1. Body Mass Index and Weight Change in Patients With HER2-Positive Early Breast Cancer: Exploratory Analysis of the ALTTO BIG 2-06 Trial
- Author
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Matteo Lambertini, Andrea Gombos, Christine Desmedt, Anna Manukyants, Christian Maurer, Larissa A. Korde, Alvaro Moreno-Aspitia, Noam Pondé, Samuel Martel, Amylou C. Dueck, Dominique Agbor-Tarh, Evandro de Azambuja, Serena Di Cosimo, Vicki Paterson, Martine Piccart, and Florentine Hilbers
- Subjects
medicine.medical_specialty ,business.industry ,Weight change ,Hazard ratio ,Overweight ,medicine.disease ,Obesity ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Weight loss ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,030212 general & internal medicine ,medicine.symptom ,Underweight ,business ,Weight gain ,Body mass index - Abstract
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, 2; normal weight, 18.5 to 2; overweight, ≥25 to 2; 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.
- Published
- 2021