Body mass index; Early breast cancer; HER2-positive; Obesity; Overweight; Receptor, ErbB-2; ERBB2 protein, human; Trastuzumab; Humans; Female; Middle Aged; Adult; Aged; Thinness; Chemotherapy, Adjuvant; Prognosis; Disease-Free Survival; Breast Neoplasms/drug therapy; Breast Neoplasms/pathology; Breast Neoplasms/mortality; Breast Neoplasms/metabolism; Body Mass Index; Receptor, ErbB-2/metabolism; Receptor, ErbB-2/antagonists & inhibitors; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Obesity/complications; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Oncology; Cancer Research
Abstract :
[en] [en] BACKGROUND: Body mass index (BMI) may affect prognosis in patients with breast cancer (BC). We assessed the association of BMI and weight changes with outcomes of patients with HER2-positive early BC included in the APHINITY trial.
METHODS: This is an exploratory analysis of APHINITY (NCT01358877), randomized trial testing adjuvant dual vs. single HER2 blockade plus chemotherapy in HER2-positive early BC. BMI was collected at baseline and at two years after randomization. Patients were classified as underweight/normal weight (BMI<25 kg/m2) and overweight/obese (BMI≥25 kg/m2). The association of BMI with invasive disease-free survival (iDFS), distant recurrence-free interval (DRFI) and overall survival (OS) was investigated. Landmark approach was used to compare event for weight change ≥ 5.0 % at 2 years from baseline.
RESULTS: Of 4787 patients included, 2252 (47 %) were overweight/obese and 2535 (53 %) underweight/normal weight. Patients who were overweight/obese had more often chemotherapy discontinuation compared to underweight/normal weight patients (14 % vs. 9 %, p < 0.001). Patients who were overweight/obese exhibited worse iDFS (adjusted hazard ratio [aHR] 1.27; 95 % CI 1.06-1.52), DFRI (aHR 1.32; 95 % CI 1.06-1.64) and OS (aHR 1.38; 95 %CI 1.08-1.77) than underweight/normal weight patients. This effect on iDFS remained after adjusting for chemotherapy discontinuation (iDFS aHR 1.26, 95 % CI 1.05-1.51; DRFI aHR 1.31, 95 % CI 1.06-1.63; OS aHR 1.35 95 % CI 1.05-1.73). Weight changes at 2 years were not associated with clinical outcomes.
CONCLUSIONS: Our exploratory findings suggest that overweight/obesity at diagnosis was associated with worse survival outcomes.
Disciplines :
Oncology
Author, co-author :
Dauccia, Chiara; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium, Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
Alice Franzoi, Maria; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium
Martel, Samuel; Hôpital Charles-Le Moyne, Internal Medicine Department, Université de Sherbrooke, Quebec, Canada
Agbor-Tarh, Dominique; Frontier Science Scotland, Kincraig, Scotland, UK
Fielding, Shona; Frontier Science Scotland, Kincraig, Scotland, UK
Piccart, Martine; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium
Bines, Jose; Instituto Nacional do Cancer, Rio de Janeiro, Brazil
Loibl, Sibylle; German Breast Group c/o GBG Forschungs GmbH, Goethe University, Frankfurt, Germany
Di Cosimo, Serena; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Vaz-Luis, Ines; Cancer Survivorship Group, INSERM 981 - Department for the Organization of Patient Pathways, Gustave Roussy, France
Di Meglio, Antonio; Cancer Survivorship Program, UMR 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
Del Mastro, Lucia; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università degli Studi di Genova, Genova, Italy
Gombos, Andrea; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium
Desmedt, Christine; Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
Jerusalem, Guy ; Université de Liège - ULiège > Département des sciences cliniques > Oncologie
Reaby, Linda; Patient Representative, Newcastle, Australia
Pienkowski, Tadeus; Postgraduate Medical Education Center, Warsaw, Poland
Lambertini, Matteo; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università degli Studi di Genova, Genova, Italy
Agostinetto, Elisa; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium. Electronic address: elisa.agostinetto@hubruxelles.be
Azambuja, Evandro de; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium
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