Effect of a Goal Setting Intervention on Exercise in Women With Metastatic Breast Cancer: An Exploration of The Lipogenic Pathway

• Secondary objectives: Time to progression [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  goal-setting intervention versus standard of care: Time to progression
• Change in Body Mass Index (BMI) [ Time Frame: Baseline, 6 months ] [ Designated as safety issue: No ]
• Health related quality of life [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  As measured by questionnaires: FACT-B and nutrition quest diet and activity survey
• Correlative Science outcomes in peripheral blood [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  Circulating Tumor Cells (CTC) and Real time polymerase chain reaction (RT-PCR) expression of Lipoprotein lipase (LPL), fatty acid synthase (FASN), cluster of differentiation antigen 36 (CD36), spot-14 (S14), serum estradiol and fasting insulin levels
• Correlative science outcomes in tissue biopsies [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  relative protein expression of LPL, CD36, Spot 14 and FASN of the original tumor to the metastatic tumor at baseline and at the end of the study.
• correlative science in >= 22500 steps [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  Compare correlative science outcomes in those who achieve greater than or equal to 22500 steps/ week to those who do not.
• participants who achieve >= 22500 steps/week [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Determine the proportion of participants who are able to achieve greater than or equal to 22,500 steps/week

• Secondary objectives: Time to progression [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  goal-setting intervention versus standard of care: Time to progression
• Change in BMI [ Time Frame: Baseline, 6 months ] [ Designated as safety issue: No ]
• Health related quality of life [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  As measured by questionnaires: FACT-B and nutrition quest diet and activity survey
• Correlative Science outcomes in peripheral blood [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  CTC and RT-PCR expression of LPL, FASN, CD36, S14, serum estradiol and fasting insulin levels
• Correlative science outcomes in tissue biopsies [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  relative protein expression of LPL, CD36, Spot 14 and FASN of the original tumor to the metastatic tumor at baseline and at the end of the study.
• correlative science in >= 22500 steps [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
  Compare correlative science outcomes in those who achieve greater than or equal to 22500 steps/ week to those who do not.
• participants who achieve >= 22500 steps/week [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Determine the proportion of participants who are able to achieve greater than or equal to 22,500 steps/week

This study is a randomized prospective clinical trial of women and men with metastatic breast cancer. The purpose of the study is to test if an intervention of regular physical activity review and physical activity goal setting will allow the subjects to achieve a moderate increase in physical activity of 6,000 steps per week. The physical activity review will consist of weekly telephone call to inquire about symptoms and to set physical activity goals. The study will also look to see if the goal setting intervention will affect the time to progression, change in BMI, and quality of life. Quality of life will be measured by answers to questionnaires provided to subjects at regular intervals during the course of the study. Finally, the study will examine the impact of physical activity on circulating tumor cells, expression of tumor molecular molecules, insulin levels, and estradiol levels.

Through an intervention of regular physical activity review and goal setting, the investigators hypothesize that a moderate increase in level of physical activity of 6000 steps per week or more can be obtained by patients with metastatic breast cancer who receive a goal setting intervention. The investigators propose that those who are able to achieve and maintain greater than or equal to 22500 steps per week will demonstrate biologic and molecular differences compared to those who are not able to achieve that level of physical activity. The investigators expect that people who are more active will have longer to progression.

• Experimental: Arm A-Pedometer and Goal setting

  Physical Activity Goal Setting

  Patients receive physical therapy (PT) consult, educational materials, and telephone calls and are contacted weekly/monthly for physical activity (PA) goal setting with registered nurse (RN). Physical Activity completed is measured with pedometers and recorded on patient log.

  Intervention: Behavioral: Physical Activity Goal Setting
• No Intervention: ARM B
  Patients receive standard physical activity recommendations and follow up.

Inclusion Criteria:

• Subjects with measurable per Response Evaluation Criteria in Solid Tumors (RECIST) criteria 1.1 and biopsy-able (as determined by Co-Investigator John Gemery, MD) new or progressive metastatic carcinoma of the breast greater than 4 weeks from last treatment for metastatic disease and greater than 12 months from completing adjuvant therapy, including trastuzumab.
• Physically able to undertake a moderate physical activity program.
• Greater than 4 weeks from any radiation treatments for metastatic disease.
• Able to follow directions and fill out questionnaires and physical activity diaries in English.
• Willing to consent to biopsies and be randomly assigned to one of two study arms which may or may not include physical activity goal setting.
• Consents to be contacted via phone or internet (see Appendix K).
• No to all questions on Physical Activity Readiness Questionnaire (see appendix A) or approved by primary care provider for participation.
• Hb >10 without transfusion, liver function tests less than 3 times upper limits of normal, normal thyroid-stimulating hormone (TSH), absolute neutrophil count (ANC) >1500.
• Karnofsky performance status ≥ 80%
• Life expectancy of 6 months or more.
• Previous Physical Therapy consultation and treatments acceptable.

Exclusion Criteria:

• Patients less than 18 years of age.
• Patients unable to give informed consent indicating they are aware of the investigational nature of this treatment, prior to entry into the study.
• Pregnant or nursing women.
• Patients with leptomeningeal or any central nervous system (CNS) disease, treated or untreated.
• Patients with other active cancers requiring treatment.
• Patients with clotting or bleeding disorder precluding biopsy.
• Patients with significant cardiovascular disease, including uncontrolled high blood pressure, unstable angina, congestive heart failure, myocardial infarction within the previous 6 months or serious cardiac arrhythmias will be excluded.
• Current use of supplements containing conjugated linoleic acid, or use within the 30 days preceding registration.
• Persons with a known diagnosis of diabetes are not eligible. Prior use of metformin allowable if previously enrolled on MA.32 trial as part of their adjuvant therapy for early stage breast cancer.
• Persons of male gender.