Exercise Therapy and Radiation Therapy (EXERT) for Metastatic Prostate Cancer
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|ClinicalTrials.gov Identifier: NCT04556045|
Recruitment Status : Not yet recruiting
First Posted : September 21, 2020
Last Update Posted : November 26, 2021
|Condition or disease||Intervention/treatment||Phase|
|Metastatic Prostate Cancer||Behavioral: Exercise therapy + radiation therapy Radiation: Radiation therapy||Not Applicable|
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.
Aim 1. Quantify the potential of ET to mitigate RT toxicities and physical function decline. The hypothesis is that ET mitigates patient-reported QOL and toxicities of RT. Our approach in 1A will be to use standardized questionnaires and assessment tools: toxicity is measured using the NIH Patient-Reported Outcomes Measurement Information System library + Common Terminology Criteria for Adverse Events. In 1B, we will use 30-second chair stand and timed up-and-go. Pre vs post difference scores for each variable would be compared with a generalized estimating equations (GEE) model with an ordinal logistic link function.
Aim 2. Characterize the immunologic mechanism by which ET mitigates RT toxicity. The hypothesis is that ET training mitigates toxicity of RT (measured in aim 1) by increasing serum interleukin-1Ra. Our approach will be to measure IL-1Ra pre-RT and 1 month post-RT±ET. We will similarly measure exploratory pro-inflammatory (IL-1B, IL-6, TNF-α, IL-8, IL-15, CRP) and anti-inflammatory (IL-10) markers using a GEE model with ordinal logistic link function.
Aim 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 random assignment to date of death. This pilot work is essential for the development of a full scale randomized trial, to be funded by an R01 application to NCI, planned for submission within 1 year of pilot study completion.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||80 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Supportive Care|
|Official Title:||Exercise Therapy and Radiation Therapy (EXERT) for Metastatic Prostate Cancer|
|Estimated Study Start Date :||February 1, 2022|
|Estimated Primary Completion Date :||February 1, 2024|
|Estimated Study Completion Date :||February 1, 2025|
Experimental: Radiation therapy + exercise therapy (RT+ET) group
The RT+ET group will receive the exercise intervention. At their baseline visit, they will meet with the exercise physiologist, each participant will be provided a personalized exercise prescription to follow at home and will be asked to record what they do in between daily radiation treatment visits on the exercise tracking log provided to them. Participants will exercise between 1 and 7 times/week depending on the patient's tolerance to the treatment and exercise prescription. The exercise physiologist will meet with the participant at every radiation treatment visit for a brief 15-30 minute exercise counseling check in. After the participant's five radiation treatments, the exercise physiologist will follow-up with the participants via phone call once per week for 4 weeks during the follow-up period.
Behavioral: Exercise therapy + radiation therapy
The exercise intervention will last 6 weeks and consist of 5-times weekly resistance training intervention combined with aerobic exercise.
Other Name: ET + RT
Experimental: Radiation therapy (RT) group
The RT group will continue with their usual care. The study team will provide patients with an educational pamphlet at the end of their baseline visit. 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.
Radiation: Radiation therapy
Participant will receive radiation therapy.
Other Name: RT
- Quality of life using the Patient-Reported Outcomes Measurement Information System (PROMIS Scale v1.2-Global Health) [ Time Frame: At 1 month follow up ]Patient Reported Outcome Measurement Information System (PROMIS) Global Health v1. 2 short form is a 10-item instrument representing multiple domains. Scores are assigned for both Global Physical Health component and Global Mental Health component. The response scores range from 1-5, where 1 = always and 5 = Never. A higher score from responses indicate better health.
- Progression free survival [ Time Frame: Within 5 years ]The hypothesis is that adding exercise therapy (ET) to radiation therapy (RT) will improve progression free survival, measured using RECIST criteria
- Overall survival [ Time Frame: Within 5 years ]The hypothesis is that adding exercise therapy (ET) to radiation therapy (RT) will improve overall survival, from the date of start of palliative radiotherapy until death.
- Quantification of IL-1Ra in blood [ Time Frame: At 1 month follow up ]A 2-4mL blood sample will be collected to determine participants levels of the biomarker IL-1Ra. Samples will be run via ELISA and concentrations will be reported as pg/mL.
- Physical Function: Short Physical Performance Battery [ Time Frame: At 1 month follow up ]
Objectively-measured physical function will be assessed using the Short Physical Performance Battery (SPPB).
