BReast Cancer Randomized EXercise InTervention - BREXIT

Nov 16, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
World Health Organization’s World Cancer Research Fund
Date Published:
11/07/2022
Original Posted Date:
11/16/2022
References

Contribution To Literature:

The BREXIT trial failed to show that exercise training prevented functional disability.

Description:

The goal of the trial was to evaluate exercise training compared with usual care among women with breast cancer undergoing anthracycline-based chemotherapy.

Study Design

  • Randomized
  • Parallel
  • Stratified

Women with breast cancer undergoing anthracycline-based chemotherapy were randomized to exercise training (n = 52) vs. control (n = 52) for 12 months. Exercise training consisted of 3–4 days per week of aerobic and anaerobic exercise.

  • Total number of enrollees: 104
  • Duration of follow-up: 12 months
  • Mean patient age: 50 years
  • Percentage female: 100%
  • Percentage with diabetes: 2%

Inclusion criteria:

  • Women 40–75 years of age
  • Stage 1–3 breast cancer

Exclusion criteria:

  • Structural heart disease
  • Contraindication to cardiac magnetic resonance imaging
  • Contraindication to exercise
  • Non-English speaking
  • Significant cognitive impairment

Principal Findings:

The primary outcome, functional disability at 12 months, defined as peak volume of oxygen uptake (VO2peak) ≤18.0 mL/kg/min, was similar for exercise vs. control (odds ratio 0.27, 95% confidence interval 0.06-1.12, p = 0.07).

Secondary outcomes:

  • Change in VO2peak from baseline to 12 months: +2.0 mL/kg/min in the exercise group vs. -1.5 mL/kg/min in the control group (p < 0.001)
  • Change in left ventricular ejection fraction (LVEF) from baseline to 12 months: -2.2% in the exercise group vs. -1.2% in the control group (p = 0.42)
  • Change in B-type natriuretic peptide (BNP) from baseline to 12 months: 9.4 ng/L in the exercise group vs. 6.5 ng/L in the control group (p = 0.30)

Interpretation:

Among women with breast cancer undergoing anthracycline-based chemotherapy, exercise training failed to prevent functional disability. Exercise training produced a mixed picture with modest improvement in VO2peak but no improvement in LVEF or BNP.

References:

Foulkes SJ, Howden EJ, Haykowsky MJ, et al. Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BReast Cancer Randomized EXercise InTervention (BREXIT) Study. Circulation 2022;Nov 7:[Epub ahead of print].

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Exercise

Keywords: Anaerobiosis, Anthracyclines, Breast Neoplasms, Cardiotoxicity, Exercise, Exercise Therapy, Heart Failure, Natriuretic Peptide, Brain, Oxygen Consumption, Primary Prevention, Stroke Volume, Ventricular Function, Left


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