LEUVEN CANCER INSTITUTE (LKI) – ONCOFORUM 2024 :
Highlights from the symposium
On 28th of May 2024, the 20th edition of the Oncoforum was organized by the Leuven Cancer Institute at the University Hospital of Leuven (UZ Leuven).
Some members of CarEdOn who are affiliated as post-doctoral or PhD researcher in Internal Disorders and Oncology (GRID-ONCO) research group at the University of Leuven and/or the MOVANT research group at the University of Antwerp were present at the Oncoforum 2024.
The event began with an impressive keynote speech by Dr. Lee Jones from the Memorial Sloan Kettering Cancer Center, New York, USA, on the ‘Development of exercise therapy as a candidate anti-cancer therapy’. He provided information on the effect of exercise therapy on cancer recurrence and tumor biology. In this blog-post, I would like to summarize the research on tumor biology presented by Dr. Jones.
Exercise and mortality risk
In the PLCO trial, the effect of postdiagnosis exercise on all-cause mortality and cancer-specific mortality in cancer survivors was investigated (1). A total of 11,480 patients with cancer enrolled in this trial. Compared with non-exercise, exercise was associated with a 25% reduced risk of all-cause mortality (HR, 0.75; 95% CI, 0.70 to 0.80) and a significant reduction in cancer mortality (HR, 0.79; 95% CI, 0.72 to 0.88). Median survival was 19 years in the exercisers, whereas it was 15 years on the non-exercisers.
Exercise and tumor progression
In his non-published study (Koelwyn, Jones et al.), breast tumor volume decreased significantly in the voluntary wheel running group compared to the control group (p<0.05). The effect of aerobic exercise on pancreatic ductal adenocarcinoma was also searched (2). They revealed that aerobic exercise activates the accumulation of tumor-infiltrating IL15Rα+ CD8 T cells, which are responsible for the tumor-protective effects. Therefore, aerobic exercise reduces pancreatic ductal adenocarcinoma tumor growth by modulating systemic and intra-tumoral immunity (2).Moreover, voluntary wheel running was associated with the over 60% reduction in tumor incidence and growth (3). In the study of Lu et al., it was found that phosphocreatine levels which are linked to mitochondrial energy demands were associated with inhibition of tumor growth (4).
Evidence for dose-response relationship
In the CANcer Toxicities (CANTO) study, a non-linear relationship was observed between the dosage of pretreatment exercise and distant recurrence-free interval. Increasing exercise ≥ 5 MET-h/week was associated with an inverse linear reduction in DRFI events up to approximately 25 MET-h/week. Thus, the therapeutic window was between 5 MET-h/ week and 25 MET-h/ week (5).
At the end of his presentation, Dr. Jones concluded that exercise therapy is a promising anti-cancer strategy. He emphasized that the translational drug-development approach is required for the rational development and increased likelihood of success of exercise interventions, in particular for understanding dose-response relationship.
After the presentation by Dr. Jones, the poster pitches began. Drs. Marthe Van Overbeke presented the PECAN project about ‘Effectiveness of an eHealth self-management support program for persistent pain after breast cancer treatment’. The PECAN project is a three-arm randomized clinical trial that aims to investigate the superiority of the eHealth self-management program over the usual care intervention and non-inferiority compared to the face-to-face program for persistent pain-related disability after breast cancer treatment. You can find further information on the PECAN project by clicking this link: Effectiveness of an eHealth self-management support program for persistent pain after breast cancer treatment | CarEdOn.
Our colleague, Drs. Kaat Verbeelen, presented the LymphSens project ‘The enigma of subjective lymphedema: Why do patients report lymphedema after breast cancer treatment without an objective measurable swelling? The role of sensory processing and subclinical lymphedema’. In this longitudinal observational study, breast cancer patients will be followed from baseline up to 12 months post-surgery in terms of subjectively and objectively measured swelling, subclinical lymphoedema, nociceptive, neuropathic, and central sensory problems. We aim to understand when and why patients report a swelling sensation in their arm and/or trunk/ breast, even when there is no measurable swelling. If you are interested in the LymphSens project, you can find further information by following this link: The enigma of subjective lymphedema: Why do patients report lymphedema after breast cancer treatment without an objective measurable swelling? | CarEdOn.
