Bootcamp during neoadjuvant chemotherapy for breast cancer: a randomized pilot trial

Abstract

Introduction: Exercise may improve cancer outcomes. Neoadjuvant chemotherapy (NC) for breast cancer provides a unique setting to evaluate intervention effects. Treatments leading to decreased post-neoadjuvant Ki-67 levels, smaller tumor size, and higher pathologic response are associated with improved survival and lower recurrence. This randomized, prospective pilot trial evaluates the feasibility of supervised exercise during NC for breast cancer.

Methods: Stage II-III, ER positive, cancer patients with BMI > 25 receiving NC were randomized to standard NC with supervised bootcamp (NC + BC) or NC alone. Ki-67, C-peptide, BMI, and tumor size were measured before chemotherapy and at time of surgery.

Results: There were no initial differences between groups in regards to tumor size, C-peptide, BMI, and Ki-67. The NC + BC (n = 5) group had a lower mean BMI at the conclusion of NC compared with those (n = 5) in the NC group (28.0 versus 35.8, P = 0.03). Final tumor size was 2.59 cm in the NC + BC group versus 3.16 cm for NC (P = 0.76) Mean Ki-67 for NC + BC was 7% versus 29% with NC (P = 0.14). C-peptide (ng/mL) was equivalent between the two groups (4.55 NC + BC versus 4.74 NC, P = 0.85).

Conclusions: Adding a supervised exercise program to NC is feasible, decreases BMI, and may lead to lower Ki-67 levels and improved survival.

Keywords: Ki-67; breast cancer; exercise; neoadjuvant chemotherapy.

Figure 1

Study design. Note: Schema of randomized pilot trial. Abbreviations: ER, estrogen receptor; BMI, body mass index; IGF-1, IGF-insulin like growth factor 1.

Figure 2

Ki-67 change. Notes: Ki-67 initial reflects Ki-67 in core biopsy sample, final reflects Ki-67 after neoadjuvant chemotherapy in final surgical specimen for each patient. Bootcamp arm had marked changes in Ki-67, a potential indicator of improved breast cancer prognosis.

Figure 3

BMI change. Notes: Patient BMI at the time of diagnosis and at the conclusion of neaodjuvant chemotherapy. Statistically significant changes (P=0.03) in BMI were noted in the bootcamp arm.