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Brown M, Murphy MH, McAneney H, McBride K, Crawford F, Cole A, O'Sullivan JM, Jain S, Prue G. Feasibility of home-based exercise training during adjuvant treatment for metastatic castrate-resistant prostate cancer patients treated with an androgen receptor pathway inhibitor (EXACT). Support Care Cancer 2023; 31:442. [PMID: 37402060 DOI: 10.1007/s00520-023-07894-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Exercise is an effective adjuvant therapy that can alleviate treatment-related toxicities for men with prostate cancer (PC). However, the feasibility of delivering exercise training to men with advanced disease and the wider impact on clinical outcomes remain unknown. The purpose of the EXACT trial was to determine the feasibility and effects of home-based exercise training in men with metastatic castrate-resistant prostate cancer (mCRPC). METHODS Patients with mCRPC receiving ADT + an androgen receptor pathway inhibitor (ARPI) were prescribed 12 weeks of home-based, remotely monitored, moderate intensity, aerobic and resistance exercise. Feasibility was assessed using recruitment, retention and adherence rates. Safety and adverse events were monitored throughout, with functional and patient-reported outcomes captured at baseline, post-intervention and at 3-month follow-up. RESULTS From the 117 screened, 49 were deemed eligible and approached, with 30 patients providing informed consent (61% recruitment rate). Of those who consented, 28 patients completed baseline assessments, with 24 patients completing the intervention and 22 completing follow-up (retention rates: 86% and 79% respectively). Task completion was excellent throughout, with no intervention-related adverse events recorded. Self-reported adherence to the overall intervention was 82%. Exercise training decreased mean body mass (-1.5%), improved functional fitness (> 10%) and improved several patient-reported outcomes including clinically meaningful changes in fatigue (p = 0.042), FACT-G (p = 0.054) and FACT-P (p = 0.083), all with moderate effect sizes. CONCLUSION Home-based exercise training, with weekly remote monitoring, was feasible and safe for men with mCRPC being treated with an ARPI. Given that treatment-related toxicities accumulate throughout the course of treatment, and as a result, negatively impact functional fitness and health-related quality of life (HRQoL), it was positive that exercise training improved or prevented a decline in these clinically important variables and could better equip patients for future treatment. Collectively, these preliminary feasibility findings support the need for a definitive, larger RCT, which downstream may lead to the inclusion of home-based exercise training as part of adjuvant care for mCRPC.
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Affiliation(s)
- Malcolm Brown
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, School of Sport, Ulster University, Belfast, UK
- School of Education and Sport, The University of Edinburgh, Scotland, UK
| | - Helen McAneney
- Northern Ireland Public Health Research Network, School of Medicine, Ulster University, Belfast, UK
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Ken McBride
- Northern Ireland Cancer Research Consumer Forum, Belfast, UK
| | - Ffiona Crawford
- Northern Ireland Cancer Research Consumer Forum, Belfast, UK
| | - Aidan Cole
- The Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
- The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Joe M O'Sullivan
- The Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
- The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Suneil Jain
- The Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
- The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Mir N, Burke O, Yates S, Rajasekaran T, Chan J, Szmulewitz R, Kanesvaran R. Androgen receptor pathway inhibitors, prostate cancer, and older adults: a global Young International Society of Geriatric Oncology drug review. Ther Adv Med Oncol 2023; 15:17588359221149887. [PMID: 36743522 PMCID: PMC9893362 DOI: 10.1177/17588359221149887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/21/2022] [Indexed: 01/29/2023] Open
Abstract
Prostate cancer is a disease of older adults that has undergone a significant therapeutic paradigm shift in the last decade with the emergence of novel androgen receptor pathway inhibitors (ARPis). One of the more commonly used ARPis is enzalutamide. This drug, along with darolutamide and apalutamide, initially received approvals in the metastatic castrate-resistant prostate cancer setting but is now utilized frequently in the metastatic castrate-sensitive and non-metastatic castration-resistant settings. Landmark phase III data illustrating ARPi efficacy in older adults are limited to those with excellent performance status. However, its role in unfit older prostate cancer patients remains to be explored in the context of a narrative review. This first-of-its-kind drug review aims to shed light on the most up-to-date evidence behind the unique toxicity profile of ARPis in the context of geriatric vulnerabilities such as cognitive and functional impairment, along with potential solutions and supporting evidence that exists to circumvent these issues in the vulnerable older adult.
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Affiliation(s)
- Nabiel Mir
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637, USA
| | - Olivia Burke
- Hospice and Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samuel Yates
- Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Tanujaa Rajasekaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Johan Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Russell Szmulewitz
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Coletta AM, Playdon MC, Baron KG, Wei M, Kelley K, Vaklavas C, Beck A, Buys SS, Chipman J, Ulrich CM, Walker D, White S, Oza S, Zingg RW, Hansen PA. The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors. PLoS One 2021; 16:e0258135. [PMID: 34637457 PMCID: PMC8509995 DOI: 10.1371/journal.pone.0258135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. METHODS Retrospective analysis of data collected from 2016-2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program's assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. RESULTS Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. CONCLUSION Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.
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Affiliation(s)
- Adriana M. Coletta
- Department of Health & Kinesiology, The University of Utah, Salt Lake City, UT, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Mary C. Playdon
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Nutrition and Integrative Physiology, The University of Utah, Salt Lake City, UT, United States of America
| | - Kelly G. Baron
- Department of Family and Preventive Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Mei Wei
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Kristen Kelley
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Christos Vaklavas
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Anna Beck
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Saundra S. Buys
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Jonathan Chipman
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Population Health Sciences, The University of Utah, Salt Lake City, UT, United States of America
| | - Cornelia M. Ulrich
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Population Health Sciences, The University of Utah, Salt Lake City, UT, United States of America
| | - Darren Walker
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Shelley White
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Sonal Oza
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
| | - Rebecca W. Zingg
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
| | - Pamela A. Hansen
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
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