Clinical Outcomes Of A Combined Exercise And Dietary Intervention In Patients With Ovarian Cancer

Toxicity-induced treatment modifications affect the efficacy of (neo)adjuvant chemotherapy in patients with ovarian cancer. A chemotherapy relative dose intensity (RDI) below 85% has been associated with reduced survival. Exercise and dietary interventions can improve physical function and body composition, potentially reducing the need for treatment modifications and improving survival rates. The Physical Activity and Dietary intervention in women with OVArian cancer (PADOVA) trial examined the effects of a combined exercise and dietary intervention on physical function, body composition and fatigue as primary endpoint and RDI and progression free survival (PFS) as exploratory secondary endpoints. PURPOSE: To explore the effects of a combined exercise and dietary intervention on RDI and PFS in patients with ovarian cancer receiving (neo)adjuvant chemotherapy treatment. METHODS: A total of 81 patients with ovarian cancer were randomized into a combined supervised exercise (twice weekly for 60 minutes, aerobic and resistance) and dietary (counselling every 3 weeks) intervention or usual care control group. Clinical data was retrieved from medical records. RDI was calculated as the percentage of the given dose to the planned dose and time. We explored intervention effects using logistic and Cox regression analyses. We computed the posterior probability of correctly identifying the best arm using a Bayesian-adaptive decision-theoretic approach. RESULTS: The proportion of patients with a RDI ≥85% was 74% in the intervention group compared to 62% in the control group (n=78, odds ratio=1.81, 95%CI=0.67;4.87). PFS was not significantly different between groups (n=78, hazard ratio=1.32, 95%CI=0.69;2.52), the proportion of patients without disease progression at 18 months was 73% in the intervention group compared to 51% in the control group. The posterior probability that the intervention group was the best study arm was 88%. CONCLUSIONS: The combined exercise and dietary intervention group showed higher proportion of patients achieving RDI ≥85% and higher 18-month PFS compared to the control group, with a 88% posterior probability of being the best arm. These findings support future studies investigating the effects of exercise and dietary interventions with clinical outcomes as primary endpoint. Supported by the Dutch Cancer Society, grant number VU 2015-7950.