@article{20f4c1d8a69b4904ae4f5a3980d0d4a7,
title = "Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials",
abstract = "Background: We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy. Methods: Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5 years; secondary objectives included BMI changes at 1 and 3 years; BMI changes on disease-specific survival (DSS) and overall survival (OS); and effects of baseline BMI. Stratified analyses included trial therapy and composite trial stratification factors. Results: In pre-/peri-/early post-menopausal chemotherapy trials (N = 2793), baseline BMI did not impact any endpoint and increased BMI from baseline did not significantly affect BCFI (P = 0.85) after 5 years although it was associated with worse BCFI (P = 0.03) and DSS (P = 0.07) after 1 year. BMI increase by 3 and 5 years was associated with better DSS (P = 0.01; 0.01) and OS (P = 0.003; 0.05). In pre-menopausal endocrine therapy trial MA.12 (N = 672), patients with higher baseline BMI had worse BCFI (P = 0.02) after 1 year, worse DSS (P = 0.05; 0.004) after 1 and 5 years and worse OS (P = 0.01) after 5 years. Increased BMI did not impact BCFI (P = 0.90) after 5 years, although it was associated with worse BCFI (P = 0.01) after 1 year. In post-menopausal endocrine therapy trials MA.14 and MA.27 (N = 8236), baseline BMI did not significantly impact outcome for any endpoint. BMI change did not impact BCFI or DSS after 1 or 3 years, although a mean increased BMI of 0.3 was associated with better OS (P = 0.02) after 1 year. With the administration of trastuzumab (N = 1395) baseline BMI and BMI change did not significantly impact outcomes. Conclusions: Higher baseline BMI and BMI increases negatively affected outcomes only in pre-/peri-/early post-menopausal trial patients. Otherwise, BMI increases similar to those expected in healthy women either did not impact outcome or were associated with better outcomes. Clinical Trials numbers: CAN-NCIC-MA5; National Cancer Institute (NCI)-V90-0027; MA.12-NCT00002542; MA.14-NCT00002864; MA.21-NCT00014222; HERA, NCT00045032;CAN-NCIC-MA24; MA-27-NCT00066573.",
keywords = "BMI, disease specific survival, overall survival, triple negative, weight change",
author = "R. Yerushalmi and B. Dong and Chapman, {J. W.} and Goss, {P. E.} and Pollak, {M. N.} and Burnell, {M. J.} and Levine, {M. N.} and Bramwell, {V. H.C.} and Pritchard, {K. I.} and Whelan, {T. J.} and Ingle, {J. N.} and Shepherd, {L. E.} and Parulekar, {W. R.} and L. Han and K. Ding and Gelmon, {K. A.}",
note = "Publisher Copyright: {\textcopyright} 2017 European Society for Medical Oncology",
year = "2017",
month = jul,
doi = "10.1093/annonc/mdx152",
language = "אנגלית",
volume = "28",
pages = "1560--1568",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Elsevier Ltd.",
number = "7",
}
