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Randomised controlled trial of intermittent vs continuous energy restriction during chemotherapy for early breast cancer

Lookup NU author(s): Professor Alastair GreystokeORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021, The Author(s). Background: Excess adiposity at diagnosis and weight gain during chemotherapy is associated with tumour recurrence and chemotherapy toxicity. We assessed the efficacy of intermittent energy restriction (IER) vs continuous energy restriction (CER) for weight control and toxicity reduction during chemotherapy. Methods: One hundred and seventy-two women were randomised to follow IER or CER throughout adjuvant/neoadjuvant chemotherapy. Primary endpoints were weight and body fat change. Secondary endpoints included chemotherapy toxicity, cardiovascular risk markers, and correlative markers of metabolism, inflammation and oxidative stress. Results: Primary analyses showed non-significant reductions in weight (−1.1 (−2.4 to +0.2) kg, p = 0.11) and body fat (−1.0 (−2.1 to +0.1) kg, p = 0.086) in IER compared with CER. Predefined secondary analyses adjusted for body water showed significantly greater reductions in weight (−1.4 (−2.5 to −0.2) kg, p = 0.024) and body fat (−1.1 (−2.1 to −0.2) kg, p = 0.046) in IER compared with CER. Incidence of grade 3/4 toxicities were comparable overall (IER 31.0 vs CER 36.5%, p = 0.45) with a trend to fewer grade 3/4 toxicities with IER (18%) vs CER (31%) during cycles 4–6 of primarily taxane therapy (p = 0.063). Conclusions: IER is feasible during chemotherapy. The potential efficacy for weight control and reducing toxicity needs to be tested in future larger trials. Clinical trial registration: ISRCTN04156504.

Publication metadata

Author(s): Harvie M, Pegington M, Howell SJ, Bundred N, Foden P, Adams J, Graves L, Greystoke A, Mattson MP, Cutler RG, Williamson J, Livingstone K, McMullen D, Sellers K, Lombardelli C, Cooper G, McDiarmid S, Howell A

Publication type: Article

Publication status: Published

Journal: British Journal of Cancer

Year: 2021

Online publication date: 15/12/2021

Acceptance date: 22/11/2021

Date deposited: 12/01/2022

ISSN (print): 0007-0920

ISSN (electronic): 1532-1827

Publisher: Springer Nature


DOI: 10.1038/s41416-021-01650-0


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Funder referenceFunder name
Breast Cancer Research Trust
NIHR Manchester Biomedical Research Centre (IS-BRC-1215-20007)