Physical Activity And Cancer-related Outcomes In Patients With Metastatic Renal Cell Carcinoma

Abstract

PURPOSE: Tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have revolutionized advanced or metastatic renal cell carcinoma (mRCC). Despite improvements in detection and treatment, mRCC remains a lethal cancer, with 5-year disease-specific mortality ~12%. While physical activity (PA) has been identified as an effective intervention that may improve cancer-related outcomes in patients with other metastatic cancer, there is limited information regarding: 1) the level of physical activity in patients newly diagnosed with mRCC; 2) how this compares to patients with localized renal cell carcinoma (RCC) and healthy controls (HC) and; 3) how it impacts cancer-related outcomes. METHODS: We enrolled 35 consecutive patients with newly diagnosed mRCC who were planning to receive TKI-based systemic therapy with/without ICIs at City of Hope. We also enrolled 29 patients with localized RCC who were scheduled to undergo surgery without systemic therapy. Twenty HC were recruited from acquaintances of patients with RCC. All participants completed a questionnaire about physical activity and demographics at diagnosis. RESULTS: At diagnosis, patients with mRCC were significantly more likely to be older (65.2 vs 52.9 years), have dyslipidemia (31 vs 17%), and a history of coronary artery disease (17 vs 0 %) when compared to HC (P < 0.05). Average minutes of weekly PA was 109.5 min in patients with mRCC, 123.2 min in patients with localized RCC, and 125.8 min in HC. There was no statistically significant difference in the number of participants who met the recommended PA >150 min/week across three groups: 11 patients with mRCC (31%), 8 patients with localized RCC (27%), and 7 HC (35%). In patients with mRCC, there were no statistically significant differences in time to disease progression between patients who met the recommended PA and physically inactive patients (53.7 months [active] vs 48.2 months [inactive]; P = 0.73). CONCLUSIONS: Patients with mRCC have a high burden of chronic comorbidities at diagnosis. In these patients, we found no association between PA and cancer related outcomes, which may be due to the overall low reported PA in this group. Additional studies are needed to examine the impact of increasing PA on health outcomes in patients with mRCC.