Exercise may improve chemotherapy efficacy in esophageal cancer

Patients with esophageal cancer who engaged in prehabilitation exercise demonstrated improved responses to neoadjuvant chemotherapy than those who did not, according to a study published in British Journal of Sports Medicine.

“Whilst we are always cautious about overstating the outcomes from relatively small trials, these results that showed an improvement in chemotherapy response in patients on an exercise program are undoubtedly exciting,” Andrew Davies, MSc, MBChB, MD, FRCS, consultant general surgeon at Guy’s and St. Thomas’ Hospitals NHS Trust in London, told Healio. “Not only is it the first time this relationship has been shown in a human trial, but the implications are more far-reaching than the patients with esophageal cancer enrolled in this study.”

Davies noted the documented benefits of exercise and growing interest in preparing patients for high-risk operations with prehabilitation programs.

“We also know that chemotherapy affects patients’ physical fitness nearly as much as a major cancer surgery. Therefore, it makes sense to start this process at the beginning of the treatment pathway, thus maximizing its potential benefit,” he said. “The main driver is to try to improve patients’ outcomes and their functional quality of life by equipping them with the physical and psychological capabilities to deal with the treatment in front of them.”

Davies and colleagues performed a prospective, nonrandomized trial that compared a prehabilitation exercise intervention during neoadjuvant chemotherapy (n = 21) with conventional practice (n = 19) among a small cohort of patients with esophageal cancer. The intervention consisted of moderate exercise involving aerobic and strength training until the day before surgery, for an average of 5 months.

The researchers performed biochemical and body composition analyses at multiple time points, with radiologic and pathologic markers of disease regression as outcome measures.

“The novel finding of enhanced chemotherapy response with exercise should encourage further studies to verify the clinical findings and understand the basic science behind this relationship,” Davies said.