Low-Protein Diet for Cancer

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: State University of New York at Buffalo

Must be taking: Immune checkpoint inhibitors

Must not be taking: Systemic corticosteroids, High dose calcitriol

Disqualifiers: ECOG status 2+, Systemic immunosuppressive therapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4 months

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a low-protein diet can enhance the body's immune response to fight cancer more effectively when combined with immune checkpoint inhibitors. Participants will follow either a low-protein or regular protein diet to determine if the low-protein option improves treatment effectiveness. Individuals with solid tumor cancers treatable with these therapies, especially those that have metastasized, may qualify. As an unphased trial, this study provides a unique opportunity to contribute to groundbreaking research that could improve future cancer treatments.

Will I have to stop taking my current medications?

The trial requires that you stop taking systemic corticosteroids and high dose calcitriol (a form of vitamin D) at least 28 days before joining. Inhaled, intranasal, and topical steroids are allowed.

What prior data suggests that this diet is safe for cancer patients?

Research suggests that eating less protein might lower cancer risk and extend lifespan. Some studies have found that people who consume less protein have lower levels of IGF-1, a substance linked to cancer growth. This diet might slow tumor growth.

However, reducing protein intake could cause side effects. People with cancer might feel weaker and lose weight. It's important to weigh these risks against the benefits.

Overall, while signs are promising, potential participants should consider both the pros and cons of a low-protein diet. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the low-protein diet approach for cancer because it offers a unique dietary intervention that could complement traditional treatments like chemotherapy and radiation. Unlike standard cancer treatments that directly target cancer cells, this diet aims to alter the body's nutrient supply, potentially slowing cancer growth by reducing protein intake to 10%. The control diet, with about 20% protein content, provides a comparative baseline. This novel strategy highlights how dietary modifications might play a crucial role in cancer management, offering a non-invasive option that could enhance the effectiveness of existing therapies.

What evidence suggests that a low-protein diet could be effective for cancer?

Research has shown that eating less protein might help fight cancer by altering the environment around tumors. This trial will compare a low-protein diet arm, with 10% protein content, to a control diet arm, with approximately 20% protein content. The low-protein diet could strengthen the body's immune system, enhancing the effectiveness of cancer treatments. Studies have found that reducing protein intake can slow tumor growth and improve the body's ability to combat cancer. Additionally, eating less protein is linked to a lower risk of developing cancer and dying from it, especially in people 65 and younger. Evidence also suggests that a low-protein diet can slow tumor growth. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

Adults over 18 with solid tumor cancers suitable for immunotherapy can join this trial. They must have a certain level of white blood cells, platelets, and proper organ function. People on high-dose vitamin D, systemic steroids or immunosuppressants, those with poor physical status (ECOG >2), or infections needing antibiotics recently cannot participate.

Inclusion Criteria

My cancer is suitable for immunotherapy treatment.

Total bilirubin ≤ 2 x upper limit of normal (ULN)

My scans show cancer has spread to my bones or soft tissues.

Exclusion Criteria

I am taking more than 7.0 μg of calcitriol per week.

I am not on systemic corticosteroids, but I may use inhaled, nasal, or topical steroids.

I need medication to suppress my immune system.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive immunotherapy combined with either a low-protein diet or a control diet for 3 cycles

4 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Diet

Trial Overview The study is testing if eating low-protein meals can boost the body's immune response to cancer when patients are also receiving treatments known as immune checkpoint inhibitors. The goal is to see if diet changes can make these cancer treatments more effective.

How Is the Trial Designed?

Group I: Low-Protein Diet Arm Active Control 1 Intervention

intervention low-protein diet arm (10% protein content)

Group II: Control Diet Arm Active Control 1 Intervention

control diet arm (\~20% protein content)

Who Is Running the Clinical Trial?

State University of New York at Buffalo

Lead Sponsor

Trials

279

Recruited

52,600+

Published Research Related to This Trial

Low protein diets, whether from natural foods or amino acid supplements, are safe and effective in slowing the progression of chronic kidney disease (CKD) without negatively impacting patient outcomes during Renal Replacement Therapy.

These diets improve various health markers, such as reducing proteinuria and serum levels of uric acid and phosphate, while also decreasing the need for medications like hypotensive drugs and erythropoietin, ultimately enhancing patient quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low protein diets are mainstay for management of chronic kidney disease. De Santo, NG., Perna, A., Cirillo, M.[2022]

In a study of 29,017 postmenopausal women followed for 15 years, substituting vegetable protein for carbohydrates was linked to a 30% reduction in coronary heart disease (CHD) mortality, suggesting that plant-based proteins may be healthier than carbohydrates.

Conversely, higher intake of red meats and dairy products was associated with increased CHD mortality, indicating that not all protein sources are equally beneficial and that long-term high-protein diets could have negative health effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Kelemen, LE., Kushi, LH., Jacobs, DR., et al.[2023]

In a study involving 43 female C2H mice with mammary tumors, those on a standard protein diet had greater body weight but experienced increased tumor growth and reduced survival compared to those on a protein-depleted diet.

The results suggest that while protein intake supports the host's body weight, it may also enhance tumor growth, leading to a detrimental effect on overall survival in tumor-bearing animals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of protein-intake on tumor-growth and host survival in tumor-bearing animals. Torosian, M.[2019]

In a study of 6,348 women with stage I to III breast cancer, higher protein intake was associated with a modest improvement in survival rates, particularly with animal protein, suggesting that protein consumption may be beneficial post-diagnosis.

