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J Cell Physiol. 2020 Jan 15. doi: 10.1002/jcp.29445. [Epub ahead of print]

Impact of BMI on HER2+ metastatic breast cancer patients treated with pertuzumab and/or trastuzumab emtansine. Real-world evidence.

Author information

1
Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
2
Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
3
Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
4
Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
5
Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy.
6
Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy.
7
Medical Oncology, Sandro Pertini Hospital, Rome, Italy.
8
Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University, Chieti, Italy.
9
Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy.
10
Department of Oncology, University Campus Biomedico of Rome, Rome, