Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival.

Introduction Patients with metastatic non-small cell lung cancer (mNSCLC) suffer from numerous symptoms linked to disease and treatment which may further impair the patient’s overall condition. In addition to its benefits on quality of life and fatigue, physical exercise may improve treatment response, notably due to its known effects on the immune system. The ERICA study is designed to assess the feasibility of a supervised acute physical exercise therapy realised immediately prior immune-chemotherapy infusion in patients with mNSCLC. Secondary objectives will examine the effects of acute exercise combined with an unsupervised home-walking programme on clinical, physical, psychosocial and biological parameters. Methods and analysis ERICA is a prospective, monocentric, randomised controlled, open-label feasibility study conducted at the Centre Léon Bérard Comprehensive Cancer Center (France). Thirty patients newly diagnosed with mNSCLC will be randomised (2:1 ratio) to the ‘exercise’ or the ‘control’ group. At baseline and during the last treatment cycle, participants in both groups will receive Physical Activity recommendations, and two nutritional assessments. In the exercise group, participants will receive a 3-month programme consisting of a supervised acute physical exercise session prior to immune-chemotherapy infusion, and an unsupervised home-based walking programme with an activity tracker. The acute exercise consists of 35 min interval training at submaximal intensity scheduled to terminate 15 min prior to infusion. Clinical, physical, biological and psychosocial parameters will be assessed at baseline, 3 and 6 months after inclusion. Biological measures will include immune, inflammatory, metabolic, oxidative stress biomarkers and molecular profiling. Ethics and dissemination The study protocol was approved by the French ethics committee (Comité de protection des personnes Ile de France II, N°ID-RCB 20.09.04.65226, 8 December 2020). The study is registered on ClinicalTrials.gov (NCT number:NCT04676009) and is at the pre-results stage. All participants will sign an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences.

Background/Objectives: Recent preclinical studies suggest that acute exercise induces immune modulation, enhances tumor blood perfusion, and is associated with reduced tumor growth. Adding exercise to immunochemotherapy treatment (ICT) has been proposed as a strategy to increase treatment effectiveness. The ERICA trial (NCT04676009) aimed to assess the feasibility of acute aerobic exercise performed immediately before the administration of ICT in patients with metastatic non-small cell lung cancer (mNSCLC) and to explore hypothesis-generating outcomes related to physical fitness and patient-reported outcomes. Methods: Newly diagnosed mNSCLC patients were randomly assigned (2:1) to the exercise or control group. The exercise intervention included supervised acute exercise before each of four ICT cycles plus a 3-month home-based walking program with an activity tracker and step goals. The feasibility of the exercise protocol was assessed through adherence, acceptability, tolerability, and safety. Clinical, physical, and patient-reported outcomes were assessed at baseline and after 3 months. Results: Twenty-six patients (mean age 60.6 years; SD 10.65) participated, with an 87.5% acceptance rate. In the exercise group (n = 17), 80.9% of participants completed the acute exercise sessions, with a median interval of 38 min [IQR, 20–60] between exercise and ICT. No exercise-related adverse effects were reported. After 3 months, 60% of participants in the exercise group were classified as active and maintained their step goals. Self-reported measures suggest that maintaining physical fitness is favorable for reducing fatigue and insomnia, and therefore improving quality of life. Conclusions: Acute exercise performed immediately before each ICT administration in patients with mNSCLC appears feasible and safe.

Purpose: Despite its demonstrated benefits, prehabilitation before lung cancer surgery remains poorly implemented. This study investigated the preferences, interests, and barriers to exercise‐based prehabilitation among patients eligible for thoracic surgery. Method: This cross‐sectional study conducted from January 2022 to July 2023 used self‐administered questionnaires to collect data on preferences and barriers to exercise‐based prehabilitation in cancer patients scheduled for lung resection at a French comprehensive cancer center. Results: Most of the 23 participants ( n = 20, 90.9%) were unaware of prehabilitation but expressed a strong interest in participating in an exercise program prior to lung surgery ( n = 16, 72.7%). Walking ( n = 16, 80.0%) and home‐based exercise ( n = 14, 70.0%) were the most preferred activities. Programs of short to moderate duration (1–4 weeks) and located within 30 min travel from home were preferred. Participants preferred exercising alone or with family members and showed limited interest in the group or facility‐based sessions. While 81.8% ( n = 18) felt capable of engaging in an exercise‐based prehabilitation program, common barriers included distance from the care center, breathlessness, and fatigue. Physical and medical limitations were more frequently reported than psychological ones. Conclusion: Despite limited awareness, lung cancer patients show a strong interest in exercise‐based prehabilitation. Home‐based and flexible programs aligned with patient preferences may help overcome participation barriers. These findings support the development of personalized, accessible prehabilitation strategies to enhance engagement before lung surgery.

L’activité physique (AP) réalisée après le diagnostic d’un cancer a été associé à une amélioration de la survie spécifique au cancer et globale dans des études observationnelles. De plus, des études précliniques ont rapporté que l'exercice physique peut réduire la croissance tumorale chez les rongeurs. Cependant, les mécanismes sous-jacents sont encore à étudier. Cette recherche doctorale a examiné l'hypothèse selon laquelle l’exercice physique effectué juste avant l'administration de l'immunochimiothérapie dans les cancers métastatiques est faisable et a des effets bénéfiques sur la croissance tumorale. Plus précisément, cette recherche doctorale a évalué les effets de l'exercice physique aigu avant l'administration de l'immunochimiothérapie dans un modèle murin de cancer colorectal et a évalué la faisabilité de l'exercice préalable à l'immunochimiothérapie chez les patients atteints de Cancer Bronchique Non à Petites Cellules métastatique (étude ERICA). Nos recherches ont montré l'acceptabilité et la faisabilité de l'exercice physique aigu avant chaque cycle d'immunochimiothérapie chez les patients atteints de CBNPC métastatique, sans provoquer d'effets indésirables liés à l'exercice. L’étude ERICA a également identifié des effets bénéfiques potentiels de cette intervention aiguë combinée à un programme de marche à domicile sur la réduction de la fatigue, l'amélioration de la qualité de vie et de la qualité du sommeil, ainsi que sur l'augmentation du niveau d'AP des participants. Dans notre modèle murin du cancer colorectal (MC38), nous avons observé que la combinaison de l'exercice physique aigu avant l'administration de l'immunochimiothérapie ralentissait la croissance tumorale après une semaine de traitement par rapport aux souris recevant uniquement l'immunochimiothérapie. De plus, nous avons observé une augmentation significative de l'infiltration lymphocytaire dans la tumeur. Cependant, après 16 jours d'exercice, nous n'avons pas observé d'effets supplémentaires de l'exercice combiné au traitement sur la croissance tumorale ou sur les voies moléculaires impliquées dans la prolifération et la mort cellulaire au sein du microenvironnement tumoral. Ces derniers résultats peuvent s'expliquer par l'efficacité importante de l'immunochimiothérapie dans ce modèle murin du cancer colorectal. Cette thèse montre pour la première fois la faisabilité de l’exercice aérobie aigu avant l’administration de l’immunochimiothérapie chez les patients atteints de CBNPC métastatique. Elle encourage le développement d'études à plus grande échelle pour évaluer davantage l'efficacité de ce type d'intervention, qu'elle soit combinée ou non à un programme de marche. Les résultats de notre modèle préclinique mettent en évidence l'importance de poursuivre la recherche sur les interactions entre l'exercice et les traitements du cancer, ainsi que sur les effets de l'exercice sur la croissance tumorale, dans le but d'optimiser la prescription d’AP pour les patients atteints de cancer métastatique.