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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2015

01-02-2015 | Clinical Trial

Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials

Authors: Caterina Fontanella, Bianca Lederer, Stephan Gade, Mieke Vanoppen, Jens Uwe Blohmer, Serban Dan Costa, Carsten Denkert, Holger Eidtmann, Bernd Gerber, Claus Hanusch, Jörn Hilfrich, Jens Huober, Andreas Schneeweiss, Stefan Paepke, Christian Jackisch, Keyur Mehta, Valentina Nekljudova, Michael Untch, Patrick Neven, Gunter von Minckwitz, Sibylle Loibl

Published in: Breast Cancer Research and Treatment | Issue 1/2015

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Abstract

Obesity is associated with an increased risk of breast cancer (BC) and poorer outcome. We assessed the impact of body mass index (BMI) on pathological complete response (pCR), disease-free (DFS), and overall survival (OS), according to BC subtypes in patients with primary BC treated with neoadjuvant chemotherapy. 8,872 patients with primary BC from eight neoadjuvant trials were categorized according to BMI: underweight (<18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), obese (30 to <40 kg/m2), and very obese (≥40 kg/m2). BC subtypes were defined as luminal-like (ER/PgR-positive and HER2-negative), HER2/luminal (ER/PgR-positive and HER2-positive), HER2-like (ER/PgR-negative and HER2-positive), and triple-negative (TNBC; ER/PgR- and HER2-negative). pCR rate was higher in normal weight patients compared with all other BMI groups (P = 0.003). Mean DFS and OS were shorter in obese (87.3 months, P = 0.014 and 94.9 months, P = 0.001, respectively) and very obese (66.6 months, P < 0.001 and 75.3 months, P < 0.001, respectively) compared with normal weight patients (91.5 and 98.8 months, respectively) which was confirmed by subpopulation treatment effect pattern plot analyses and was consistent in luminal-like and TNBC. No interaction was observed between BMI and pCR. Normal weight patients experienced less non-hematological adverse events (P = 0.002) and were more likely to receive full taxane doses (P < 0.001) compared with all other BMI groups. In multivariable analysis, the dose of taxanes was predictive for pCR (P < 0.001). Higher BMI was associated with lower pCR and a detrimental impact on survival. Normal weight patients had the best compliance to chemotherapy and received the highest taxane doses, which seems to be related with treatment outcomes.
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Metadata
Title
Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials
Authors
Caterina Fontanella
Bianca Lederer
Stephan Gade
Mieke Vanoppen
Jens Uwe Blohmer
Serban Dan Costa
Carsten Denkert
Holger Eidtmann
Bernd Gerber
Claus Hanusch
Jörn Hilfrich
Jens Huober
Andreas Schneeweiss
Stefan Paepke
Christian Jackisch
Keyur Mehta
Valentina Nekljudova
Michael Untch
Patrick Neven
Gunter von Minckwitz
Sibylle Loibl
Publication date
01-02-2015
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2015
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-015-3287-5

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