• FMD Tolerability as measured by adverse events [ Time Frame: 16 weeks ]
  Severity of AEs will be assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 for toxicity and adverse event reporting. AEs not corresponding to the CTCAE term will be assessed according to their impact on the subject's ability to perform daily activities as follows:

  • Mild (grade 1) - the AE does not interfere in a significant manner with the subject's normal functioning level. It may be an annoyance.
  • Moderate (grade 2) - the AE produces some impairment of functioning, but is not hazardous to health. It is uncomfortable or an embarrassment.
  • Severe (grade 3) - the AE produces significant impairment of functioning or incapacitation and is a definite hazard to the subject's health.
  • Life threatening (grade 4) - Life threatening or disabling.
  • Fatal (grade 5) - Causes death of the participant.
• FMD Tolerability as measured by QOL Questionnaire [ Time Frame: 16 weeks ]
  Mean differences in QOL between patients during the FMD versus normal diet sequence will be measured using a repeated measures analysis of variance. QOL questionnaire used will be the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.
• Incidence of neutropenia [ Time Frame: 16 weeks ]
  Differences in neutropenia between patients during the FMD versus normal diet sequence

Randomization and blinding:

Subjects will be allocated to sequence 1 (normal diet first, FMD second) or sequence 2 (FMD first, normal diet second) using a computer generated randomization scheme. There will be no blinding

Intervention:

Over the course of three rounds of chemotherapy, patients in the FMD will consume a diet that consists of 10 cal/kg/day and includes 50% fat, 40% carbohydrates, and no more than 10% protein. The diet includes nuts, olives, vegetable broth, broccoli/cauliflower, white rice/puffed rice cake, onion, tea/coffee, almond milk. The diet prohibits meat products, dairy, alcohol, sugar, and artificial sweeteners. Patients will be instructed to drink 2 cups of water each morning, take their usual medications and limit exercise to walking.

The table below provides the schedule of fasting during the cycle of chemotherapy

(Time during chemotherapy cycle, Diet)

• 2 days prior to chemotherapy, Fasting mimicking diet
• 1 day prior to chemotherapy, Fasting mimicking diet
• Day of chemotherapy, Full fasting(water only)
• 1 day after chemotherapy, Fasting mimicking diet
• 2 days after chemotherapy, Fasting mimicking diet

Prior to each chemotherapy cycle and coincident FMD arm, weight, and laboratory testing will be conducted and patients will be asked to keep track of side effects as per usual care for patients undergoing chemotherapy. Patients will be asked to keep a food log and record the quality of their sleep as part of the study.

There will be no restrictions for use of usual standard medications, including anti-nausea medication. This is generally Zofran oral, q8 hours PRN. Anti-nausea medication usage will be recorded in the study database. Although it is expected to be consistent throughout the diet and control periods for each subject, dosage and frequency will be recorded throughout the study, and it will be noted if anti-nausea medication is effective during the control period for each subject.

Endpoint evaluation:

Severity of AEs will be assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 for toxicity and adverse event reporting. A copy of the CTCAE Version 3.0 can be downloaded from https://www.eortc.be/services/doc/ctc/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.

AEs not corresponding to the CTCAE term will be assessed according to their impact on the subject's ability to perform daily activities as follows:

Mild (grade 1) - the AE does not interfere in a significant manner with the subject's normal functioning level. It may be an annoyance.

• Moderate (grade 2) - the AE produces some impairment of functioning, but is not hazardous to health. It is uncomfortable or an embarrassment.
• Severe (grade 3) - the AE produces significant impairment of functioning or incapacitation and is a definite hazard to the subject's health.
• Life threatening (grade 4) - Life threatening or disabling.
• Fatal (grade 5) Causes death of the participant.

Estimated study duration:

Patient participation is approximately 16 weeks.

• Chemotherapy Effect
• Chemotherapeutic Toxicity
• Fasting

• Active Comparator: FMD (fasting-mimicking diet)
  Over the course of three rounds of chemotherapy, patients in the FMD will consume a diet that consists of 10 cal/kg/day and includes 50% fat, 40% carbohydrates, and no more than 10% protein. The diet includes nuts, olives, vegetable broth, broccoli/cauliflower, white rice/puffed rice cake, onion, tea/coffee, almond milk. The diet prohibits meat products, dairy, alcohol, sugar, and artificial sweeteners. Patients will be instructed to drink 2 cups of water each morning, take their usual medications and limit exercise to walking.
  Intervention: Dietary Supplement: FMD
• No Intervention: regular diet
  Diet not influenced by a fast-mimicking diet.

• Di Biase S, Longo VD. Fasting-induced differential stress sensitization in cancer treatment. Mol Cell Oncol. 2015 Dec 10;3(3):e1117701. doi: 10.1080/23723556.2015.1117701. eCollection 2016 May.
• Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, Fontana L, Mirisola MG, Guevara-Aguirre J, Wan J, Passarino G, Kennedy BK, Wei M, Cohen P, Crimmins EM, Longo VD. 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. Cell Metab. 2014 Mar 4;19(3):407-17. doi: 10.1016/j.cmet.2014.02.006.
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Inclusion Criteria:

• 18 years of age and older
• English speaking
• Patients undergoing chemotherapy with Taxol/carboplatin planned for at least 6 cycles
• Willing to comply with diet and tests
• No significant medical problem that would make fasting dangerous (insulin dependent diabetes, history of hypoglycemia)

Exclusion Criteria:

• Insulin dependent diabetes
• Pregnancy
• History of hypoglycemia, or any other medical condition that the treating physician considers not suitable for fasting