Exercise-based cardio-oncology rehabilitation for cardiotoxicity prevention during breast cancer chemotherapy: The ONCORE randomized controlled trial

Prog Cardiovasc Dis. 2024 Jul-Aug:85:74-81. doi: 10.1016/j.pcad.2024.02.002. Epub 2024 Feb 21.

Abstract

Background: Breast cancer (BC) treatment with anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies is associated with an increased risk of cardiovascular disease complications, including cancer therapy-related cardiac dysfunction (CTRCD). While Cardio-Oncology Rehabilitation (CORe) programs including exercise have emerged to minimize these risks, its role in preventing CTRCD is unclear.

Objectives: We investigated the effectiveness of an exercise-based CORe program in preventing CTRCD [left ventricular ejection fraction (LVEF) drop ≥10% to a value <53% or a decrease >15% in global longitudinal strain (GLS)]. Secondary outcomes examined changes in cardiac biomarkers, physical performance including peak oxygen consumption, psychometric and lifestyle outcomes. Safety, adherence, and patient satisfaction were also assessed.

Methods: This is a randomized controlled trial including 122 early-stage BC women receiving anthracyclines and/or anti-HER2 antibodies, randomized to CORe (n = 60) or usual care with exercise recommendation (n = 62). Comprehensive assessments were performed at baseline and after cardiotoxic treatment completion. The average duration of the intervention was 5.8 months.

Results: No cases of CTRCD were identified during the study. LVEF decreased in both groups, but was significantly attenuated in the CORe group [-1.5% (-2.9, -0.1); p = 0.006], with no changes detected in GLS or cardiac biomarkers. The CORe intervention led to significant body mass index (BMI) reduction (p = 0.037), especially in obese patients [3.1 kg/m2 (1.3, 4.8)]. Physical performance and quality-of-life remained stable, while physical activity level increased in both groups. No adverse events were detected.

Conclusions: This study suggests that CORe programs are safe and may help attenuate LVEF decline in BC women receiving cardiotoxic therapy and reduce BMI in obese patients.

Keywords: Breast cancer; Cardio-oncology rehabilitation; Cardiotoxicity; Cardiovascular prevention; Exercise.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anthracyclines / adverse effects
  • Antineoplastic Agents* / adverse effects
  • Antineoplastic Agents, Immunological / adverse effects
  • Breast Neoplasms* / drug therapy
  • Cardiac Rehabilitation* / methods
  • Cardio-Oncology* / methods
  • Cardiotoxicity* / diagnosis
  • Cardiotoxicity* / physiopathology
  • Cardiotoxicity* / prevention & control
  • Cardiotoxicity* / rehabilitation
  • Exercise Therapy* / methods
  • Female
  • Humans
  • Middle Aged
  • Recovery of Function
  • Stroke Volume / drug effects
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left / drug effects

Substances

  • Anthracyclines
  • Antineoplastic Agents
  • Antineoplastic Agents, Immunological