ASCO 2016

Trial shows exercise beneficial for patients undergoing chemotherapy

Dr Ian Kleckner - University of Rochester Medical Center, New York, USA

This is my first ASCO conference and I’m here because I want to delve deeper into clinical research on cancer. I’ve been studying cancer for the past one year and previously I was studying psychology and neuroscience so I’m excited to be able to apply that interdisciplinary experience to the cancer domain.

That’s an interesting intersection of the physical biology with the more whole patient holistic attitude of things.

Yes, definitely. So the work that I’m presenting here was an exercise study and that’s my primary interest too. So I’m interested in side effects from chemotherapy, especially chemotherapy induced peripheral neuropathy or CIPN, and using exercise to treat that toxicity. That’s some of the data that I presented here today. In the future work I’m going to be studying how exercise affects the brain and as a mediating factor for that toxicity and others.

Exercise has recently been linked to being able to prevent the chances of developing cancer, being able to improve treatment during cancer and improve recovery after. What has your research focussed on in terms of the platinum associated toxicities?

I studied chemotherapy induced peripheral neuropathy or CIPN and CIPN is a big problem right now because it’s highly prevalent, associated with platinums, taxanes, I think alkaloids, bortezomib and thalidomide, chemotherapy regimens and there’s no established treatments for this toxicity. There have been over fifty randomised clinical trials testing drugs but still no established treatments and more recently some studies have been showing the promise of exercise to treat CIPN and ours is the first study. It’s a very large randomised clinical trial, it was a secondary analysis though, in 314 cancer patients and we studied the effect of exercise on CIPN and we showed that exercise was beneficial for CIPN when performed during chemotherapy compared to chemotherapy alone. We showed that the effect is particularly strong for older patients.

Could you just explain some of the patient selection and how the arms were divided there?

There was an original randomised clinical trial that we derived my sample from and that trial was led by a PI, Karen Mustian, also at University of Rochester Medical Center, and that trial had about 619 patients. They had to be chemo-naïve, non-metastatic cancer, at least 70 kps, over 21 years old and they had to be sedentary. Then I restricted that sample further, down to 314 patients by additionally requiring that they were on one of these CIPN inducing chemotherapy regimens that I mentioned which was previously established in the literature. So it had to be platinum, taxane, I think alkaloid, bortezomib or thalidomide, one of those five.

I’d like to mention too, this was a nationwide trial through the NCI Community Oncology Research Programme, or NCOR, and so it was good that we had a diverse sample, in that regard, across the country. In the future actually what we’re thinking of doing is designing a randomised clinical trial with this toxicity as the primary outcome, CIPN as the primary outcome, and we will be focussing on people who have these symptoms.

I’m really excited that I was awarded the Best of ASCO for this abstract and was able to present an oral presentation. The reason is because people realise that this is a highly prevalent severe toxicity, we have no established treatments and we’re just at the cusp of understanding what behavioural interventions like exercise can do for cancer and cancer treatment toxicities. I hope that in the future we’ll have a lot more studies, a lot more positive results using exercise and that we’ll be able to understand how exercise works mechanistically in affecting these toxicities through the brain and through inflammation and other factors that we’re going to be thinking about, including psychosocial factors.