Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial

Quist, Morten; Langer, Seppo W.; Lillelund, Christian; Winther, Lotte; Laursen, Jørgen H.; Rørth, Mikael; Adamsen, Lis

doi:10.1016/j.lungcan.2020.05.003

Cited by 50 publications

(63 citation statements)

References 33 publications

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“…Investigators are increasingly incorporating exercise training and physical activity into practice and in clinical trials to improve quality of life, [117][118][119][120] improve cardiorespiratory function, [121][122][123] and even as a preventive and/ or therapeutic anticancer intervention. 124 Exercise was proposed as an immunotherapy by de Araújo et al as a way to counter immunosenescense in aging cancer patients.…”

Section: Incorporation Of Exercise Into Clinical Applications and Translationmentioning

confidence: 99%

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy

Gustafson

Wheatley‐Guy

Rosenthal

et al. 2021

J Immunother Cancer

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The remarkable success of cancer immunotherapies has provided new hope to cancer patients. Unfortunately, a significant proportion of patients remain unable to respond to immunotherapy or maintain durable clinical responses. The lack of objective responses likely results from profound immune dysfunction often observed in patients with cancer. There is substantial evidence that exercise and physical activity can reduce incidence and improve outcomes in cancer patients. As the immune system is highly responsive to exercise, one potential avenue to improve immune function is through exercise and physical activity. A single event of dynamic exercise results in the substantial mobilization of leukocytes with increased functional capacities into the circulation. Chronic, or long-term, exercise leads to higher physical fitness in terms of greater cardiorespiratory function and/or muscle strength and endurance. High aerobic capacity, as measured by maximal oxygen uptake, has been associated with the reduction of dysfunctional T cells and improvements in the abundance of some T cell populations. To be sure, however, the mechanisms of exercise-mediated immune changes are both extensive and diverse. Here, we examine the evidence and theorize how acute and chronic exercise could be used to improve responses to cancer immunotherapies including immune checkpoint inhibitors, dendritic cell vaccines, natural killer cell therapies, and adoptive T cell therapies such as chimeric antigen receptor (CAR) T cells. Although the parameters of optimal exercise to yield defined outcomes remain to be determined, the available current data provide a compelling justification for additional human studies and clinical trials investigating the adjuvant use of exercise in immuno-oncology.

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Section: Incorporation Of Exercise Into Clinical Applications and Translationmentioning

confidence: 99%

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy

Gustafson

Wheatley‐Guy

Rosenthal

et al. 2021

J Immunother Cancer

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“…To our knowledge, ERICA is the first study to assess the feasibility and effects of acute physical exercise performed within 1 hour prior to immunotherapy (pembrolizumab) and chemotherapy (platinum-based doublet) infusion in patients with mNSCLC. Despite therapeutic advances, notably immunotherapy combined with chemotherapy, the prognosis of many patients with mNSCLC continues to be poor, and disease burden, cachexia, comorbidities and treatment side effects lead to deconditioning and adversely affect exercise capacity in people with advanced NSCLC 17 63–66. Conversely, evidence from meta-analyses suggests that exercise training in patients with advanced lung cancer could be feasible and safe with no serious adverse events reported and may improve or avoid the decline of physical capacity 15 67.…”

Section: Discussionmentioning

confidence: 99%

Effect of acute aerobic exercise before immunotherapy and chemotherapy infusion in patients with metastatic non-small-cell lung cancer: protocol for the ERICA feasibility trial

