In a French study (CANTO) reported in the Journal of Clinical Oncology, Soldato et al found that increasing pretreatment exercise levels was associated with a longer distant recurrence–free interval up to a threshold exercise level in patients with primary breast cancer. The benefit of exercise level was particularly notable in some patient subgroups.
Study Details
The multicenter prospective cohort analysis included 10,359 patients enrolled in the CANTO study between 2012 and 2018. Postdiagnosis/pretreatment exercise level was assessed using the Global Physical Activity Questionnaire-16, expressed as the standardized metabolic equivalent of task-hours per week (MET-h/wk).
Key Findings
During a median follow-up of 5.4 years (interquartile range = 3.8–6.4 years), distant recurrence was observed in 502 patients.
In the total cohort, the relationship between exercise and distant recurrence–free interval was found to be nonlinear. Increasing exercise beyond 5 MET-h/wk was associated with an inverse linear reduction in distant recurrence–free interval events up to approximately 25 MET-h/wk; beyond this threshold, no additional benefit was observed for increasing exercise. On the basis of this finding, the association was analyzed according to exercise levels of < 5 MET-h/wk (n = 4,205, 40.6%) vs ≥ 5 MET-h/wk (n = 6,154, 59.4%). For ≥ vs < 5 MET-h/wk, the adjusted hazard ratio for distant recurrence–free interval was 0.82 (95% confidence interval [CI] = 0.61–1.00).
The benefit of exercise was notable in some patient subgroups. Hazard ratios for distant recurrence–free intervals with exercise of ≥ vs < 5 MET-h/wk follow:
- 0.59 (95% CI = 0.38–0.92) among 984 patients with hormone receptor (HR)-negative/HER2-negative disease
- 0.37 (95% CI = 0.14–0.96) among 392 patients with HR-negative/HER2-positive disease
- 0.64 (95% CI = 0.48–0.86) among 3,602 premenopausal patients.
The investigators concluded: “Postdiagnosis/pretreatment exercise is associated with lower risk of distant recurrence–free interval events in a nonlinear fashion in primary breast cancer; exercise has different impact on distant recurrence–free interval as a function of subtype and menopausal status.”
Ines Vaz-Luis, MD, PhD, of the Supportive Care and Pathways Department (DIOPP), Gustave Roussy, Villejuif, France, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the French Government under the Investment for the Future program managed by the National Research Agency and others. For full disclosures of the study authors, visit ascopubs.org.