Furthermore, Drs. Nieke Vets performed a poster presentation on the UPLIFT-BC project ‘Identifying prognostic variables for persistent upper limb dysfunctions after breast cancer treatment: protocol of a longitudinal cohort study’. The UPLIFT-BC study aims to identify the contributing factors to chronic upper limb dysfunctions. In this project, the breast cancer survivors will be assessed before the surgery, one and six months after the surgery and radiotherapy (if applicable). A model will be formed to predict persistent upper limb dysfunction in breast cancer survivors covering all aspects of the International Classification of Functioning, Disability and Health (ICF). You can find further information on the UPLIFT-BC project by this link: UPper LImb FuncTion after Breast Cancer | CarEdOn.
Lastly, Dr. Lore Dams presented the project, ‘Empowering an active lifestyle during and beyond cancer treatment at UZ Leuven’. This project aims to improve cancer patients' quality of life by providing tailored exercise interventions during treatment. Dr. Lore Dams emphasized the importance of implementation of education and rehabilitation programs that can support oncological patients in achieving better physical functioning and well-being.
As a result, the symposium fostered multidisciplinary collaboration, knowledge exchange, and inspiring discussions in cancer research. See you at the next Oncoforum in 2025!
By Ceren Gursen
Post-doctoral researcher at KU Leuven Department of Rehabilitation Sciences
References:
1) Lavery JA, Boutros PC, Scott JM, Tammela T, Moskowitz CS, Jones LW. Pan-Cancer Analysis of Postdiagnosis Exercise and Mortality. J Clin Oncol. 2023 Nov 10;41(32):4982-4992. doi: 10.1200/JCO.23.00058. https://pubmed.ncbi.nlm.nih.gov/37651670/
2) Kurz E, Hirsch CA, Dalton T, Shadaloey SA, Khodadadi-Jamayran A, Miller G, Pareek S, Rajaei H, Mohindroo C, Baydogan S, Ngo-Huang A, Parker N, Katz MHG, Petzel M, Vucic E, McAllister F, Schadler K, Winograd R, Bar-Sagi D. Exercise-induced engagement of the IL-15/IL-15Rα axis promotes anti-tumor immunity in pancreatic cancer. Cancer Cell. 2022 Jul 11;40(7):720-737.e5. doi: 10.1016/j.ccell.2022.05.006. https://pubmed.ncbi.nlm.nih.gov/35660135/
3) Pedersen L, Idorn M, Olofsson GH, Lauenborg B, Nookaew I, Hansen RH, Johannesen HH, Becker JC, Pedersen KS, Dethlefsen C, Nielsen J, Gehl J, Pedersen BK, Thor Straten P, Hojman P. Voluntary Running Suppresses Tumor Growth through Epinephrine- and IL-6-Dependent NK Cell Mobilization and Redistribution. Cell Metab. 2016 Mar 8;23(3):554-62. doi: 10.1016/j.cmet.2016.01.011. https://pubmed.ncbi.nlm.nih.gov/26895752/
4) Lu M, Sanderson SM, Zessin A, Ashcraft KA, Jones LW, Dewhirst MW, Locasale JW, Hsu DS. Exercise inhibits tumor growth and central carbon metabolism in patient-derived xenograft models of colorectal cancer. Cancer Metab. 2018 Nov 15;6:14. doi: 10.1186/s40170-018-0190-7. https://pubmed.ncbi.nlm.nih.gov/30473788/
5) Soldato D, Michiels S, Havas J, Di Meglio A, Pagliuca M, Franzoi MA, Pistilli B, Iyengar NM, Cottu P, Lerebours F, Coutant C, Bertaut A, Tredan O, Vanlemmens L, Jouannaud C, Hrab I, Everhard S, Martin AL, André F, Vaz-Luis I, Jones LW. Dose/Exposure Relationship of Exercise and Distant Recurrence in Primary Breast Cancer. J Clin Oncol. 2024 Jun 5:JCO2301959. doi: 10.1200/JCO.23.01959. https://pubmed.ncbi.nlm.nih.gov/38838281/