Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Effects of structured exercise on lean body mass and muscle strength in patients with metastatic breast cancer: The multinational randomized controlled PREFERABLE-EFFECT Study (#82)

Helene Rundqvist 1 , Gustav Joernaker 1 , Dorothea Clauss 2 , Mark Trevaskis 3 , Anouk E Hiensch 4 , Martina E Schmidt 5 , Evelyn M Monninkhof 4 , Phillip Zimmer 6 , Jon Belloso 7 , Elisa Heyrman 1 , Rodrigo Fernandez Gonzalo 1 , Joachim Wiskemann 8 , Jana Mueller 8 , Renske Altena 1 , Bruce Mann 9 , Prudence Francis 10 , Gary Richardson 11 , Yoland Antill 11 , Michelle White 11 , Peter Savas 9 10 , Elsken van der Wall 4 , Neil K Aaronson 12 , Elzbieta Senkus 13 , Ander Urruticoechea 7 , Martijn M Stuiver 12 , Karen Steindorf 5 , Wilhelm Bloch 2 , Yvonne Wengstrom 1 14 , Anne M May 4 , Eva M Zopf 3 15
  1. Karolinska Institutet, Stockholm, Sweden
  2. German Sport University Cologne, Cologne, Germany
  3. Australian Catholic University, Melbourne, Victoria, Australia
  4. University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  5. German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
  6. Institute for Sport and Sport Science, Dortmund University, Dortmund, Germany
  7. Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
  8. Heidelberg University Hospital and NCT Heidelberg, Heidelberg, Germany
  9. The Royal Melbourne Hospital , Melbourne, Victoria, Australia
  10. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  11. Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
  12. Netherlands Cancer Institute, Amsterdam, The Netherlands
  13. Medical University of Gdańsk, Gdańsk, Poland
  14. Karolinska University Hospital, Stockholm, Sweden
  15. Cabrini Health, Melbourne, Victoria, Australia

Aims: Reduced lean body mass (LBM) is common in patients with metastatic breast cancer (mBC) and has been associated with increased treatment-related toxicity and poorer treatment outcomes. Exercise can improve LBM and muscle strength, however evidence in patients with mBC is lacking. The multinational randomized controlled PREFERABLE-EFFECT study (NCT04120298) showed that exercise significantly reduces fatigue and improves quality of life in patients with mBC. Here we report the exercise effects on LBM and muscle strength (secondary outcomes).

Methods: Patients with mBC from five European countries (Germany, Spain, Netherlands, Poland, Sweden) and Australia were eligible for inclusion. Participants were randomized to usual care (UC) or a 9-month supervised and individualized exercise program (EX) involving twice weekly aerobic, resistance, and balance exercises. LBM was assessed via dual-energy x-ray absorptiometry in a subset of patients (n=66). Body mass index (BMI) was assessed as standard. Lower leg strength was assessed via hypothetical 1-repetition maximum test on the leg press, where deemed safe (n=126). Changes from baseline to 3 and 6 months were compared between groups using adjusted mixed models for repeated measures.

Results: A total of 357 patients were randomized (EX=178, UC=179; accrual target=350). Mean age was 55.4 ± 11.1 years, mean BMI 26.2 ± 5.2 kg/m2, 74.8% were on 1st/2nd treatment lines and 67.2% had bone metastases. Compared to UC, EX resulted in improved LBM at 3 months (between-group difference=0.8kg, 95%CI [0.2; 1.4], p-value=0.018) with no difference between groups at 6 months (0.3kg, [-0.3; 0.9], p-value=0.333). No difference between groups was observed for BMI. EX improved lower leg strength at 3 months (18.3kg, [7.7; 28.9], p-value=0.001) and 6 months (34.2kg, [23.0; 45.4], p-value<0.001), compared to UC.

Conclusions: The results of this large multinational study support the prescription of supervised aerobic and resistance exercise in patients with mBC to improve LBM and muscle strength.