Exercise Therapy as a Candidate Anticancer Strategy
With increasing evidence supporting the role of regular physical activity in controlling cancer symptoms, oncology guidelines now recommend exercise before, during, and after cancer treatment. The field of exercise-oncology has emerged to explore the potential benefits of exercise in cancer prevention and treatment, focusing on its feasibility, safety, and biological activity.
Background and Translational Framework
The concept of using exercise therapy to lower cancer risk or improve outcomes has gained considerable interest over the past two decades. Initial research focused on the safety and symptom control benefits of exercise in early-stage cancer patients, particularly those with breast cancer. This research has expanded to include a broader range of cancer diagnoses and stages, leading to the development of exercise guidelines by the American College of Sports Medicine (ACSM) and ASCO.
A translational framework has been established to investigate exercise therapy's potential as an anticancer strategy, mirroring the approach used in drug development. Observational studies have shown a promising association between postdiagnosis exercise and improved cancer outcomes, supported by preclinical evidence of exercise's ability to suppress tumor growth.
The PRESTO-1 Trial
The PRESTO-1 trial represents a significant step forward in understanding the biological efficacy of exercise therapy. This phase Ia dose-finding trial evaluated the impact of various exercise doses on tumor biology in men with localized prostate cancer. Conducted remotely, the trial assessed the feasibility and biological activity of exercise therapy, identifying a recommended phase II dose of 225 minutes per week based on its promising biological activity and feasibility.
Future Directions
Building on the findings of PRESTO-1, a phase II randomized trial is underway to investigate the efficacy of longer-term exercise therapy on prostate cancer endpoints and disease progression. Additionally, the planned PRESTO-2 trial aims to explore the feasibility and activity of exercise therapy across multiple solid tumors, potentially leading to refined exercise prescription guidelines and combination approaches with drug therapies.
These ongoing efforts underscore the potential of exercise therapy as a beneficial anticancer strategy, with future research poised to provide deeper insights into its mechanisms of action and optimal implementation in cancer care.
References: The ASCO Post, January 2025
