Fasting protocol for Irinotecan?

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behconsult
Posts: 264
Joined: Fri Jul 04, 2014 4:53 pm

Fasting protocol for Irinotecan?

Postby behconsult » Wed Apr 12, 2023 8:18 pm

I am seeking details on the fasting protocols for Irinotecan? Did it make a difference?

The side-effects make me anxious as I don't want to look too scary for my kids. My bio line is not accurate. I have had about 170 rounds of chemo, radiation, and about 5 surgeries. I did the doublet therapy for Braf patients and recently started on Avastin/Lonsurf. My cea doubled from 84. I recently has bone and adrenal mets added to my list that included lung and hilar mets. Anything you care to share is much appreciated. God Bless you fellow travelers.
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Fasting protocol for Irinotecan?

Postby Rock_Robster » Wed Apr 12, 2023 9:16 pm

I haven’t tried it myself, but I understand a fairly typical protocol is a 48 hour water fast prior to the infusion, and no re-feeding until treatment is complete. Unfortunately if you’re doing FOLFIRI this means an additional 48 hours fasting during the 5-FU infusion, to ensure you aren’t refeeding at the same time as treatment and hence risking liver injury. This makes it quite a long fast.

Good luck - hope it helps.

Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

behconsult
Posts: 264
Joined: Fri Jul 04, 2014 4:53 pm

Re: Fasting protocol for Irinotecan?

Postby behconsult » Fri Apr 14, 2023 7:44 am

Rock_Robster wrote:I haven’t tried it myself, but I understand a fairly typical protocol is a 48 hour water fast prior to the infusion, and no re-feeding until treatment is complete. Unfortunately if you’re doing FOLFIRI this means an additional 48 hours fasting during the 5-FU infusion, to ensure you aren’t refeeding at the same time as treatment and hence risking liver injury. This makes it quite a long fast.

Good luck - hope it helps.

Rob


Thank you so much. I do love to eat and that is a long time. Bob
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

zephyr
Posts: 363
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting protocol for Irinotecan?

Postby zephyr » Fri Apr 14, 2023 10:50 am

I've become somewhat of a pro at fasting on Folfiri because it makes such a big difference for me. That said, I'm not familiar with eating requirements, if any, for Lonsurf so you might need to make adjustments.

You don't need to do a complete fast; you can eat up to 500 calories per day. It's a fast-mimicking diet (FMD) and as long as you stay in that 500 calories per day range, your body will think you're fasting. You want your healthy cells to think there's a famine coming and sort of go into hibernation. Your cancer cells have no such self-regulating mechanism so they just keep getting hungrier and hungrier. When the chemo hits your system, the cancer cells think they found the all-you-can-eat buffet and gobble it up. Your normal cells are just kicking back - again, think hibernation - and aren't taking in much so there's less toxicity and fewer side effects. Theoretically, your cancer cells should get extra portions of chemo. That's my understanding but I'm sure someone here can give you a better (and more accurate) scientific explanation.

Start the FMD 48 hours before irinotecan to get your body ready and give your healthy cells time to adjust. Then continue the FMD through the infusion and 24 hours afterward. Then break the fast slooooowly for the next 24 hours with soft, easily digestible foods. In my case, I get Folfiri on Monday so I start the FMD on Saturday, continue through the infusion (Monday) and 2 days of the pump (Tuesday/Wednesday), then another 24 hours (Thursday). I start to break the fast Thursday night or Friday morning. It's not easy and it requires planning but it really does make a difference.

All that being said, there's been some recent research showing that a complete water fast for 2 days leading up to the infusion has even better results. One of my doctors told me about it. I don't have links to give you, sorry. I read the research but pretty much felt that I already knew it so I didn't keep track of the citations. I have an infusion buddy who says the FMD worked well for her but a complete water fast for the 48 hours leading up to the infusion and the day of the infusion made an even bigger difference. She doesn't get a pump so it's just 3 days of fasting. I haven't tried it.

Hope this helps. If you have any questions, feel free to email me.
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS
Aug-2016-May-2018 Folfox, 5FU, Folfiri & Avastin
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy
Feb-2023 Folfiri & Avastin
Nov-2023 Xeloda & Avastin


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