Page 50 - Read Online

Page 6 of 8 Lo Re et al. J Cancer Metastasis Treat 2019;5:81 I http://dx.doi.org/10.20517/2394-4722.2019.30

Therefore, if physical activity were recognized as a determining factor in the induction and maintenance
of antitumor immune function, it could be used as adjuvant and maintenance therapies in the on and off
phases of the active antineoplastic therapy, respectively.

Physical activity may have surprising positive results, especially in patients with a life-threatening
disease, such as PDAC, who have undergone systemic treatments that cause long-term sequelae such
as neurotoxicity with a negative impact on their quality of life. After a slow and progressive clinical
improvement, our patient undertook a constant course of physical exercise until he reached more than
[33]
15,000 km of walking. These results are described in his book , which deals with his manifold experiences,
feelings, and personal reflections, as well as the clinical approach to his neoplastic disease. During the
five-year follow-up period and walking activity, the stability of the disease was confirmed. Therefore, this
could be linked to the contribution of the physical exercise as maintenance of response obtained after
FOLFIRINOX. It is also worth noting the stability of the hematological and immunological profile, with a
reduction trend of PLT/Lymph ratio, the normalization of CRP after treatment, and its maintenance over
time during physical activity, which are indirect indices of immune surveillance. However, no statistical
considerations can be made due to the lack of comparative data during an actual rest phase for the relative
constant physical activity of the patient.

His unique experience should make us profoundly reflect on the effects of reactive depression to a cancer
diagnosis, and to further study the relationships between physical activity and both treatment efficacy
and immunosuppression. Prospective studies involving medical oncologists, immunologists, biologists,
neurologists, and physiotherapists are needed to confirm these results.

DECLARATIONS
Authors’ contributions
Conceptualization, data curation, formal analysis, investigation, methodology, project administration,
software, supervision, validation, visualization, writing - original draft, writing - review & editing, and
used in attributes: Lo Re G, Magnaldi S, Doretto P, Innocente R, Lo Re F

Availability of data and materials
We declare that the patient’s data derive from personal treatment and clinical-instrumental follow-up. The
scientific data reported derive from the international literature and it is listed in the references.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.