Gouez

Pérol

et al. 2022

BMJ Open

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IntroductionPatients with metastatic non-small cell lung cancer (mNSCLC) suffer from numerous symptoms linked to disease and treatment which may further impair the patient’s overall condition. In addition to its benefits on quality of life and fatigue, physical exercise may improve treatment response, notably due to its known effects on the immune system. The ERICA study is designed to assess the feasibility of a supervised acute physical exercise therapy realised immediately prior immune-chemotherapy infusion in patients with mNSCLC. Secondary objectives will examine the effects of acute exercise combined with an unsupervised home-walking programme on clinical, physical, psychosocial and biological parameters.Methods and analysisERICA is a prospective, monocentric, randomised controlled, open-label feasibility study conducted at the Centre Léon Bérard Comprehensive Cancer Center (France). Thirty patients newly diagnosed with mNSCLC will be randomised (2:1 ratio) to the ‘exercise’ or the ‘control’ group. At baseline and during the last treatment cycle, participants in both groups will receive Physical Activity recommendations, and two nutritional assessments. In the exercise group, participants will receive a 3-month programme consisting of a supervised acute physical exercise session prior to immune-chemotherapy infusion, and an unsupervised home-based walking programme with an activity tracker. The acute exercise consists of 35 min interval training at submaximal intensity scheduled to terminate 15 min prior to infusion. Clinical, physical, biological and psychosocial parameters will be assessed at baseline, 3 and 6 months after inclusion. Biological measures will include immune, inflammatory, metabolic, oxidative stress biomarkers and molecular profiling.Ethics and disseminationThe study protocol was approved by the French ethics committee (Comité de protection des personnes Ile de France II, N°ID-RCB 20.09.04.65226, 8 December 2020). The study is registered on ClinicalTrials.gov (NCT number:NCT04676009) and is at the pre-results stage. All participants will sign an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences.

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“…In patients with COPD, HADS is used for both symptom screening and evaluation of changes in symptoms following an intervention. 3 , 22 , 29 , 30 To our knowledge no study has reported reliability and agreement parameters for the HADS in patients with COPD. Likewise, we were unable to find any study in patients with COPD concerning reproducibility for the widely used generic questionnaire EuroQol 5D (EQ-5D-3L), which assesses health related quality of life.…”

Section: Introductionmentioning

confidence: 99%

Inter-Day Test–Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD

Hansen

Beyer

Frølich

et al. 2021

PROM

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Introduction In patients with COPD, the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and EuroQol 5D (EQ-5D-3L) are widely used patient reported outcome measures (PROMs) of respiratory symptoms, anxiety, depression and quality of life. Despite established validity, responsiveness and minimal important change (MIC), the reproducibility and especially important agreement parameters remain unreported in these frequently used PROMs. The aim of this study was to investigate the inter-day test–retest reliability and agreement of the CAT, CCQ, HADS and EQ-5D-3L in patients with severe and very severe COPD (FEV1 <50%) eligible for hospital-based pulmonary rehabilitation. Patients and Methods Fifty patients (22 females, mean [SD] age 67 [9] yrs.; FEV 1 32[9] %; 6-minute walk distance 347 [102] meters; CAT 21 [6] points; BMI: 26 [6] kg/m 2 ) completed the questionnaires (CAT, CCQ, HADS, EQ-5D-3L) in combination with functional performance test instructed by one assessor on test-day one (T1) and by another assessor 7–10 days later on test-day two (T2). Results The inter-day test–retest reliability ICC was 0.88 (LL 95CI : 0.80) for CAT; 0.69 (LL 95CI : 0.46) for CCQ; 0.86 (LL 95CI : 0.75) and 0.90 (LL 95CI : 0.82) for HADS-anxiety (A) and depression (D) and 0.87 (LL 95CI : 0.76) for EQ-5D-VAS. The corresponding agreements within a single measurement (standard error of measurement, SEM) and for repeated measurement errors (smallest real difference, SRD) were respectively 2.1 and 2.9 points for CAT; 0.5 and 0.7 points for CCQ total; 1.3 and 1.9 points for HADS-A; 0.9 and 1.3 points for HADS-D and 6.8 and 9.7 VAS-score for EQ-5D-3L, respectively. Ceiling/flooring effect was present in <5% for all questionnaires. Conclusion In patients with severe and very severe COPD, the CAT, CCQ, HADS and EQ-5D-3L questionnaires presented moderate to excellent inter-day test–retest reliability, and no floor or ceiling effect was documented for any of the questionnaires. Only CAT and HADS had an acceptable SRD below the established MIC for assessing change over time on group level, and none of the PROMS were fit to assess individual changes over time.

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Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial

Cited by 50 publications

References 33 publications

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy

Effect of acute aerobic exercise before immunotherapy and chemotherapy infusion in patients with metastatic non-small-cell lung cancer: protocol for the ERICA feasibility trial

Inter-Day Test–Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD

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