Journal article
Effect of Body Mass Index- and Actual Weight-Based Neoadjuvant Chemotherapy Doses on Pathologic Complete Response in Operable Breast Cancer
Clinical breast cancer, Vol.16(6), pp.480-486
12/01/2016
DOI: 10.1016/j.clbc.2016.06.008
PMCID: PMC5801768
PMID: 27431461
Abstract
The effect of body mass index (BMI) on pathologic complete response (pCR) accounting for neoadjuvant chemotherapy (NAC) dose reductions remains undefined. In 171 patients with operable breast cancer who received NAC, those with a BMI of >= 25 were less likely to tolerate uncapped taxane doses. Any chemotherapy dose reduction resulted in greater odds of not attaining a pCR in obese patients, independent of known predictors.
Introduction: The effect of body mass index (BMI) and chemotherapy dose reduction on pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for locoregional breast cancer remains unclear. Contemporary studies have reported largely on trial populations and used dose-capping. Patients and Methods: Patient registries at the University of Iowa were queried to identify patients with operable breast cancer who received NAC. Dose reductions were calculated for taxanes (T), anthracyclines (A) and non A-T chemotherapy. Clinical-pathologic characteristics, chemotherapy dose reductions, and adverse events were compared between normal (BMI <25) and overweight/obese patients (BMI >= 25),. Additionally, the synergistic effect of BMI and chemotherapy dose reduction on pCR was assessed. Results: Of 171 eligible patients, 112 were overweight/obese. Chemotherapy dosing was capped in 2 patients; all others initiated full weight-based treatment. Overweight/obese patients required more frequent taxane (44.6% vs. 25.4%; P =.01) and any chemotherapy dose reductions (50.9% vs. 33.9%; P =.03). pCR was attained in 29.2% of patients. In a multivariable model, the interaction term for BMI as a continuous variable and any chemotherapy dose reduction was significant independent of the clinical stage and tumor receptor status (P =.04). For obese patients, any chemotherapy dose reduction was significantly associated with increased odds of not attaining pCR. Conclusion: During NAC, overweight/obese patients more often have chemotherapy dose reductions. Chemotherapy dose reduction in obese patients was a powerful predictor of not attaining pCR. This was not seen for normal or overweight patients. Opportunities might exist to improve pCR rates in this higher-risk group. (C) 2016 Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- Effect of Body Mass Index- and Actual Weight-Based Neoadjuvant Chemotherapy Doses on Pathologic Complete Response in Operable Breast Cancer
- Creators
- Rachna Raman - University of IowaSarah L. Mott - University of IowaMary C. Schroeder - University of IowaSneha Phadke - University of IowaJad El Masri - University of IowaAlexandra Thomas - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Clinical breast cancer, Vol.16(6), pp.480-486
- DOI
- 10.1016/j.clbc.2016.06.008
- PMID
- 27431461
- PMCID
- PMC5801768
- NLM abbreviation
- Clin Breast Cancer
- ISSN
- 1526-8209
- eISSN
- 1938-0666
- Publisher
- Cig Media Group, Lp
- Number of pages
- 7
- Grant note
- U54TR001356 / Institute for Clinical and Translational Science at the University of Iowa (CTSA) Program P30-CA86862 / Holden Comprehensive Cancer Center's National Cancer Institute Cancer Center Support Grant
- Language
- English
- Date published
- 12/01/2016
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984359702202771
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