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Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials.

ABSTRACT: Background:We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy. Methods:Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5 years; secondary objectives included BMI changes at 1 and 3 years; BMI changes on disease-specific survival (DSS) and overall survival (OS); and effects of baseline BMI. Stratified analyses included trial therapy and composite trial stratification factors. Results:In pre-/peri-/early post-menopausal chemotherapy trials (N?=?2793), baseline BMI did not impact any endpoint and increased BMI from baseline did not significantly affect BCFI (P?=?0.85) after 5 years although it was associated with worse BCFI (P?=?0.03) and DSS (P?=?0.07) after 1 year. BMI increase by 3 and 5 years was associated with better DSS (P?=?0.01; 0.01) and OS (P?=?0.003; 0.05). In pre-menopausal endocrine therapy trial MA.12 (N?=?672), patients with higher baseline BMI had worse BCFI (P?=?0.02) after 1 year, worse DSS (P?=?0.05; 0.004) after 1 and 5 years and worse OS (P?=?0.01) after 5 years. Increased BMI did not impact BCFI (P?=?0.90) after 5 years, although it was associated with worse BCFI (P?=?0.01) after 1 year. In post-menopausal endocrine therapy trials MA.14 and MA.27 (N?=?8236), baseline BMI did not significantly impact outcome for any endpoint. BMI change did not impact BCFI or DSS after 1 or 3 years, although a mean increased BMI of 0.3 was associated with better OS (P?=?0.02) after 1 year. With the administration of trastuzumab (N?=?1395) baseline BMI and BMI change did not significantly impact outcomes. Conclusions:Higher baseline BMI and BMI increases negatively affected outcomes only in pre-/peri-/early post-menopausal trial patients. Otherwise, BMI increases similar to those expected in healthy women either did not impact outcome or were associated with better outcomes. Clinical Trials numbers:CAN-NCIC-MA5; National Cancer Institute (NCI)-V90-0027; MA.12-NCT00002542; MA.14-NCT00002864; MA.21-NCT00014222; HERA, NCT00045032;CAN-NCIC-MA24; MA-27-NCT00066573.

SUBMITTER: Yerushalmi R

PROVIDER: S-EPMC5834037 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials.

Yerushalmi R R Dong B B Chapman J W JW Goss P E PE Pollak M N MN Burnell M J MJ Levine M N MN Bramwell V H C VHC Pritchard K I KI Whelan T J TJ Ingle J N JN Shepherd L E LE Parulekar W R WR Han L L Ding K K Gelmon K A KA

Annals of oncology : official journal of the European Society for Medical Oncology 20170701 7

<h4>Background</h4>We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy.<h4>Methods</h4>Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5 years; secondary objectives included BMI changes at 1 and 3 years; BMI ch ...[more]

PMID: 28379421

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Project description:ObjectiveCardiovascular disease is an underappreciated issue in prison medicine. Recent studies have revealed a higher prevalence of cardiovascular disease risk factors (CVDRFs) among individuals in prison, but the impact of incarceration on CVDRFs over time is not well understood. This review aimed to assess available literature and quantify the relationship between incarceration and trends in major CVDRFs in high-income countries.DesignSystematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-regression on weight change and obesity.Data sourcesMedline, Embase, PubMed, Cochrane Central Wiley and Web of Science.Eligibility criteria for selecting studiesLongitudinal studies reporting on the incidence of, or trends in any CVDRF among current or former people in prison over time, in high-income countries.Data extraction and synthesisTwo authors independently screened articles for eligibility, extracted data and assessed quality using an adapted version of the Newcastle-Ottawa Scale. Trends in CVDRFs during and following incarceration were summarised and in those with sufficient data a meta-regression was performed.ResultsTwenty-six articles were identified. CVDRFs assessed included obesity, hypertension, diabetes, dyslipidaemia, tobacco use, physical inactivity and unhealthy diet. A meta-regression on change in weight during incarceration found a mean increase of 5.3 kg (95% CI 0.5 to 10.1) and change in body mass index of 1.8 kg/m2 (95% CI -0.9 to 4.6) at 2 years. Weight gain appeared most pronounced right after entering prison and then plateaued at 2 years. Concerning hypertension, the results were inconclusive, despite a trend towards rising blood pressure or prevalence of hypertension during incarceration, and an increased incidence of hypertension following incarceration. Results are contradictory or inconclusive for the other CVDRFs reviewed.ConclusionPossible explanations for the association between incarceration and weight include a sedentary lifestyle, unhealthy diet, forced smoking cessation, psychotropic medication use and high levels of stress. Incarceration may be an independent risk factor for cardiovascular disease.

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Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials.

Publications

Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials.

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