Running as if my life depended upon it

As far as cancer treatment goes, it’s been an uneventful 3 months since my last post. I’m tolerating immunotherapy well, although a pattern has emerged that for 24-48 hours after the infusion, I get really fatigued so I’ve learned now to not schedule anything for some days following treatment. I’ve also recently had results back from my last MRI, and they were encouraging in that immunotherapy has stabilised the cancer from metastasizing further - no new tumours have been found, and of those that have been identified none have increased in size. One nodule has even declined in size. So yay.

But perhaps the major achievement for me since my last post detailing my early retirement, is completing my first 100 mile (161km) ultramarathon race on 11th/12th June: Centurion’s South Downs Way 100. I’d entered this race whilst I thought I was in remission last year, but decided I’d still give it a go, to raise money for Oracle Cancer Trust, the UK's leading national charity dedicated to head and neck cancer. The race started in Winchester and mainly tracked the South Downs Way, ending at Eastbourne on the south coast, with almost 4000m of hills climbed on the way!

Over 400 runners started the race, with about 300 finishing. I had no idea how I was going to do, but I knew that my training had gone really well. My main goal was of course to finish within the 30h time-limit. In fact each of the 12 aid stations along the way had its own cut-off time, and if you missed one, you were taken off the race. Brutal. But I also had a secondary (secret) goal of trying to complete the course in under 24h, to get the much coveted 1-day finishers buckle!

And in that I was successful (23h, 33mins).

But there was absolutely no way that I could have done this without the expert coaching by Toby (Queer Runnings). Highlights were also having David and my friend Jill come specially to the finish line at 5am (!!) to see me finish, and the knowledge that almost 200 supporters believed that I could also do this.

Photo credit: Jill Waters

June has also been designated Cancer Immunotherapy Month by the non-profit organisation Cancer Research Institute. I previously blogged about #RunningWithCancer, and the importance of exercise and physical fitness in (i) preventing the onset of many cancer types, (ii) regulating cancer progression, and (iii) improving the effectiveness of some cancer treatments. A recent call to action has been made to revise cancer exercise guidelines, and to provide a road-map for clinical oncologists to convince them that exercise is medicine.

Tying these threads together, I am extremely interested in how physical activity, especially running, impacts specifically on immunotherapy treatment. But although studies are emerging on how exercise can improve the prognosis and quality of life of those undergoing immunotherapy treatment, it seems that our understanding of the underlying mechanisms is still not well developed to all. And this is especially the case with regard to positive and negative impacts of exercise on immune checkpoint inhibitors such as Pembrolizumab (my current drug of choice!).

For example, when you do an exercise, such as running or cycling, it quickly mobilises white blood cells to the blood stream, and can also lead to increased activation of T-cells and their redistribution to tumour sites. Furthermore, the quality of the immune cells involved in fighting cancer is higher in people who consistently undertake lots of exercise and have a higher fitness base-line (as determined by measuring one’s VO2 max (or maximum oxygen uptake during exercise)).

In one case study, when exercise was coupled with another immune checkpoint inhibitor drug called nivolumab, the combination of both appears to further reduce tumour growth. But there is so much that we still don’t know, because the immunotherapy revolution is still in its early stages. For me, this is an exciting time in determining the mechanisms of how exercise can augment immunotherapy (a future ‘dynamic duo’ if you will), and will hopefully become established as part of treatment control. To this end a scoping review has been proposed to determine the role for physical activity for patients specifically on immunotherapy treatments. However, although another review did find evidence that physical activity (concurrent with immunotherapy) has benefits for tumour growth rate and volume, this is based on only very few studies. Perhaps the study's biggest finding of all was the lack of work being done in this field.

To finish, while the title of this blog post sounds quite dramatic, for me it has become a truth. And although this 'truth' needs further evidence with regard to exercise augmenting the positive effects of immunotherapy, for my mental health and physical well-being in general, the running is fundamental to living my best life.