Prevention of Frailty With Fisetin and Exercise in Breast Cancer Survivors

PRIMARY OBJECTIVE: I. To determine the effect of fisetin and/or exercise on physical function, as assessed using the 6-minute walk distance (6MWD), in chemotherapy-treated postmenopausal breast cancer survivors. SECONDARY OBJECTIVES: I. To determine the effect of fisetin and/or exercise on heart rate and step count, as measured by wearable device. II. To determine the effect of fisetin on other measures of physical function beyond 6MWD (short physical performance battery \[SPPB\], grip strength, frailty phenotype, physical activity). III. To determine the effect of fisetin and/or exercise on fatigue (Borg Rating of Perceived Exertion \[RPE\]). IV. To determine the effect of fisetin and/or exercise on neuropathy (Quality of Life Questionnaire - Chemotherapy-Induced Peripheral Neuropathy 20 \[QLQ-CIPN20\]). V. To determine the effect of fisetin and/or exercise on cognition (Patient Reported Outcomes Measurement Information System \[PROMIS\] cognitive function short form). VI. To determine the effect of fisetin and/or exercise on health-related quality of life (Short Form \[SF\]-36). VII. To determine the effect of fisetin on local and distant recurrence free survival (RFS). VIII. To determine the effect of fisetin on breast cancer-specific survival and overall survival. IX. To evaluate the safety and tolerability (National Cancer Institute \[NCI\] Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\]5.0) of fisetin. X. To estimate rates of adherence to fisetin and/or exercise regimen. EXPLORATORY OBJECTIVES: I. To determine the effect of fisetin and/or exercise on p16 expression in peripheral CD3+ T-cells. II. To determine the effect of fisetin and/or exercise on circulating senescence-associated secretory phenotype (SASP) inflammatory factors in blood and urine. OUTLINE: Patients are randomized to 1 of 4 arms. ARM AB: Patients receive fisetin orally (PO) on days 1-3 of each cycle. Treatment repeats every 14 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive individually tailored supervised exercise training consisting of 30-45 minutes of aerobic training and 20-30 minutes of resistance training three times a week over 16 weeks. Patients undergo collection of blood samples on study. ARM A: Patients receive fisetin PO on days 1-3 of each cycle. Treatment repeats every 14 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive handout on the importance of physical activity during baseline. Patients undergo collection of blood samples on study. ARM B: Patients receive placebo PO on days 1-3 of each cycle. Treatment repeats every 14 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive individually tailored supervised exercise training consisting of 30-45 minutes of aerobic training and 20-30 minutes of resistance training three times a week over 16 weeks. Patients undergo collection of blood samples on study. ARM C: Patients receive placebo PO on days 1-3 of each cycle. Treatment repeats every 14 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive handout on the importance of physical activity during baseline. Patients undergo collection of blood samples on study. Following completion of study intervention, patients are followed up on days 120 and 180 and then annually for up to 3 years.