Abstract P1-13-01: Lipoprotein and metabolite responses to physical exercise during adjuvant breast cancer treatment
Authors: Madssen Torfinn Støve , Flote Vidar Gordon , Thune Inger , Bertheussen Gro Falkener , Husøy Anders , Lundgren Steinar , Frydenberg Hanne , Wist Erik , Schlichting Ellen , Lømo Jon , McTiernan Anne , Bathen Tone Frost , Giskeødegård Guro Fanneløb 
Published: March 2020

Abstract
Background: Adjuvant breast cancer treatment may cause metabolic perturbations, such as dyslipidaemia, potentially exacerbating risk of cardiometabolic disease as well as risk of breast cancer recurrence. Physical exercise may have beneficial metabolic effects, but it’s effect on serum lipoprotein- and metabolite profiles during adjuvant breast cancer treatment including chemotherapy is not yet well established.
Methods: The women participating in this pilot study of Energy Balance and Breast Cancer Aspects (EBBA)-II, were aged 38-69 years and diagnosed with stage I-II breast cancer. 60 breast cancer patients were randomized after surgery to a control group (n = 29, usual care) or an intervention group (n = 31, intervention), stratified by menopausal status. The patients in the intervention group received a detailed exercise program and met for supervised training sessions in groups of 10-12 women for 60 minutes twice a week during a 12 month period, and were in addition asked to perform at least 60 minutes of exercise at home (a total of 180 minutes of exercise weekly). Fasting serum samples were collected pre-surgery and after six months, and analysed by nuclear magnetic resonance (NMR)-spectroscopy and mass spectrometry. 170 metabolites and 109 lipoprotein subclass variables were quantified and analysed using orthogonalized partial least squares discriminant analysis. Statistical significance was assessed by permutation testing. Single variables were tested with Mann Whitney U-tests or multiple linear regression (NCT02240836).
Results: The breast cancer patients (n = 60) had at pre-surgery the following means: Age at diagnosis of 55.4 years (38-69 years), low density lipoprotein (LDL)-cholesterol 145.4 mg/dl (3.76 mmol/L), high density lipoprotein (HDL)-cholesterol 70.4 mg/dl (1.82 mmol/L), and triglycerides 101.9 mg/dl (1.15 mmol/L), and 58.3 % of the patients underwent chemotherapy (paclitaxel/docetaxel/5-FU/epirubicin/cyclophosphamide based adjuvant chemotherapy). Physical exercise ameliorated chemotherapy-induced increases in very low density lipoprotein (VLDL)- and intermediate density lipoprotein (IDL)-associated lipids, and reduced triglyceride enrichment in LDL and HDL compared with chemotherapy controls (p = 0.003). Physical exercise also significantly increased apoA1 (4.6 % increase vs 11.3 % decrease, q = 0.02) and apoA2 (5.2 % increase vs 13.0 % decrease, q = 0.01) compared with chemotherapy control patients. The NMR-measured lipid signal at 1.55-1.60 ppm increased after six months in chemotherapy recipients, but this was attenuated among chemotherapy recipients in the intervention group. No statistically significant effect of physical exercise on serum levels of small-molecular metabolites was detected.
Conclusion: Our findings suggest that physical exercise may prevent atherogenic alterations in lipoprotein profile induced by chemotherapy. The results indicate increased HDL particle number- and function, as well as increased triglyceride clearance in the intervention group. Thus, atherogenic alterations in lipoprotein profile may play a role in evaluating breast cancer treatment, and could potentially be biomarkers of importance for breast cancer prognosis and co-morbidity.
Citation Format: Torfinn Støve Madssen, Vidar Gordon Flote, Inger Thune, Gro Falkener Bertheussen, Anders Husøy, Steinar Lundgren, Hanne Frydenberg, Erik Wist, Ellen Schlichting, Jon Lømo, Anne McTiernan, Tone Frost Bathen, Guro Fanneløb Giskeødegård. Lipoprotein and metabolite responses to physical exercise during adjuvant breast cancer treatment [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-13-01.