Effect of body mass index on response to neo-adjuvant therapy in HER2-positive breast cancer: an exploratory analysis of the NeoALTTO trial

Medientyp: E-Artikel
Titel: Effect of body mass index on response to neo-adjuvant therapy in HER2-positive breast cancer: an exploratory analysis of the NeoALTTO trial
Beteiligte: Di Cosimo, Serena; Porcu, Luca; Agbor-tarh, Dominique; Cinieri, Saverio; Franzoi, Maria Alice; De Santis, Maria Carmen; Saura, Cristina; Huober, Jens; Fumagalli, Debora; Izquierdo, Miguel; Piccart, Martine; Daidone, Maria Grazia; de Azambuja, Evandro
Erschienen: Springer Science and Business Media LLC, 2020
Erschienen in: Breast Cancer Research
Sprache: Englisch
DOI: 10.1186/s13058-020-01356-w
ISSN: 1465-542X
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Obesity is a risk factor for breast cancer (BC) development, recurrence, and death. In view of this, we aimed to investigate the clinical value of obesity in BC patients treated with anti-HER2 therapies in the NeoALTTO trial, which randomized 455 patients to neo-adjuvant lapatinib, trastuzumab, or their combination plus paclitaxel.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients were classified according to their basal body mass index (BMI) into underweight (< 18.5 kg/m<jats:sup>2</jats:sup>), normal (≥ 18.5; < 25 kg/m<jats:sup>2</jats:sup>), overweight (≥ 25; < 30 kg/m<jats:sup>2</jats:sup>), and obese (≥ 30 kg/m<jats:sup>2</jats:sup>) WHO categories. Univariate and multivariate logistic regression analyses were performed using BMI as a categorical variable. Pathological complete response (pCR) and event-free survival (EFS) were the NeoALTTO primary and secondary outcomes, respectively.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among 454 patients analyzed, 14 (3%), 220 (48%), 137 (30%), and 83 (18%) were classified as underweight, normal weight, overweight, and obese, respectively; 231 (51%) and 223 (49%) had hormone receptor (HR)-positive and HR-negative primary tumors; 160 (35%) achieved pCR. In the overall patient population, no association was found between BMI groups and pCR, as we reported pCR rates of 57.1%, 35%, 30.7%, and 39.8% in underweight, normal weight, overweight, and obese cases, respectively. In contrast, in HR-positive tumors, overweight or obesity was generally associated with decreased likelihood of achieving a pCR independently of other clinical variables, including planned surgery, nodal status, and tumor size (odds ratio [OR] = 0.55, 95%CI 0.30–1.01, as compared to normal or underweight; <jats:italic>p</jats:italic> = 0.053); notably, no differential effect of BMI with respect to pCR was observed in HR-negative cases (odds ratio [OR] = 1.30, 95%CI 0.76–2.23, as compared to normal or underweight; <jats:italic>p</jats:italic> = 0.331), resulting in a statistically significant interaction between BMI and HR status (<jats:italic>p</jats:italic> = 0.036). There was no association between BMI and EFS neither in the overall nor in the HR-positive population, but this analysis was under-powered.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>NeoALTTO patients overweight or obese at baseline and with HR-positive primary BC appeared less likely to achieve pCR after neo-adjuvant anti-HER2 therapies. This finding paves the way to future research in targeting the interplay between HER2/HR signaling and metabolism.</jats:p> </jats:sec>
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