Impact of a one-year supervised physical activity program on long-term cancer-related fatigue and mediating effects of the gut microbiota in metastatic testicular cancer patients: protocol of the prospective multicentre, randomized controlled phase-III STARTER trial

BMC Cancer. 2024 Jan 15;24(1):84. doi: 10.1186/s12885-024-11824-7.


Background: Testicular germ cell tumours (TGCTs) are the most common malignancy in men aged 15-40 years, with increasing incidence worldwide. About 33 ~ 50% of the patients present with metastatic disease at diagnosis. TGCT survivors experience short- and long-term sequelae, including cancer-related fatigue (CRF). Physical activity (PA) has established effects on reducing CRF and other sequelae and improving health-related quality of life (HRQoL). However, its impact on TGCT survivors has so far received little attention. The gut microbiota plays a crucial role in various physiological functions, including cognition and metabolism, and may mediate the effects of PA on CRF and other sequelae, but this has not been investigated in randomized controlled trials.

Methods: This national, multicentre, phase-III trial will evaluate the impact of a one-year supervised PA program on CRF and other short- and long-term sequelae in metastatic TGCT patients receiving cisplatin-based chemotherapy combined with etoposide+/-bleomycin. It will also investigate potential mediating effects of the gut microbiota and its metabolites involved in the gut-brain axis on the relationship between PA and CRF and other sequelae. A total of 236 men ≥ 18 years of age with metastatic TGCT (seminoma and non-seminoma) will be enrolled before starting first-line chemotherapy in several French hospitals. The primary (CRF) and secondary (cognitive/psychological/metabolic sequelae, HRQoL, etc.) outcomes and gut microbiota and relevant metabolites will be assessed at inclusion, during and at the end of the one-year intervention, and annually until 10 years since inclusion to assess long-term sequelae, more specifically CRF, cardiovascular toxicities, and second primary cancer occurrence in this population.

Discussion: This trial will provide comprehensive and novel insights into the effects of a long-term supervised PA program on CRF and other sequelae in metastatic TGCT patients receiving first-line chemotherapy. It will also contribute to understanding the potential role of the gut microbiota and its metabolites in mediating the effects of PA on these outcomes. The findings of this study will help the development of effective PA interventions to improve the health of TGCT survivors and may have implications for other cancer populations as well.

Trial registration: The study was registered on (NCT05588700) on 20 Oct. 2022.

Keywords: Cancer-related fatigue; Cancer-related sequelae; Gut microbiota; Gut microbiota-derived metabolites; Gut-brain axis; Health-related quality of life; Physical activity; Testicular cancer.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • Adolescent
  • Cancer Survivors*
  • Clinical Trials, Phase III as Topic
  • Exercise
  • Fatigue / etiology
  • Gastrointestinal Microbiome*
  • Humans
  • Male
  • Multicenter Studies as Topic
  • Neoplasms, Germ Cell and Embryonal* / complications
  • Neoplasms, Second Primary* / complications
  • Prospective Studies
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Testicular Neoplasms* / complications
  • Testicular Neoplasms* / therapy

Supplementary concepts

  • Testicular Germ Cell Tumor

Associated data