Acupuncture and Exercise for EV-Pembro-Induced Peripheral Neuropathy

Prior treatment

• History of documented grade 2 or greater peripheral or motor neuropathy prior to EV-Pembro initiation; may confound assessment of the intervention's preventative effect
• Receiving more than 10mg prednisone daily for any condition

Other illness

• Patients with uncontrolled medical conditions that would preclude them from participating in moderate-to-vigorous intensity exercise in a virtual setting. Given the exercise environment is virtual, only patients with stable medical conditions should be enrolled to ensure their safety. Physical Activity Readiness Questionnaire (PARQ+) will be used during screening to facilitate conversations about present or historical medical conditions
• History of bleeding diathesis (von Willebrand disease, hemophilia A/B)
• Known history of seizure disorder or taking antiepileptic drugs

Age

• Individuals who are not yet adults (infants, children, teenagers \< 18 years)

Other

• Having continued grade 2 or higher adverse effects of their current treatment (EV-Pembro)
• Participate in more than 60 minutes of moderate or vigorous structured exercise/week
  • Investigators will not include the following special populations:
• Adults unable to consent
• Pregnant people
• Prisoners

• Age ≥ 18 years old
• Diagnosed with pathologically proven urothelial cancer (UC)
• Have received at least one cycle of EV-Pembro treatment with enrollment occurring after the 1st cycle and prior to the 4th cycle
• Self-reported ability to walk for 6 minutes and/or 2 blocks
• Deemed acceptable for exercise by their treating provider
• Sedentary, currently engaging in less than or equal to 60 minutes of moderate or vigorous structured exercise/week, as assessed by the Godin Leisure-Time Exercise Questionnaire
• Willing to adhere to all study-related procedures, including randomization to either treatment group
• Referrals to physical therapy are allowed during the study if necessary
• Participants taking any of medications listed below must be on a stable regimen, with no changes in the past three months. Use of these medications may continue while on study.
• Duloxetine, amitriptyline, nortriptyline, gabapentin, and pregabalin
• Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety of efficacy assessment of investigational regimen will be eligible.