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The effectiveness of aerobic and resistance exercise in tumor-infiltrating lymphocytes, Ki-67 proliferation index and tumor size in breast cancer patients undergoing neoadjuvant chemotherapy : preliminary results from the NEOprogram
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Abstract(s)
Objetivo: Investigar o efeito do exercício aeróbio (AE) e de força (RE) durante a quimioterapia neoadjuvante nos linfócitos infiltrantes do tumor (TILs), índice de proliferação celular Ki-67 e tamanho tumoral em pacientes com cancro da mama. Métodos: Numa subamostra do programa NEO, 33 participantes foram randomizados em: 1) AE (n=11); 2) RE (n=11), ou 3) grupo de controlo (n=11). As variáveis foram medidas antes e pós-intervenção. Foi realizada uma análise de intenção de tratamento (ITT) e uma por protocolo (PP) (excluindo participantes que desistiram e que tiveram uma adesão <70%). Os TILs e o Ki-67 foram avaliados por biópsias tumorais, e o tamanho tumoral por ressonância magnética. A intensidade de treino foi monitorizada por frequência cardíaca e escalas subjetivas de esforço, em sessões supervisionadas. Resultados: Na análise ITT, não houve diferenças significativas entre os grupos para o Ki67, tamanho tumoral e TILs (p>0,05). A análise PP, revelou uma interação entre grupos para os TILs a favorecer o RE (β; -5,3 (-9,35; -1,26)) em comparação com o AE. Observouse também uma redução intra grupo no Ki-67 e tamanho tumoral em todos os grupos (p<0,05). Conclusões: As interações intragrupo refletem o efeito da quimioterapia, enquanto a análise PP sugere que o RE, pode ter um efeito positivo no perfil imunitário tumoral quando comparado com o AE. Desta forma, são necessárias mais investigações sobre intervenções de exercício personalizado como terapias complementares durante a quimioterapia neoadjuvante em pacientes com cancro da mama, melhorando as respostas terapêuticas e melhorando os resultados dos pacientes .
Purpose: Investigate the effects of aerobic (AE) and resistance exercise (RE) during neoadjuvant chemotherapy (NAC) on tumor-infiltrating lymphocytes (TILs), proliferation index Ki-67, and tumor size in breast cancer patients. Methods: In a subsample of the NEO-program, 33 participants were randomized into one of three study arms: 1) AE (n=11), 2) RE (n=11), or 3) control group (n=11). Outcomes were measured at baseline and post-intervention. An intention-to-treat (ITT) analysis was performed, followed by a per-protocol (PP) analysis (excluded dropouts and those with adherence <70%). TILs and Ki-67 were evaluated through tumor biopsies. The tumor size was quantified through magnetic resonance imaging, with additional body composition and physical fitness assessments. Heart rate tracking and subjective scales monitored exercise intensity during each supervised session. Results: In the ITT analysis, no significant between-group changes were observed for the Ki-67, tumor size, and TILs (p≥0.05). However, the PP analysis revealed a between-group interaction for TILs favoring RE (β; -5.3 (-9.35; -1.26)) compared to the AE. Moreover, a favorable within-group effect was observed for all groups for the Ki-67 and tumor size outcomes (p<0.05). Conclusion: The within-group interactions are consistent with exposure to chemotherapy. However, due to the limitations of this preliminary sample size, significant interactions in ITT are not evident. PP analysis suggests that the type of exercise, especially RE, may have a differential positive effect on tumor immune profiles. Further investigation into personalized exercise interventions as adjunct therapies during NAC in breast cancer treatment is therefore warranted, enhancing therapeutic responses and improving patient outcomes
Purpose: Investigate the effects of aerobic (AE) and resistance exercise (RE) during neoadjuvant chemotherapy (NAC) on tumor-infiltrating lymphocytes (TILs), proliferation index Ki-67, and tumor size in breast cancer patients. Methods: In a subsample of the NEO-program, 33 participants were randomized into one of three study arms: 1) AE (n=11), 2) RE (n=11), or 3) control group (n=11). Outcomes were measured at baseline and post-intervention. An intention-to-treat (ITT) analysis was performed, followed by a per-protocol (PP) analysis (excluded dropouts and those with adherence <70%). TILs and Ki-67 were evaluated through tumor biopsies. The tumor size was quantified through magnetic resonance imaging, with additional body composition and physical fitness assessments. Heart rate tracking and subjective scales monitored exercise intensity during each supervised session. Results: In the ITT analysis, no significant between-group changes were observed for the Ki-67, tumor size, and TILs (p≥0.05). However, the PP analysis revealed a between-group interaction for TILs favoring RE (β; -5.3 (-9.35; -1.26)) compared to the AE. Moreover, a favorable within-group effect was observed for all groups for the Ki-67 and tumor size outcomes (p<0.05). Conclusion: The within-group interactions are consistent with exposure to chemotherapy. However, due to the limitations of this preliminary sample size, significant interactions in ITT are not evident. PP analysis suggests that the type of exercise, especially RE, may have a differential positive effect on tumor immune profiles. Further investigation into personalized exercise interventions as adjunct therapies during NAC in breast cancer treatment is therefore warranted, enhancing therapeutic responses and improving patient outcomes
Description
Keywords
Cancro da mama Exercício aeróbio Exercício de força Infiltração linfocitária tumoral Ki-67 Quimioterapia neoadjuvante Aerobic exercise Breast cancer Ki-67 Neoadjuvant chemotherapy Physical activity Resistance exercise Tumor-infiltrating lymphocytes Tumor size