A structured group exercise program for patients with metastatic cancer receiving chemotherapy and CTNNB1 (β-catenin) as a biomarker of exercise efficacy

Abstract

IntroductionExercise can improve the symptoms of cancer. However, is it a cancer treatment? We tested the feasibility of group exercise for metastatic cancer patients while on chemotherapy. A biomarker for exercise efficacy in colorectal cancer (CRC), β-catenin, was tested.MethodsPatients undergoing palliative chemotherapy were eligible for a pre–post, single-arm study comprising an indefinite, weekly group exercise intervention using strength and aerobic training. The Functional Assessment of Chronic Illness Therapy (FACIT) and Piper Fatigue Scale (PFS) questionnaires were administered, and aerobic capacity assessed using the 6-minute walk test. Selection bias, as measured by invitation rate, as well as participation, compliance, and attrition rates, was measured. CRC patients had surgical sections stained for β-catenin and correlated to survival. The statistical analysis was primarily exploratory and hypothesis generating.ResultsOf the 124 eligible patients, 53 (43%) patients were invited and 35 (28%) patients participated. The median number of classes attended was 16, the compliance rate was 73.1% (95% confidence interval [CI] 67.0–79.4), and the modified attrition rate was 24%. There were no injuries. No significant improvements were seen in the FACIT or PFS at 30 weeks. Aerobic capacity significantly improved at 30 weeks. Participation of CRC patients in the exercise pilot vs nonparticipation was not associated with a change in survival (hazard ratio [HR] =0.98, 95% CI 0.32–2.97). For all CRC patients, strong nuclear staining for β-catenin, compared to weak, suggested a lower risk of mortality (HR =0.54, 95% CI 0.14–1.96). However, CRC participants in the exercise program with weak nuclear staining for β-catenin had a trend to lower mortality (HR =0.39, 95% CI 0.025–6.1).ConclusionExercise for patients with metastatic cancer receiving chemotherapy is feasible and safe. β-Catenin is a potential biomarker for exercise anticancer effect in CRC.

The Regulation of the Metastatic Cascade by Physical Activity: A Narrative Review

“…Together with the higher expression of the tumor suppressor E-cadherin [52], the lower expression of β-catenin indicates that tumor invasion is reduced after 6 weeks of wheel running in mice. In human, low levels of nuclear β-catenin in normal and colorectal cancer cells of exercising patients were associated with reduced mortality risk [53]. These results confirm previous findings that patients with low nuclear β-catenin levels and high physical activity levels (>18 MET-h/week) after cancer diagnosis had lower cancer mortality rates [54].…”

Effect of exercise on colorectal cancer prevention and treatment

“…In a study evaluating whether B-catenin predicted the benefit of exercise in patients with metastatic colon cancer receiving chemotherapy, it was found that exercise did not affect the survival (HR: 0.98, 95%CI: 0.32–2.97). However, patients with weak staining for B-catenin in the exercise program had a lower mortality rate (HR: 0.39, 95%CI: 0.025–6.1)[132]. In clinical practice, CTNNB1 status can be used as a predictive biomarker in response to exercise applications[133].…”

Exercise Timing and Cancer Treatment: Avenues for Chronobiological Research

“…A similar beneficial effect of exercise was observed to improve tamoxifen treatment in a mouse model of breast cancer [25]. In human studies, inconsistent results are reported: some indicate improvements [21,[26][27][28], others indicate null findings [29][30][31][32][33][34].…”

“…Overall, several studies exploring adjunctive exercise interventions and treatment efficacy outcomes among cancer survivors indicate no adverse effect on treatment efficacy [28,29,[33][34][35].…”