The SPPB is an accumulation of balance tests, 4-meter gait speed, and 5-chair stands. Based on the time needed to complete the chair stands, a score is given. A summation of scores from all tests is taken, ranging from 0 -12. A higher score = Higher physical function.
- Aerobic Capacity: Six Minute Walk Test [ Time Frame: At 1 month follow up ]
Objectively-measured physical function will be assessed using the Six Minute Walk Test (6MWT).
Distance walked during 6 minutes (measured in meters) is measured. Longer distance = higher aerobic capacity.
- Strength: Hand Grip Strength measured by the grip strength dynamometer test [ Time Frame: At 1 month follow up ]Reliable and valid evaluation of hand strength can provide an objective index of general upper body strength. Hand grip strength can be quantified by measuring the amount of static force that the hand can squeeze around a dynamometer. The force is measured in kilograms and/or pounds and corresponds.
- 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) [ Time Frame: At 1 month follow up ]QoL will be assessed with the validated 30-item self-assessment questionnaire of the 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) [ Time Frame: At 1 month follow up ]The PRO-CTCAE characterizes the frequency, severity, interference, and presence/absence of symptomatic toxicities that include pain, fatigue, nausea, and cutaneous side effects that can be meaningfully reported from the patient perspective. PRO-CTCAE responses are scored from 0 to 4 (or 0/1 for absent/present) and evaluate the symptom attributes of frequency, severity, interference, amount, presence/absence. Each symptomatic Adverse Event is assessed by 1-3 attributes. Criteria for grading on the CTCAE scale vary by toxicity. Grade 1: asymptomatic or mild symptoms not requiring intervention. Grade 2: moderate symptoms that interfere somewhat with daily function and where some intervention may be indicated. Grade 3: severe symptoms that interfere with daily activities or require more significant intervention. Grade 4: toxicity that is life-threatening, with urgent intervention indicated.
- Godin Physical Activity Questionnaire [ Time Frame: At 1 month follow up ]
Physical activity behavior in the domains of commuting activity, leisure time activities such as cycling, walking, and sports, household and occupational activity will be assessed via a standardized and validated questionnaire, the Godin Physical Activity Questionnaire. Total weekly leisure activity is calculated in arbitrary units by summing the products of the separate components, as shown in the following formula:
Weekly leisure activity score = (9 × Strenuous) + (5 × Moderate) + (3 × Light) Higher activity score = more active
- Fatigue: Fatigue Symptom Inventory [ Time Frame: At 1 month follow up ]The Fatigue Symptom Inventory (FSI) assesses the frequency and severity of fatigue as well as its perceived disruptiveness. Frequency is measured as the number of days in the past week (0-7) respondents felt fatigued as well as the percentage of each day on average they felt fatigued (0 = none, 10 = entire day).
- Work Productivity and Activity Impairment Questionnaire [ Time Frame: At 1 month follow up ]The Work Productivity and Activity Impairment Questionnaire assesses the effect of patient's health problems on their ability to work and perform regular activities. Subjects self reports as "fill in blank" answers to questions and also as circling a number on a 10 point scale where 0 = Problem had no effect on my work and 10 = Problem completely prevented me from doing my daily activities.
- Barriers to Exercise RM 5-FM [ Time Frame: At 1 month follow up ]Examines factors that have an impact on the development and implementation of and adherence to a personal physical activity plan. Questions are scored on a range of 0-3 where, Very Unlikely = 0 and Very Likely = 3. Barriers to physical activity fall into one or more of seven categories: lack of time, social influences, lack of energy, lack of willpower, fear of injury, lack of skill, and lack of resources. A score of 5 or above in any category shows that this is an important barrier to overcome.
- Exploratory pro-inflammatory (IL-1B, IL-6, TNF-α, IL-8, IL-15, CRP) and anti-inflammatory (IL-10) markers [ Time Frame: At 1 month follow up ]A 2-4mL blood sample will be collected to determine participants levels of pro- and anti-inflammatory biomarkers.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04556045
|Contact: Nicholas G Zaorsky, MD, MSfirstname.lastname@example.org|
|Contact: Josephine Chan, PhD, MBA||216-286-6639||Josephine.Chan@uhhospitals.org|
|United States, Ohio|
|University Hospitals, 11100 Euclid Ave|
|Cleveland, Ohio, United States, 44106|
|Contact: Josephine Chan, PhD, MBA 216-286-6639 Josephine.Chan@uhhospitals.org|
|Principal Investigator:||Nicholas Zaorsky, MD||University Hospitals|