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Impact of body mass index on the efficacy of aromatase inhibitors in patients with metastatic breast cancer

  • Clinical trial
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Abstract

Purpose

Higher levels of estrogen in obese patients may lead to incomplete inhibition by aromatase inhibitors (AIs). The aim of this study was to determine the impact of body mass index (BMI) on efficacy of AIs in patients with metastatic hormone receptor (HR)-positive breast cancer (BC).

Methods

We performed a retrospective chart review of all female patients with metastatic HR-positive BC on an AI in first- or second-line settings and seen at our academic institution between 2001 and 2020. The primary endpoint was progression-free survival (PFS), defined as the time from start of AI to disease progression or death from any cause.

Results

We identified 219 patients who had received an AI in the first- or second-line settings for metastatic HR-positive BC and with documented information on BMI. Of the 219 patients, 56% (123) had a low BMI (defined as < 27 kg/m2) and 44% (96) had a high BMI (≥ 27 kg/m2). The median PFS was 21.9 months (95% CI 14.5 to 28.4) in the low BMI group versus 20.2 months (95% CI 14.3 to 27.5) in the high BMI group (p = 0.73).

Conclusion

While BMI influences efficacy of AIs in the adjuvant setting, our results suggest that in the metastatic setting, BMI may not impact the efficacy of AIs. This discrepancy could be due to other differences in disease characteristics that make complete aromatase inhibition more important in the adjuvant setting when disease burden is the lowest.

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Data availability

De-identified data will be stored until completion and publication of study. It is available from the corresponding author on reasonable request.

Code availability

R (version 4.0.3) was used for analysis. Custom code is available upon reasonable request.

Abbreviations

ABCSG:

Austrian Breast and Colorectal Cancer Study Group

AI:

Aromatase inhibitor

ATAC:

Arimidex, Tamoxifen Alone or in Combination

BMI:

Body mass index

BWEL:

Breast Cancer Weight Loss

CDK:

Cyclin-dependent kinase

EMR:

Electronic medical record

ER:

Estrogen receptor

HER-2:

Human epidermal growth factor receptor 2

HR:

Hormone receptor

PFS:

Progression-free survival

PR:

Progesterone receptor

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Funding

No funding was used for this study.

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Author notes

  1. Rima Patel and Zhiqiang Li are co-first authors.

Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029-6574, USA

    Rima Patel, Brittney S. Zimmerman, William K. Oh & Amy Tiersten

  2. Sema4, Stamford, CT, USA

    Zhiqiang Li, Marc Y. Fink, Jason D. Wells, Xiang Zhou, Kristin Ayers, Arielle Redfern, Scott Newman, Eric Schadt, William K. Oh & Rong Chen

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  1. Rima Patel
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Corresponding authors

Correspondence to Rima Patel, Rong Chen or Amy Tiersten.

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Conflict of interest

R.P., B.S.Z., and A.T. report no conflicts of interest. Z.L., M.Y.F., J.D.W., X.Z., and A.R. report being employees of Sema4. K.A., S.N., and R.C. report being employees of Sema4 and holding company stock/stock options. E.S. reports being Chief Executive Officer and board member for Sema4 and on the scientific advisory board for Berg Pharma. W.K.O. reports serving as a consultant to Astellas, Astra-Zeneca, Bayer, Janssen, Pfizer and Sanofi. He also serves as Chief Medical Science Officer for Sema4.

Ethical approval

This study was approved by the Institutional Review Board at the Mount Sinai Health System (STUDY-20-02162).

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Waiver for consent for this retrospective study was obtained from the Institutional Review Board at the Mount Sinai Health System.

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All authors have reviewed this version of the manuscript and provided consent for publication.

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Supplementary Information

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Supplementary file1 (DOC 115 kb)

10549_2021_6504_MOESM2_ESM.tiff

Supplementary file2 (TIFF 34124 kb) Supplementary Fig 1. Kaplan-Meier curves for progression-free survival according to BMI in first line AI subgroup. Median PFS and 95% CI for each group are shown on the top right. There was no statistically significant difference in PFS between patients in the two BMI groups with AI as the first line therapy (p = 0.44; two-sided log-rank test)

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Patel, R., Li, Z., Zimmerman, B.S. et al. Impact of body mass index on the efficacy of aromatase inhibitors in patients with metastatic breast cancer. Breast Cancer Res Treat 192, 313–319 (2022). https://doi.org/10.1007/s10549-021-06504-0

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  • DOI: https://doi.org/10.1007/s10549-021-06504-0

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