Background: Fasting-mimicking diets (FMD) are studied as adjunctive cancer therapies, with trials
supporting chemotherapy synergy. Yet research focuses solely on primary tumor response. No studies
have examined FMD's effect on recurrence. This gap is clinically significant, as late metastatic
recurrences stem from dormant disseminated tumor cells persisting post-treatment. Autophagy, which
FMD modulates, plays a paradoxical role: sensitizing primary tumors to therapy while sustaining dormant
cell survival. Whether FMD-induced autophagy influences dormant cell fate is entirely unstudied.
Methods: A literature review was conducted using PubMed and Embase with MeSH-controlled vocabulary. Search terms included fasting-mimicking diet, caloric restriction, autophagy, cancer dormancy, disseminated tumor cells, and metastatic recurrence. Peer-reviewed preclinical and clinical studies from 2010–2025 were included. After duplicate removal, articles underwent title/abstract screening followed by full-text review. Studies were organized into three streams: (1) FMD and autophagy, (2) autophagy in dormancy, and (3) dormancy reactivation. Evidence was weighted by study design with limitations noted. Results: Synthesis of preclinical data reveals FMD produces context- dependent autophagy effects, with inhibition observed in some cancers and induction in others. Dormancy literature shows autophagy inhibition can either eliminate dormant cells or trigger reactivation depending on tumor type and microenvironment. No studies directly address FMD's impact on minimal residual disease or include recurrence endpoints.
Conclusion: This review identifies a critical gap at the intersection of FMD, autophagy, and cancer dormancy. Findings are limited by selection bias and preclinical predominance but highlight the need for trials incorporating recurrence endpoints and may inform guidance for survivors exploring dietary interventions.
Methods: A literature review was conducted using PubMed and Embase with MeSH-controlled vocabulary. Search terms included fasting-mimicking diet, caloric restriction, autophagy, cancer dormancy, disseminated tumor cells, and metastatic recurrence. Peer-reviewed preclinical and clinical studies from 2010–2025 were included. After duplicate removal, articles underwent title/abstract screening followed by full-text review. Studies were organized into three streams: (1) FMD and autophagy, (2) autophagy in dormancy, and (3) dormancy reactivation. Evidence was weighted by study design with limitations noted. Results: Synthesis of preclinical data reveals FMD produces context- dependent autophagy effects, with inhibition observed in some cancers and induction in others. Dormancy literature shows autophagy inhibition can either eliminate dormant cells or trigger reactivation depending on tumor type and microenvironment. No studies directly address FMD's impact on minimal residual disease or include recurrence endpoints.
Conclusion: This review identifies a critical gap at the intersection of FMD, autophagy, and cancer dormancy. Findings are limited by selection bias and preclinical predominance but highlight the need for trials incorporating recurrence endpoints and may inform guidance for survivors exploring dietary interventions.