Exercise Therapy and Radiation Therapy (EXERT) for Metastatic Prostate Cancer
Status
RECRUITING
Phase
NA
Age
≥ 18 Years
Enrollments
80Conditions
Metastatic Prostate CancerSummary
This study is being done to determine if patients receiving personalized exercise therapy (versus those who do not receive personalized exercise therapy) have improved quality of life and physical functioning after completing their radiation therapy. Second, the study is being done to find if the quality of life changes during therapy correlate with measurements of inflammation in the blood. Third, the study is being done to see if adding exercise therapy to radiation therapy will improve survival.
Detailed Description
In 2018, 30,000 patients were diagnosed metastatic prostate cancer in the US. Short-course radiation therapy (RT) is a mainstay of treatment for symptomatic metastases, and it stimulates an immune response against the tumor. However, RT also decreases systemic interleukin-1 receptor antagonist (IL-1Ra), placing the body in a pro-inflammatory state, and increasing fatigue and reducing quality of life (QOL). Fatigue and QOL are surrogates of the limited 2-20 month survival time. If fatigue and quality of life are improved, then toxicity and survival will follow.
Our long-term goal is to identify the potential for exercise therapy (ET) to improve RT treatment toxicities and outcomes among metastatic cancer patients. The mechanistic hypothesis is that adding ET training to RT decreases long-term systemic inflammation, mitigating toxicity thereby widening the therapeutic window.
Objective 1. Quantify the potential of Exercise Therapy (ET) to mitigate Radiation Treatment (RT) toxicities and physical function decline. The hypothesis is that ET mitigates patient-reported quality of life (QOL) and toxicities of RT. Our approach will be to use standardized questionnaires and assessment tools to assess QOL and physical function.
Objective 2. Characterize the immunologic mechanism by which ET mitigates RT toxicity. The hypothesis is that ET mitigates the toxicity of RT (measured in objective 1) by increasing serum interleukin-1Ra (IL-1Ra).
Objective 3. Evaluate the ability of ET to improve survival. Since physical function is a surrogate of survival, the hypothesis is that adding ET to RT will improve overall survival, measured from the date of start of radiotherapy until death.
Locations
1 location Found with status Recruiting
Status
- RECRUITING
Central Contacts
- Nicholas G Zaorsky, MD, MS
- 1-800-641-2422
- [email protected]
Principal Investigator
- Nicholas Zaorsky, MD
Eligibility Criteria
Inclusion Criteria:
* Subjects must have metastatic disease consistent with prostate cancer
* Males ≥18 years of age receiving first palliative course of RT for metastatic prostate cancer
* Patient receiving radiation dose of 20 Gray (Gy) in 5 fractions or stereotactic body radiation therapy (SBRT)
* Patient may have received prior hormone therapy. Prior or current use of chemotherapy agents is allowed, but not necessary.
* Fluent in written and spoken English
* Must be able to provide and understand informed consent
* Must have an ECOG Performance Status (PS) of ≤ 3
* Primary attending radiation oncologist approval
Exclusion Criteria:
* Performing > 90 minutes/week of exercise therapy prior at time of enrollment
* Evidence in the medical record of an absolute contraindication for exercise
* Cardiac exclusion criteria:
* Class II, III or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system
* History of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty or stenting within the past 6 months prior to the start of radiation therapy
* Uncontrolled arrhythmias; patients with rate-controlled atrial fibrillation for >1 month prior to start of radiation therapy may be eligible
* syncope
* acute myocarditis, pericarditis, or endocarditis
* acute pulmonary embolus or pulmonary infarction
* thrombosis of lower extremities
* suspected dissecting aneurysm
* pulmonary edema
* respiratory failure
* acute non-cardiopulmonary disorder that may affect exercise performance or be aggravated by exercise
* Mental impairment leading to inability to complete study requirements
* In-patient receiving radiation therapy for a radiation emergency (e.g. cord compression, Superior vena cava (SVC) syndrome, brain metastases)
* High risk of fracture or spine instability (Mirels score ≥7, SINS ≥7)
* Children (the protocol will only include men age 18 and older)
Study Plan
Radiation Therapy + Exercise Therapy
EXPERIMENTAL
This group will receive exercise intervention in addition to their standard of care radiation treatment. At the baseline visit, they will meet with the certified exercise trainer (CET) and will be provided with a personalized exercise prescription and log to record what they do in between daily radiation treatment visits. The participant will also undergo an in-person exercise session prior to radiation therapy, which will take place either on the same day that the physical function tests are preformed or on a separate day. Participants will exercise between 1 and 7 times/week depending on the patient's tolerance to the exercise prescription. The CET will meet with the participant at every radiation treatment visit for an exercise counseling check-in. After five radiation treatments, the CET will follow-up with the participants via phone call once per week for 4 weeks during the follow-up period.
BEHAVIORAL:
Exercise therapyDescription:
The exercise therapy intervention will last 4 weeks. Each participant assigned to this intervention will receive a personalized ET regimen, including in-person, supervised exercise sessions; other activities to be followed at home. Participants will exercise between one and seven times per week depending on their tolerance to the treatment and exercise program.
Radiation Therapy
NO_INTERVENTION
The observational group will continue with their usual standard of care of radiation therapy. The study team will provide patients with an educational pamphlet at the end of their baseline visit. They will also be provided with a self-directed exercise program framework. Additionally, the participant's medical record will be reviewed for serious adverse events during their time on study. Baseline and final measurements will be obtained.
Outcome Measures
Primary Outcome Measures
Quality of life using the Patient-Reported Outcomes Measurement Information System (PROMIS Scale v1.2-Global Health)
Secondary Outcome Measures
Progression free survival
Overall survival
Physical Function: Short Physical Performance Battery
Aerobic Capacity: Six Minute Walk Test
Strength: Hand Grip Strength measured by the grip strength dynamometer test
Health-related Quality of Life: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0)
Evaluation of symptomatic toxicity in study participants using the Common Terminology Criteria for Adverse Events- Patient Reported Outcomes (CTCAE-PRO)
Godin Physical Activity Questionnaire
Fatigue: Fatigue Symptom Inventory
Quantification of IL-1Ra in blood
Timeline
Last Updated
July 1, 2024Start Date
September 21, 2020Today
January 23, 2025Completion Date ( Estimated )
January 1, 2026
Sponsors of this trial
Lead Sponsor
Case Comprehensive Cancer Center
RECRUITING 
21 - 64 Years