The effect of obesity on pathological complete response and survival in breast cancer patients receiving uncapped doses of neoadjuvant anthracycline-taxane-based chemotherapy.
PURPOSE
The effect of obesity in breast cancer patients undergoing neoadjuvant chemotherapy (NAC) remains controversial. The aim of this study was to determine the obesity-related effect on pathological complete response (pCR) and survival in women receiving full uncapped doses of NAC.


METHODS
We retrospectively analyzed the data of all consecutive women who underwent anthracycline-taxane-based NAC for primary breast cancer between 2005 and 2015 at the Department of Obstetrics and Gynecology, Medical University of Vienna. Following the WHO criteria, women with a body mass index (BMI) ≥30 kg/m2 at baseline were considered obese, whereas those with a BMI <30 kg/m2 were considered non-obese. Those with dose reductions or dose capping were not eligible for study inclusion. Cox regression and logistic regression were performed. The Kaplan-Meier method was used to analyze disease-free, progression-free, and overall survival. The pCR served as the main outcome measure.


RESULTS
Among 120 women who received neoadjuvant epirubicin plus cyclophosphamide and docetaxel, 28 (23.3%) were obese and 92 (76.7%) were non-obese. In the multivariate logistic regression model that adjusted for potentially confounding variables, obesity had an independent positive predictive effect on pCR (OR 4.29, 95% CI, 1.42-13.91; p = 0.011), which was significant in the postmenopausal subgroup (OR 4.72, 95% CI, 1.47-15.84; p = 0.01). When comparing non-obese with obese women, we found that obese women experienced longer progression-free survival (HR 0.10, 95% CI, 8.448 × 10-4-0.81; p = 0.025).


CONCLUSIONS
Obese women receiving full uncapped doses of anthracycline-taxane-based NAC have increased pCR and favorable progression-free survival. This could result from increased dose intensity with increased efficacy and toxicity.
['Farr|Alex|A|', 'Stolz|Myriam|M|', 'Baumann|Lukas|L|', 'Bago-Horvath|Zsuzsanna|Z|', 'Oppolzer|Elisabeth|E|', 'Pfeiler|Georg|G|', 'Seifert|Michael|M|', 'Singer|Christian F|CF|']
D000328:Adult D000368:Aged D018943:Anthracyclines D000971:Antineoplastic Combined Chemotherapy Protocols D015992:Body Mass Index D001940:Breast D001943:Breast Neoplasms D001952:Bridged-Ring Compounds D017024:Chemotherapy, Adjuvant D003520:Cyclophosphamide D018572:Disease-Free Survival D000077143:Docetaxel D015251:Epirubicin D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008875:Middle Aged D020360:Neoadjuvant Therapy D009765:Obesity D012189:Retrospective Studies D043823:Taxoids D016896:Treatment Outcome
Obesity Pathological complete response Survival Breast cancer Chemotherapy Outcome