The study found no significant differences in survival benefits based on insulin receptor status or specific types of amino acids, indicating that women with breast cancer may not need to restrict protein intake for better outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protein Intake and Breast Cancer Survival in the Nurses' Health Study. Holmes, MD., Wang, J., Hankinson, SE., et al.[2019]

Low-protein diets (≤0.7 g/kg per day) have not been shown to significantly slow the progression of kidney disease, and compliance with such diets is often poor, making them less effective as a treatment strategy.

Restricting dietary protein can lead to declines in nutritional health for patients with chronic kidney disease, who are already at risk of malnutrition, suggesting that maintaining adequate protein intake is more beneficial than restriction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dietary protein restriction as a treatment for slowing chronic kidney disease progression: the case against. Johnson, DW.[2022]

Dietary protein or amino acid restriction can enhance the tumor-fighting abilities of macrophages, leading to reduced tumor growth and improved responses to immunotherapy in animal models of prostate and renal cancer.

The study identified a specific mechanism involving a ROS/mTOR pathway that explains how protein restriction reprograms macrophage function, suggesting that dietary changes could be a supportive strategy for cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dietary Protein Restriction Reprograms Tumor-Associated Macrophages and Enhances Immunotherapy. Orillion, A., Damayanti, NP., Shen, L., et al.[2021]

In a study involving 50 rats with mammary tumors, those on a protein-depleted diet showed a significant reduction in tumor volume after 14 days compared to those on a standard protein diet, suggesting that lower protein intake may slow tumor growth.

The study found no changes in tumor cell cycle kinetics between the two diet groups, indicating that the reduced tumor growth may be due to tumor cells entering a dormant state or an overall increase in cell cycle duration rather than a shift in the distribution of cells across different phases of the cell cycle.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of protein intake on tumor growth and cell cycle kinetics. Torosian, MH.[2003]

Research indicates that both underfeeding and optimal protein intake can inhibit tumor growth, suggesting that the quantity of protein consumed is more critical than its source in cancer prevention.

The relationship between protein intake and cancer risk is complex, as high protein diets may sometimes lower tumor incidence due to reduced overall food intake, highlighting the need for careful consideration of dietary factors in cancer studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dietary protein and experimental carcinogenesis. Visek, WJ.[2019]

A very-low-protein diet (5% casein) significantly increased the incidence and number of gastric cancers in Wistar rats after exposure to a carcinogen, indicating a potential risk factor for gastric cancer.

The increase in gastric cancer incidence may be linked to elevated norepinephrine levels in the gastric wall and increased proliferation of antral epithelial cells, suggesting a mechanism by which low-protein diets could enhance carcinogenesis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced induction of gastric carcinogenesis by N-methyl-N'-nitro-N-nitrosoguanidine in Wistar rats fed a low-protein diet. Tatsuta, M., Iishi, H., Baba, M., et al.[2018]

In a study involving 72 rats with implanted hepatoma, a protein-free diet led to significantly increased mortality rates and complications like hemorrhagic cystitis, indicating that protein deficiency can negatively impact overall health during cancer treatment.

While chemotherapy (cyclophosphamide) effectively reduced tumor size and metastases in rats on a regular diet, it did not show improved outcomes in rats on a protein-free diet, suggesting that protein deficiency does not enhance chemotherapy response but may hinder treatment due to increased health risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of protein deficiency on growth and response of primary and metastatic hepatoma. Weber, TR., Dalsing, MC., Sawchuck, A., et al.[2019]

In a study of 91 older adults with advanced gastrointestinal cancer, a high protein diet (HPD) did not improve handgrip strength, indicating that increased protein intake may not enhance muscle function in this population.

However, patients on a high protein diet had a significantly longer overall survival (14.7 months) compared to those on a low protein diet (7.3 months), suggesting that HPD may help reduce cancer-related mortality and warrants further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer. Pimentel, GD., Pichard, C., Laviano, A., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7617599/

Reducing Dietary Protein Enhances the Antitumor Effects ... Limiting protein intake can suppress tumor growth by both inducing nutrient stress and enhancing anti-tumor immunity.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3988204/

Low Protein Intake is Associated with a Major Reduction ... Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0304419X18300040

Review Protein restriction and cancer Recently, low protein diets are reported to be associated with lowered cancer incidence and mortality risk of cancers in human.

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/jcsm.13276

Protein intake in cancer: Does it improve nutritional status ... A high protein intake could preserve lean body mass but may promote tumour growth, whereas a low-protein diet could reduce tumour size but without addressing ...

5. aging-us.com aging-us.com/article/203692/text

Low-protein diet applied as part of combination therapy or ... For example, protein reduction in the diet leads to less proliferation in several tumor types [8, 9, 12]. In addition, a diet that mimics ...

6. ecancer.org ecancer.org/en/news/5364-low-protein-intake-in-middle-age-is-associated-with-lowered-cancer-risk

Low protein intake in middle age is associated with ... The risk of death from cancer in these individuals was over four times that of those in the same age group with a low protein diet (hazard ratio ...

7. animalcare.umich.edu animalcare.umich.edu/our-impact/our-impact-dietary-change-starves-cancer-cells-overcoming-treatment-resistance/

Dietary Change Starves Cancer Cells, Overcoming Treatment ... The risk with a low-protein diet is that people with cancer often experience muscle weakness and weight loss, which limiting protein could ...