I was introduced to the health benefits of intermittent and periodic extended fasting and green exercsise during my health journey to reverse type 2 diabetes (see earlier posts).  While developing a proton therapy system I learned that fasting and exercise can reduce the adverse effects of radiation and chemotherapy  for cancer.

One component of my therapy is Padcev (see previous entry) - which delivers a cancer killing agent MMAE to cells (like my cancer cells) which express a protein Nectin 4.  Some studies have suggested that fasting may enhance the sensitivity of cancer cells to stress, while protecting normal cells from stress. This phenomenon is called differential stress sensitization (DSS). Fasting may induce DSS by lowering the levels of growth factors and hormones, such as insulin and IGF-1, that promote the survival and proliferation of cancer cells. Fasting may also induce DSS by activating a process called autophagy, where the cells recycle their damaged or unwanted components. Autophagy may help normal cells to cope with stress and remove toxic substances, while cancer cells may fail to perform autophagy properly and accumulate more damage.

The other component of my therapy is Keytruda (see previous entry) which boosts my immune response.  Studies have suggested that fasting may enhance the efficacy of cancer immunotherapy by boosting the immune system, increasing the immunogenicity of the tumor, and alleviating the immunosuppression caused the the tumor or chemotherapy.

I found green exercise - in my case e-biking on local roads - in addition to reducing stress and improving mode was also help in reducing insulin resistance and inflammation.  It may also boost the immune system and also enhance the effectiveness of chemotherapy and immunotherapy.

My regimen:
I begin fasting 2 days before my infusion, fast on the day of infusion and 2 days after.  The extended fasting induces autophagy.  The clearance half time for the cancer killing component of Padcev (MMAE) is 2.4 days. Fasting 2 days after infusion maintains maximal protection of normal cells and stress on cancer cells while the chemotherapy agent is most active.

I then keep my carbohydrate consumption low enough to maintain nutritional ketosis between infusions.  This helps to minimize the fuel source used by cancer low.

I continue to ride my e-bike at least 2-3 times a week which, as always is a great for stress relief, mood elevation and glucose control.

Results so far:
Other than losing a fair bit of hair, I have had no adverse effects from treatment.
I had surgery in January to remove a stent placed in my right ureter during a procedure to resect my primary tumor.  No evidence of the primary tumor was seen and my right kidney function was brisk so the stent was not replaced.

I am in my third cycle of treatment and on completion of the fourth I will have another PET/CT exam which will show whether treatment has been effective.

I would like to see more clinical trials designed to demonstrate and assess the benefits of fasting and exercise in cancer treatment and will be seeking opportunities to participate in such work.

References:

​Fasting and cancer: Benefits and effects
Adding fasting-mimicking diet to first-line carboplatin-based chemotherapy is associated with better overall survival in advanced triple-negative breast cancer patients: A subanalysis of the NCT03340935 trial
Short-Term Fasting Synergizes with Solid Cancer Therapy by Boosting Anti-tumor immunity
A review of fasting effects on the response of cancer to chemotherapy
Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions
Researchers Look to Fasting as a Next Step in Cancer Treatment
Effect of fasting on cancer: A narrative review of scientific evidence​
Fast-Mimicking Diet is Safe and Reshapes Metabolism and Antitumor Immunity in Patients with Cancer
​Safety and Feasibility of Fasting-Mimicking Diet and Effects on Nutritional Status and Circulating Metabolic and Inflammatory Factors in Cancer Patients Undergoing Active Treatment

November 29, 2023 -  My Social Security and Medicare application was approved.  Medicare was retroactive to desired start date of Nov 1 in by October application.  Because of the delays, I paid for 1 month of (very expensive) COBRA extension of my former employer insurance to cover any claims in November.   I notified my providers at the University of Tennessee Medical Center of my new coverage and prepared to start first treatment on Dec 7.   Somehow the new coverage didn't make it through the system.  I had a bit of anticipation and anxiety regarding delivery and adverse effects of treatment and was quite crestfallen to learn that the treatment would not begin that day.  It  had been 2 months since my TURBT surgery.

At the same time - had I proceeded earlier the treatment options afforded by standard of care based on information at the time - Radical Cystectomy  or Trimodality Therapy would have been quite different.  My wife and I spent our nervous energy and disappointment on retail therapy - we had lost our home to first on March 29 and decided to shop for some furniture and appliances to populate a new manufactured home we had recently ordered to replace it.

Dec 11:   I was introduced to the mechanics of my first line treatment:  Prior to any treatment, I have two tu es of blood drawn and the lab results are reviewed to determine that there is no indication that would prevent adminstration.  At the beginning of each cycle I meet with my medical oncologist and he would give the go ahead to proceed with a treatment cycle.  Two hours are allocated for the blood work and consultation.

I then proceed to the infusion center waiting room.  When they are ready I am called back to one of several suites of rooms with chemo chairs: recliners with side tables on each arm.  I choose an available seat and wait for the pharmacy to give a green check for preparation of the iv bags of the agents to be infused.  I am offered a warm blanket as I settle in and blood pressure is taken. When the green check from the pharmacy arrives, a nurse looks for a place to insert a needle for an IV line.  Ideally the first insertion is functional - otherwise the needle is removed and another site chosen and tried.  The IV line is connected to a bag with saline.  When the agents are prepared they are brought in.  I first receive a syringe push of Kytril.  On first day of the cycle I receive an infusion of Keytruda and then an infusion of Padcev - each taking 30 minutes to complete.  On completion my blood pressure is taken and I am free to go..