Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis

Gabriela G F van der Schoot; Harm L Ormel; Nico-Derk L Westerink; Johan B Wempe; Joop D Lefrandt; Anne M May; Aline H Vrieling; Coby Meijer; Jourik A Gietema; Annemiek M E Walenkamp

doi:10.1007/s00432-023-05469-5

Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis

Gabriela G F van der Schoot
, Harm L Ormel
, Nico-Derk L Westerink
, Johan B Wempe
, Joop D Lefrandt
, Anne M May
, Aline H Vrieling
, Coby Meijer
, Jourik A Gietema
, Annemiek M E Walenkamp^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity.

METHODS: In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII).

RESULTS: Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO.

CONCLUSIONS: Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer.

TRIAL REGISTRY: Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 .

TRIAL REGISTRATION NUMBER: NCT01642680.

Original language	English
Pages (from-to)	17467-17478
Number of pages	12
Journal	Journal of Cancer Research and Clinical Oncology
Volume	149
Issue number	19
Early online date	27 Oct 2023
DOIs	https://doi.org/10.1007/s00432-023-05469-5
Publication status	Published - Dec 2023

Keywords

Bleomycin
Cancer
Cisplatin
Physical exercise
Pulmonary toxicity
Vascular endothelial dysfunction

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van der Schoot, G. G. F., Ormel, H. L., Westerink, N.-D. L., Wempe, J. B., Lefrandt, J. D., May, A. M., Vrieling, A. H., Meijer, C., Gietema, J. A., & Walenkamp, A. M. E. (2023). Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis. Journal of Cancer Research and Clinical Oncology, 149(19), 17467-17478. https://doi.org/10.1007/s00432-023-05469-5

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title = "Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis",

abstract = "PURPOSE: Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity.METHODS: In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII).RESULTS: Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO.CONCLUSIONS: Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer.TRIAL REGISTRY: Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 .TRIAL REGISTRATION NUMBER: NCT01642680.",

keywords = "Bleomycin, Cancer, Cisplatin, Physical exercise, Pulmonary toxicity, Vascular endothelial dysfunction",

author = "\{van der Schoot\}, \{Gabriela G F\} and Ormel, \{Harm L\} and Westerink, \{Nico-Derk L\} and Wempe, \{Johan B\} and Lefrandt, \{Joop D\} and May, \{Anne M\} and Vrieling, \{Aline H\} and Coby Meijer and Gietema, \{Jourik A\} and Walenkamp, \{Annemiek M E\}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1007/s00432-023-05469-5",

language = "English",

volume = "149",

pages = "17467--17478",

journal = "Journal of Cancer Research and Clinical Oncology",

issn = "0171-5216",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "19",

}

van der Schoot, GGF, Ormel, HL, Westerink, N-DL, Wempe, JB, Lefrandt, JD, May, AM, Vrieling, AH, Meijer, C, Gietema, JA & Walenkamp, AME 2023, 'Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis', Journal of Cancer Research and Clinical Oncology, vol. 149, no. 19, pp. 17467-17478. https://doi.org/10.1007/s00432-023-05469-5

Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis. / van der Schoot, Gabriela G F; Ormel, Harm L; Westerink, Nico-Derk L et al.
In: Journal of Cancer Research and Clinical Oncology, Vol. 149, No. 19, 12.2023, p. 17467-17478.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy

T2 - pulmonary and vascular endothelial function-an exploratory analysis

AU - van der Schoot, Gabriela G F

AU - Ormel, Harm L

AU - Westerink, Nico-Derk L

AU - Wempe, Johan B

AU - Lefrandt, Joop D

AU - May, Anne M

AU - Vrieling, Aline H

AU - Meijer, Coby

AU - Gietema, Jourik A

AU - Walenkamp, Annemiek M E

PY - 2023/12

Y1 - 2023/12

N2 - PURPOSE: Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity.METHODS: In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII).RESULTS: Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO.CONCLUSIONS: Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer.TRIAL REGISTRY: Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 .TRIAL REGISTRATION NUMBER: NCT01642680.

AB - PURPOSE: Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity.METHODS: In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII).RESULTS: Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO.CONCLUSIONS: Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer.TRIAL REGISTRY: Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 .TRIAL REGISTRATION NUMBER: NCT01642680.

KW - Bleomycin

KW - Cancer

KW - Cisplatin

KW - Physical exercise

KW - Pulmonary toxicity

KW - Vascular endothelial dysfunction

UR - https://www.scopus.com/pages/publications/85174969495

U2 - 10.1007/s00432-023-05469-5

DO - 10.1007/s00432-023-05469-5

M3 - Article

C2 - 37889308

SN - 0171-5216

VL - 149

SP - 17467

EP - 17478

JO - Journal of Cancer Research and Clinical Oncology

JF - Journal of Cancer Research and Clinical Oncology

IS - 19

ER -

van der Schoot GGF, Ormel HL, Westerink NDL, Wempe JB, Lefrandt JD, May AM et al. Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis. Journal of Cancer Research and Clinical Oncology. 2023 Dec;149(19):17467-17478. Epub 2023 Oct 27. doi: 10.1007/s00432-023-05469-5

Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis

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