TY - JOUR
T1 - Body mass index and weight change in patients with HER2-positive early breast cancer
T2 - Exploratory analysis of the ALTTOBIG 2-06 trial
AU - Martel, Samuel
AU - Lambertini, Matteo
AU - Agbor-Tarh, Dominique
AU - Ponde, Noam F.
AU - Gombos, Andrea
AU - Paterson, Vicki
AU - Hilbers, Florentine
AU - Korde, Larissa
AU - Manukyants, Anna
AU - Dueck, Amylou
AU - Maurer, Christian
AU - Piccart, Martine
AU - Moreno-Aspitia, Alvaro
AU - Desmedt, Christine
AU - Di Cosimo, Serena
AU - De Azambuja, Evandro
N1 - Publisher Copyright:
© 2021 Harborside Press. All rights reserved.
PY - 2021/2/2
Y1 - 2021/2/2
N2 - Background: The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer. Methods: ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: Underweight, ,18.5 kg/m2; normal weight, 18.5 to ,25 kg/m2; overweight, $25 to ,30 kg/m2; and obese $30 kg/m2. A weight change from baseline of $5.0% and #5.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics. Results: A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04-1.50) and OS (aHR, 1.27; 95% CI, 1.01-1.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97-1.32).Weight loss $5.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05-1.71), DDFS (aHR, 1.46; 95% CI, 1.07-1.98), and OS (aHR, 1.83; 95% CI, 1.18-2.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients. Conclusions: In patients with HER2- positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.
AB - Background: The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer. Methods: ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: Underweight, ,18.5 kg/m2; normal weight, 18.5 to ,25 kg/m2; overweight, $25 to ,30 kg/m2; and obese $30 kg/m2. A weight change from baseline of $5.0% and #5.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics. Results: A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04-1.50) and OS (aHR, 1.27; 95% CI, 1.01-1.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97-1.32).Weight loss $5.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05-1.71), DDFS (aHR, 1.46; 95% CI, 1.07-1.98), and OS (aHR, 1.83; 95% CI, 1.18-2.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients. Conclusions: In patients with HER2- positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.
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U2 - 10.6004/jnccn.2020.7606
DO - 10.6004/jnccn.2020.7606
M3 - Article
C2 - 33401235
AN - SCOPUS:85101418545
SN - 1540-1405
VL - 19
SP - 181
EP - 189
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 2
ER -