TY - JOUR
T1 - Body mass index and weight change in patients with HER2-positive early breast cancer: Exploratory analysis of the ALTTO BIG 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 - Funding Information:
Funding: Dr. Desmedt acknowledges support from the Fondation Cancer from Luxemburg. The ALTTO trial is funded by Novartis Pharmaceuticals.
Funding Information:
We thank all of the investigators affiliated with the ALTTO study group who contributed to the study. Dr. Martel acknowledges the support from the Société des Médecins de l’Université de Sherbrooke (SMUS) for a fellowship at the Institut Jules Bordet in Brussels, Belgium. Dr. Lambertini acknowledges the support from ESMO for a Translational Research Fellowship at the Institut Jules Bordet in Brussels, Belgium. Dr. Di Cosimo is the recipient of the IG 20774 grant form Fondazione Associazione Italiana Ricerca sul Cancro.
Publisher Copyright:
© 2021 Harborside Press. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., 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
VL - 19
SP - 181
EP - 189
JO - Journal of the National Comprehensive Cancer Network : JNCCN
JF - Journal of the National Comprehensive Cancer Network : JNCCN
SN - 1540-1405
IS - 2
ER -