Sara H. Javid, L. Christine Fang, Larissa Korde and Benjamin O. Anderson
Samuel Martel, Matteo Lambertini, Dominique Agbor-Tarh, Noam F. Ponde, Andrea Gombos, Vicki Paterson, Florentine Hilbers, Larissa Korde, Anna Manukyants, Amylou Dueck, Christian Maurer, Martine Piccart, Alvaro Moreno-Aspitia, Christine Desmedt, Serena Di Cosimo and Evandro de Azambuja
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.
Therese B. Bevers, John H. Ward, Banu K. Arun, Graham A. Colditz, Kenneth H. Cowan, Mary B. Daly, Judy E. Garber, Mary L. Gemignani, William J. Gradishar, Judith A. Jordan, Larissa A. Korde, Nicole Kounalakis, Helen Krontiras, Shicha Kumar, Allison Kurian, Christine Laronga, Rachel M. Layman, Loretta S. Loftus, Martin C. Mahoney, Sofia D. Merajver, Ingrid M. Meszoely, Joanne Mortimer, Lisa Newman, Elizabeth Pritchard, Sandhya Pruthi, Victoria Seewaldt, Michelle C. Specht, Kala Visvanathan, Anne Wallace, Mary Ann Bergman and Rashmi Kumar
Breast cancer is the most frequently diagnosed malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. To assist women who are at increased risk of developing breast cancer and their physicians in the application of individualized strategies to reduce breast cancer risk, NCCN has developed these guidelines for breast cancer risk reduction.