Abstract
Weight gain is commonly reported by breast cancer patients on tamoxifen or aromatase inhibitors. Since weight gain may impact on outcome and compliance we have prospectively assessed the effects of these agents on weight change in three randomised trials for the treatment or prevention of breast cancer. Data on weight change in postmenopausal women from three large clinical trials investigating endocrine therapy for the treatment or prevention of breast cancer were analysed (ATAC, IBIS-I and IBIS-II). In the IBIS-I study, mean weight change on tamoxifen was +0.1 kg (SD 0.1) compared with +0.3 kg (SD 0.1) in women taking the placebo (P = 0.3) between baseline and 12 months of follow-up. In the IBIS-II trial, no statistically significant difference was found between anastrozole and placebo after 12 months of follow-up [+0.8 kg (SD 5.3) vs. +0.5 kg (SD 7.4), P = 0.5]. In the ATAC trial, no statistically significant differences in weight gain between anastrozole and tamoxifen were found after 12 months of follow-up [+1.4 kg (SD 3.9) vs. +1.5 kg (SD 4.0), P = 0.4]. Significant baseline predictors for gaining more than 5 kg of weight after 12 months of follow-up were: being younger than 60 years old, smoking and mastectomy. All three trials demonstrate that weight gain occurs primarily within the first 12 months of active treatment in a subset of patients. In the prevention trials, weight gain does not differ between anastrozole, tamoxifen and placebo and also did not differ between anastrozole and tamoxifen in the treatment trial.
References
Tredan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, Bachelot T, Guastalla JP, Lallemand Y, Faure C, Perol D, Bachmann P (2010) Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr 29(2):187–191
Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, Rock CL, Pierce JP (2007) Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat 105(2):177–186
Harvie MN, Campbell IT, Baildam A, Howell A (2004) Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat 83(3):201–210
Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, Trudeau M, Hood N, Redwood S (1999) Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17(1):120–129
Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, Ballard-Barbash R (2005) Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 23(4):774–782
Monnin S, Schiller MR, Sachs L, Smith AM (1993) Nutritional concerns of women with breast cancer. J Cancer Educ 8(1):63–69
Carlini P, Bria E, Giannarelli D, Ferretti G, Felici A, Papaldo P, Fabi A, Nistico C, Di Cosimo S, Ruggeri EM, Milella M, Mottolese M, Terzoli E, Cognetti F (2005) New aromatase inhibitors as second-line endocrine therapy in postmenopausal patients with metastatic breast carcinoma: a pooled analysis of the randomized trials. Cancer 104(7):1335–1342
Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415
Pfeiler G, Konigsberg R, Fesl C, Mlineritsch B, Stoeger H, Singer CF, Postlberger S, Steger GG, Seifert M, Dubsky P, Taucher S, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Gnant M (2010) Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 29(19): 2653–2659
Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378
Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, Weltzien E (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19(10):1319–1328
Goodwin PJ, Panzarella T, Boyd NF (1988) Weight gain in women with localized breast cancer—a descriptive study. Breast Cancer Res Treat 11(1):59–66
Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7(4):333–340
Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev 18(5):1403–1409
Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer—effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132
Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, Lyman GH (1997) Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Res Treat 44(2):135–143
Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, Costantino J, Redmond C, Fisher ER, Bowman DM, Deschenes L, Dimitrov NV, Margolese RG, Robidoux A, Shibata H, Terz J, Paterson AH, Feldman MI, Farrar W, Evans J, Lickley HL (1996) Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst 88(21):1529–1542
Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B (1999) Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol 17(9):2659–2669
Powles T, Eeles R, Ashley S, Easton D, Chang J, Dowsett M, Tidy A, Viggers J, Davey J (1998) Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 352(9122):98–101
Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Howell A, Sahmoud T (2003) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses. Cancer 98(9):1802–1810
Francini G, Petrioli R, Montagnani A, Cadirni A, Campagna S, Francini E, Gonnelli S (2006) Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer 95(2):153–158
Cuzick J (2008) IBIS II: a breast cancer prevention trial in postmenopausal women using the aromatase inhibitor anastrozole. Expert Rev Anticancer Ther 8(9):1377–1385
Cuzick J (2008) Chemoprevention of breast cancer. Breast Cancer 15(1):10–16
Fallowfield L (2008) There’s many a slip twixt cup and lip: adherence issues in cancer therapy. Nat Clin Pract Oncol 5(3):118–119
Vrieling A, Buck K, Kaaks R, Chang-Claude J (2010) Adult weight gain in relation to breast cancer risk by estrogen and progesterone receptor status: a meta-analysis. Breast Cancer Res Treat 123(3):641–649
Vance V, Mourtzakis M, McCargar L, Hanning R (2010) Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev 12(4): 282–294
Cuzick J, Forbes J, Edwards R, Baum M, Cawthorn S, Coates A, Hamed A, Howell A, Powles T (2002) First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 360(9336):817–824
Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, Sahmoud T (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359(9324):2131–2139
Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M (2008) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 9(1):45–53
Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365(9453):60–62
Powles TJ, Ashley S, Tidy VA, Smith IE, Dowsett M (2006) 20 year follow-up of the Royal Marsden tamoxifen breast cancer prevention trials. In: San Antonio Breast Cancer Symposium. San Antonio
Levine EG, Raczynski JM, Carpenter JT (1991) Weight gain with breast cancer adjuvant treatment. Cancer 67(7):1954–1959
Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, Brazel S, Gao J, Miller A (1998) Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat 48(1):53–64
Knobf MT (1986) Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. J Clin Oncol 4(5):678–684
DeGeorge D, Gray JJ, Fetting JH, Rolls BJ (1990) Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncol Nurs Forum 17(3 Suppl):23–28 discussion 28-30
Winningham ML, Nail LM, Burke MB, Brophy L, Cimprich B, Jones LS, Pickard-Holley S, Rhodes V, St Pierre B, Beck S et al (1994) Fatigue and the cancer experience: the state of the knowledge. Oncol Nurs Forum 21(1):23–36
Svendsen OL, Hassager C, Christiansen C (1995) Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry. Metabolism 44(3):369–373
Wing RR (1992) Obesity and weight gain during adulthood: a health problem for United States women. Womens Health Issues 2(2):114–120 discussion 120-2
Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga PL (1991) Weight gain at the time of menopause. Arch Intern Med 151(1):97–102
Beaver ME, Matheny KE, Roberts DB, Myers JN (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125(6):645–648
Nourissat A, Bairati I, Samson E, Fortin A, Gelinas M, Nabid A, Brochet F, Tetu B, Meyer F (2010) Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer. Cancer 116(9):2275–2283
Langius JA, Doornaert P, Spreeuwenberg MD, Langendijk JA, Leemans CR, Schueren MA (2010) Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiother Oncol 97(1):80–85
Kulkarni SK, Kaur G (2001) Pharmacodynamics of drug-induced weight gain. Drugs Today (Barc) 37(8):559–571
Hauber AB, Mohamed AF, Johnson FR, Falvey H (2009) Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents. Diabet Med 26(4):416–424
Harvie M, Howell T (2005) Need for weight management among postmenopausal early breast cancer patients receiving adjuvant endocrine therapy. Womens Health (Lond Engl) 1(2):205–222
Acknowledgments
This analysis was supported by the Cancer Research UK and AstraZeneca.
Conflict of interest
Ivana Sestak, Michelle Harvie and Anthony Howell have no conflict of interest to declare. Jack Cuzick received research funding from AstraZeneca. John F. Forbes received honoraria from AstraZeneca and Novartis. Mitch Dowsett received consultancy fees, honoraria, research funding and expert testimony from AstraZeneca.
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Sestak, I., Harvie, M., Howell, A. et al. Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat 134, 727–734 (2012). https://doi.org/10.1007/s10549-012-2085-6
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DOI: https://doi.org/10.1007/s10549-012-2085-6