Monitoring the responsiveness of T and antigen presenting cell compartments in breast cancer patients is useful to predict clinical tumor response to neoadjuvant chemotherapy

531 Background: Obesity in breast cancer patients is associated with increased risk of poor outcome. One possible mechanism is that obesity may affect metabolism of chemotherapeutic agents, influencing tumor response to chemotherapy. To test this hypothesis, we evaluated the relationship between body mass index (BMI, weight kg/height m2) and response to neoadjuvant chemotherapy in women diagnosed with operable breast cancer. Methods: From May 1990 - July 2004, 1169 patients diagnosed with invasive breast cancer at our institution, received neoadjuvant chemotherapy (anthracycline and/or taxane) followed by definitive surgery. Based on BMI, patients were categorized as obese (BMI ≥30), overweight (BMI 25 to <30), normal weight (18.5 to <25) and underweight (BMI <18.5). We used logistic regression to examine associations between BMI and pathologic response to therapy (complete= no invasive carcinoma, and partial) as well as tumor characteristics. Kaplan-Meier survival curves for BMI groups were compared using the log-rank test. Results: Median patient age was 50 (range 23 - 84) years; 30% were obese, 32% overweight, 36% normal weight and 1% underweight. BMI was not significantly associated with pathologic response to neoadjuvant chemotherapy even after adjusting for relevant clinical factors (OR 1.00; 95% CI 0.96–1.03, p = 0.8). Compared to patients not overweight, obese patients had higher odds of having ER negative tumors (OR 1.5; 95% CI 1.1–2.0; p = 0.01) and T3 or T4 lesions (OR 1.7; 95% CI 1.3–2.4, p < 0.001) adjusting for age, race and menopausal status. At a median follow up of 4.1 (range 0.2–14.3) years, obesity was significantly associated with poorer overall survival (p = 0.006) but not progression-free survival. Conclusions: Obese patients presented with more aggressive tumor characteristics and had worse overall survival compared to patients not overweight. However, BMI was not related to lower tumor response to anthracycline and/or taxane based neoadjuvant chemotherapy suggesting a role for other co-morbidities in influencing outcome. Understanding specific components through which overweight and obesity contribute to breast cancer outcome is essential to individualize and improve care of overweight/obese breast cancer patients. No significant financial relationships to disclose.

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Chemotherapy-induced amennorrhea: Predictive markers of response to neoadjuvant chemotherapy in breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.281 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 281-281

Author(s):

S. K. Ahn ◽

H. Moon ◽

E. Ko ◽

J. s. Kim ◽

J. M. You ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Tumor Response ◽

Locally Advanced Breast Cancer ◽

Univariate Analysis ◽

Locally Advanced ◽

Predictive Markers ◽

Breast Cancer Patients ◽

Response To Neoadjuvant Chemotherapy

281 Background: There is controversy about the benefit of chemotherapy-induced amenorrhea (CIA) in breast cancer. We investigated significance of CIA after neoadjuvant chemotherapy for predicting response to neoadjuvant chemotherapy in breast cancer patients. Methods: We reviewed the records of 198 premenopausal patients with breast cancer treated with neoadjuvant chemotherapy between January 2005 and December 2010. Chemotherapy-induced amenorrhea (CIA) was defined as serum FSH level ≥40 IU/L after completion of all scheduled neoadjuvant chemotherapy and prior to definitive surgery. Results: Among 198 breast cancer patients, 132 pts (66.7%) developed CIA after neoadjuvant chemotherapy. 156 pts (78%) underwent DA chemotherapy. The age of CIA patients was older than non-CIA patients (41.55±5.55 vs. 38.27± 6.86 years, p=0.001). The incidence of CIA after neoadjuvant chemotherapy was significantly higher in responder group (responder vs. nonresponder: 87 pts (74.4%) vs. 45 pts (55.6%); p=0.006). Additionally, FSH level after all scheduled neoadjuvant chemotherapy was significantly higher in responder group (FSH 56.41±32.41 mIU/ml vs. 45.76±30.31 mIU/ml; p=0.021). In univariate analysis, CIA (p=0.006) and total number of chemotherapy cycle regardless of chemotherapy regimen (p=0.04) were significantly predictive of tumor response. CIA was only significant predictive factor for tumor response after neoadjuvant chemotherapy on multivariate analysis (p=0.012). Conclusions: CIA is independent predictive markers of response to neoadjuvant chemotherapy in locally advanced breast cancer.

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Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.4527 ◽

2008 ◽

Vol 26 (25) ◽

pp. 4072-4077 ◽

Cited By ~ 106

Author(s):

Jennifer K. Litton ◽

Ana M. Gonzalez-Angulo ◽

Carla L. Warneke ◽

Aman U. Buzdar ◽

Shu-Wan Kau ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Pathologic Complete Response ◽

Operable Breast Cancer ◽

Obese Patients ◽

Breast Cancer Patients ◽

Significant Difference ◽

Response To Neoadjuvant Chemotherapy

Purpose To understand the mechanism through which obesity in breast cancer patients is associated with poorer outcome, we evaluated body mass index (BMI) and response to neoadjuvant chemotherapy (NC) in women with operable breast cancer. Patients and Methods From May 1990 to July 2004, 1,169 patients were diagnosed with invasive breast cancer at M. D. Anderson Cancer Center and received NC before surgery. Patients were categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI of 25 to < 30 kg/m2), or normal/underweight (BMI < 25 kg/m2). Logistic regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer–specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. All statistical tests were two-sided. Results Median age was 50 years; 30% of patients were obese, 32% were overweight, and 38% were normal or underweight. In multivariate analysis, there was no significant difference in pCR for obese compared with normal weight patients (odds ratio [OR] = 0.78; 95% CI, 0.49 to 1.26). Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (OR = 0.59; 95% CI, 0.37 to 0.95; and OR = 0.67; 95% CI, 0.45 to 0.99, respectively). Obese patients were more likely to have hormone-negative tumors (P < .01), stage III tumors (P < .01), and worse overall survival (P = .006) at a median follow-up time of 4.1 years. Conclusion Higher BMI was associated with worse pCR to NC. In addition, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.

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