From the Guidelines
Fasting for 24 hours before a docetaxel infusion is not recommended due to the potential risks of malnutrition and the lack of evidence demonstrating a clear benefit. The most recent and highest quality study, published in 2021 1, emphasizes the importance of avoiding diets that are not based on clinical evidence and may be harmful, including fasting during chemotherapy. This study highlights that there are no clinical trials demonstrating a benefit of fasting in cancer patients and that such approaches may lead to insufficient energy intake and weight loss.
Key Considerations
- The ESPEN practical guideline: clinical nutrition in cancer, published in 2021 1, provides the most up-to-date recommendations on nutrition in cancer patients.
- This guideline recommends against all forms of diets that are not based on clinical evidence, have no proven efficacy, and that potentially could be harmful.
- Fasting before, during, or after chemotherapy is not recommended due to the risks of malnutrition and the lack of evidence showing a benefit.
- Patients should maintain normal nutrition before chemotherapy to support their overall health and ability to tolerate treatment.
Clinical Implications
- Patients should follow their oncologist's specific pre-medication instructions, which typically include taking dexamethasone to reduce the risk of fluid retention and hypersensitivity reactions.
- Maintaining hydration before treatment is encouraged, as it may help reduce side effects.
- Any significant changes to eating patterns before chemotherapy should only be undertaken under direct medical supervision, as proper nutrition is important for patients undergoing cancer treatment.
- The potential benefits of fasting or fasting-mimicking diets on the effectiveness and tolerability of anticancer agents are being explored in ongoing research, but as of now, these approaches remain experimental and are not part of standard docetaxel protocols 1.
From the Research
Fasting Before Docetaxel Infusion
- The question of whether fasting for 24 hours before a Docetaxel infusion is beneficial can be approached by examining the effects of fasting on chemotherapy tolerance and efficacy.
- Studies have shown that short-term fasting (STF) can protect healthy cells against the side effects of chemotherapy and make cancer cells more vulnerable to it 2.
- A randomized pilot study found that STF was well tolerated and reduced hematological toxicity of TAC (docetaxel/doxorubicin/cyclophosphamide) in HER2-negative breast cancer patients 2.
- The study also found that STF may reduce a transient increase in, and/or induce a faster recovery of DNA damage in peripheral blood mononuclear cells (PBMCs) after chemotherapy 2.
Mechanisms and Effects of Fasting
- Fasting has been shown to induce differential stress resistance, reducing the adverse effects of chemotherapy and enhancing the efficacy of drugs 3.
- The potential benefits of fasting in combination with chemotherapy include reducing tumor progression and increasing the effectiveness of chemotherapy 3.
- However, the effects of fasting on human cancer incidence and prognosis remain unknown due to a lack of high-quality randomized clinical trials 4.
Docetaxel and Fasting
- Docetaxel is a cytotoxic taxane effective in the treatment of patients with breast cancer, and its clinical profile is well established 5.
- While there is evidence to suggest that fasting may be beneficial in reducing the toxicity of chemotherapy, including docetaxel, more human studies with adequate sample size and follow-ups are required to confirm these findings 2, 3, 4.
- A phase I trial of docetaxel administered as a 1-hour infusion in children with refractory solid tumors found that dose-related neutropenia was the primary dose-limiting toxicity 6.
- However, this study did not investigate the effects of fasting on docetaxel toxicity or efficacy.