting during chemotherapy may improve

clinical and patient-reported outcomes. For example, preliminary human trials examining

the fasting mimicking diet (very low-calorie, low-protein diet 1-week per month) or short

term fasting (48-120 hours (h)), known as periodic fasting, surrounding chemotherapy may

increase effectiveness of treatment and decrease side effects related to chemotherapy.

Yet these diets have low adherence, side effects of their own, and may increase patient

burden and decrease quality of life. In contrast, time restricted eating (TRE) is a form

of intermittent fasting with high adherence that may have similar positive effects on

treatment outcomes without the untoward side-effects. Moreover, TRE may have beneficial

effects on glucose regulation and body composition (i.e., decreased weight and body fat

gain) suggesting the potential importance of this regimen to breast cancer recurrence.

TRE is extremely accessible with no calorie counting or financial burden to the patient,

individuals just shorten their eating window daily. However TRE also does no address diet

quality. The Mediterranean diet has also been shown to improve patient and treatment

outcomes in this population. The additive effect might be even more beneficial. Despite

the potential benefits, TRE alone or TRE combined with a mediterranean has not been

investigated in breast cancer patients during chemotherapy treatment. We aim to test the

safety and feasibility of 8-h TRE compared to TRE combined with a mediterranean style

diet among female breast cancer patients initiating chemotherapy for stage I-III breast

cancer. We further strive to examine the preliminary efficacy of TRE or TRE with the

mediterranean diet on treatment related outcomes, treatment related side effects,

patient-reported quality of life and fatigue, blood-based metabolic markers and

body/weight adiposity compared to the current standard of care.

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Time Restricted Eating During Chemotherapy for Breast Cancer

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