Effect of Body Mass Index- and Actual Weight-Based Neoadjuvant Chemotherapy Doses on Pathologic Complete Response in Operable Breast Cancer

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• 作者：Rachna Raman¹ ; Sarah L. Mott² ; Mary C. Schroeder³ ; Sneha Phadke¹ ; Jad El Masri⁴ ; Alexandra Thomas¹ ; ^{alex-thomas@uiowa.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BMI ; Chemotherapy dosing ; Dose capping ; Neoadjuvant therapy ; pCR ; Taxane ; Weight-based dosing
• 刊名：Clinical Breast Cancer
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：16
• 期：6
• 页码：480-486
• 全文大小：430 K

文摘

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.