Thromboembolic events after high‐intensity training during cisplatin‐based chemotherapy for testicular cancer: Case reports and review of the literature. Issue 11 (1st July 2020)

• Record Type: Journal Article
• Authors: Thorsen, Lene; Haugnes, Hege S.; Fosså, Sophie D.; Brydøy, Marianne; Tandstad, Torgrim; Wisløff, Torbjørn; Gjerset, Gunhild M.; Edvardsen, Elisabeth; Larsen, Karl‐Otto; Sandset, Per Morten; Henriksson, Carola E.; Raastad, Truls; Negaard, Helene F. S.
• Is Part Of: International journal of cancer. Volume 147:Issue 11(2020)
• Page Start: 3189
• Page End: 3198
• Publication Date: 2020-07-01
• Subjects: cisplatin‐based chemotherapy -- high‐intensity training -- testicular cancer -- thromboembolic events; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33151
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: The randomized "Testicular cancer and Aerobic and Strength Training trial" (TAST‐trial) aimed to evaluate the effect of high‐intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin‐based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high‐intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST‐trial. What's new?: Exercise is widely acknowledged to be beneficial for cancer patients, but certain subgroups may experience adverse effects. Patients with testicular cancer who take cisplatin‐based chemotherapy often experience reduced cardiovascular function. In this study, the authors observed an increase in thromboembolic events among testicular cancer patients taking cisplatin who engaged in HIIT twice a week. In a randomized trial, 3 out of 9 patients in the exercise arm experienced TE events, including myocardial infarction and pulmonary embolism, compared with 0 of 10 patients in the control arm. The study was cut short due to the increased risk.