Modulation of Circulating Angiogenic Factors and Tumor Biology by Aerobic Training in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy
Menée sur 20 patientes atteintes d'un cancer du sein opérable et recevant une chimiothérapie néoadjuvante par doxorubicine-cyclophosphamide, cette étude évalue l'effet d'un programme d'interventions comportant des exercices d'aérobic sur la régulation des facteurs angiogéniques circulants et l'évolution du phénotype tumoral
Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We conducted a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin - cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2peak), brachial artery flow-mediated dilatation (BA-FMD)], (ii) host-related circulating factors [circulating endothelial progenitor cells (CEPs) cytokines and angiogenic factors (CAFs)], and (iii) tumor phenotype [tumor blood flow (15O-water PET), tissue markers (hypoxia, proliferation), and gene expression] in 20 women with operable breast cancer. AET consisted of three supervised cycle ergometry sessions / week at 60% to 100% of VO2peak, 30-45 min/session, for 12 weeks. There was significant time x group interactions for VO2peak and BA-FMD, favoring the AC+AET group (p<0.001 and p=0.07, respectively). These changes were accompanied by significant time x group interactions in CEPs and select CAFs (placenta growth factor, interleukin (IL)-1β, and IL-2), also favoring the AC+AET group (p's<0.05). 15O-water PET imaging revealed a 38% decrease in tumor blood flow in the AC+AET group. There were no differences in any tumor tissue markers (p's>0.05). Whole-genome microarray tumor analysis revealed significant differential modulation of 57 pathways (p's<0.01), including many that converge on NF-κB. Data from this exploratory study provide initial evidence that AET can modulate several host and tumor-related pathways during standard chemotherapy. The biological and clinical implications remain to be determined.