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

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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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Conflict of interest

Jens-Uwe Blohmer: Consultant/Advisory role by ROCHE. Claus Hanusch: Consultant/Advisory role by NOVARTIS, AMGEN. All other authors have declared no conflicts of interest.

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Authors and Affiliations

  1. German Breast Group, Neu-Isenburg, Germany

    Caterina Fontanella, Bianca Lederer, Stephan Gade, Keyur Mehta, Valentina Nekljudova, Gunter von Minckwitz & Sibylle Loibl

  2. Department of Medical Oncology, University Hospital of Udine, Piazzala Santa Maria della Misericordia 14, 33100, Udine, UD, Italy

    Caterina Fontanella

  3. Department of Oncology, Catholic University of Leuven, Leuven, Belgium

    Mieke Vanoppen & Patrick Neven

  4. Department of Gynaecology and Obstetrics, St. Gertrauden-Hospital, Berlin, Germany

    Jens Uwe Blohmer

  5. Department of Gynaecology and Obstetrics, University Hospital, Magdeburg, Germany

    Serban Dan Costa

  6. Institute of Pathology, Charité Hospital, Berlin, Germany

    Carsten Denkert

  7. Department of Gynaecology and Obstetrics, University Hospital, Kiel, Germany

    Holger Eidtmann

  8. Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany

    Bernd Gerber

  9. Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, Munich, Germany

    Claus Hanusch

  10. Department of Gynaecology and Obstetrics, Eilenriede Klinik, Hannover, Germany

    Jörn Hilfrich

  11. Department of Gynaecology and Obstetrics, University Hospital, Ulm, Germany

    Jens Huober

  12. National Center for Tumor Diseases, University Hospital, Heidelberg, Germany

    Andreas Schneeweiss

  13. Department of Gynaecology and Obstetrics, University Hospital rechts der Isar, Munich, Germany

    Stefan Paepke

  14. Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach, Germany

    Christian Jackisch

  15. Department of Gynaecology and Obstetrics, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Michael Untch

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  1. Caterina Fontanella
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  2. Bianca Lederer
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  3. Stephan Gade
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  8. Holger Eidtmann
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  9. Bernd Gerber
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  15. Christian Jackisch
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  16. Keyur Mehta
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  17. Valentina Nekljudova
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  18. Michael Untch
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  19. Patrick Neven
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  20. Gunter von Minckwitz
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  21. Sibylle Loibl
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Correspondence to Sibylle Loibl.

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Fontanella, C., Lederer, B., Gade, S. et al. Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res Treat 150, 127–139 (2015). https://doi.org/10.1007/s10549-015-3287-5

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