ATYPICAL RESPONDERS LANDSCAPE REVIEW ∙ OCTOBER, 2017 21 in cancer recurrence and mortality [50]. Researchers reported a study in mice that showed that exercise slows tumor growth [52], but similar to the development and testing of a new cancer drug, rigorous scientific testing in humans is required to test this hypothesis. As a first step, MSKCC recently launched a two-arm randomized, controlled trial to evaluate the safety and tolerability of exercise in women with advanced breast cancer (NCT01725633). Patients with advanced breast cancer will be randomly assigned to standard of care plus exercise training, or to standard of care plus progressive stretching. This study may potentially be a first step toward the ultimate goal, which is to test whether exercise inhibits tumor growth in women with MBC and perhaps other malignancies. If exercise is safe and tolerable in these patients, MSKCC plans to design the next trial to assess whether exercise affects clinical activity in women with advanced breast cancer (read more). Whether a broader variety of lifestyle factors can precipitate or preclude an atypical response to a certain therapy is unknown. Therefore, additional analyses of atypical responses in relation to identified lifestyle factors must be performed. One such study is underway at Radboud University in the Netherlands, where researchers are investigating whether the pharmacokinetics of Afinitor® (everolimus) are different in elderly or obese patients compared to controls (NCT01948960). Further investigation of the impact of co-morbidities and lifestyle factors on response to therapy, especially in patients with metastatic disease, will elucidate an explanation for the promising results above. Because such data can be obtained from cost-effective patient questionnaires, prospective clinical trials should be designed to capture this information. Such questionnaires should be standardized across trials and should collect information regarding all supplements consumed, CIM therapies practiced by the patient, co-morbidities and drugs specifically taken for them, and other elements. Published studies suggest that factors such as consumption of low-dose aspirin [53] and supplements such as Vitamin D [54] are associated with increased survival following a breast cancer diagnosis. Due to their potential, these factors should also be queried. Analysis of these data may result in hypothesis-generating models that could be tested in a systematic manner. An important aspect of data acquisition is standardization of how data are collected, de-identified, and stored on a secure platform that is accessible to authorized researchers. Complementary/Integrative Medicine (CIM) Complementary and alternative practices are those that are used to promote wellness beyond standard medical care [55]. NIH’s National Center for Complementary and Integrative Health (NCCIH) defines complementary, integrative, and alternative medicine as follows: • Complementary Medicine: If a non-mainstream practice and/or product is used together with conventional medicine, it is considered complementary. • Integrative Medicine/Integrative Health Care: Integrative health care is the practice of combining conventional and complementary approaches in a coordinated manner.