Physical activity (PA) impact on metabolome and immunity of oncogene addicted non-small cell lung cancer (NSCLC): The EXcellenT trial.
Authors: Bennati Chiara , Ferrara Roberto , Sangaletti Sabina , Tamberi Stefano , Spadoni Andrea , Attisani Giuseppe , Zanuso Silvano , Longobardi Jenny , Morigi Annalisa , Spreafico Michela , Zingaretti Chiara , Carlotti Elena , D'Arcangelo Manolo 
Published: July 2024

e20582 Background: Today patients (pts) with oncogene addicted advanced NSCLC receive molecular targeted therapies as first-line treatment ensuring high compliance to therapy, few side effects and long survival time. These pts are usually young and with a strong wish to regain the pre-diagnosis quality of life (QoL), including the ability to perform PA. It’s known that PA can impact significantly on metabolomic and immunity status, but to date only few studies on its role in NSCLC have been performed. The aim of the EXcellenT trial is to evaluate if a tailored PA program may have an impact on QoL and performances of this homogeneous subgroup of pts. An exploratory objective was to explore the complex interplay between PA and immune status and the influence of PA on metabolome. Methods: EXcellenT (Exercise in Extended oncogene addicted Lung Cancer in Active Treatment - NCT05306652) is an Italian monocentric prospective study enrolling 40 pts with oncogene-addicted advanced NSCLC in active treatment with tyrosine kinase inhibitors (TKI). Pts are randomized in 2 arms: an interventional arm of a personalized supervised PA program or a counselling group of home-based exercise. We explored peripheral variations of T cells subsets during TKI treatment combined with exercise training to better define the immuno-dependence of these tumors. Fatty acid composition (FA) of plasma has been carried out using gas chromatography-flame ionization detection (GC-FID) and liquid chromatography-mass spectrometry (LC-MS). Immature and mature neutrophils, monocytes, CD34+ cells and megakaryocytes (MK) precursors have been determined through flow cytometry analysis. Results: A preliminary exploratory analysis on the first patients enrolled with 3 complete time point (baseline; week 4 and 12) was performed. To date 23 out of 40 pts have been enrolled, 46% of them with pre-diagnosis leisure-time physical activity. The oncogene identified are: ALK 52%, EGFR 26%, BRAF 9%, RET 4%, ROS1 9%. 35% had stable brain metastasis (mts) and 39% bone mts not at risk of skeletal-related events. FA analysis (4 pts) showed significant increase of monounsaturated fatty acids (p = 0.0329) during the study. According to immunophenotype, we observed (3 pts) a significant reduction of CD34+ cancer stem cell (p 0.0112) and a consistent increase in mature CD66b+CD10+ neutrophils with a trend of decrease in CD66b+CD10- cells. Conclusions: The ExcellenT trial is showing that PA programs are feasible and well accepted by patients with oncogene-addicted NSCLC. The QoL analysis will be performed at the end of enrolment. The preliminary analysis on metabolomic and immunity status shows an improvement of fatty acid composition and an increase of mature cell precursors compared to immature counterpart suggesting a potential role of PA in hindering tumor immune escape strategies. Clinical trial information: NCT05306652 .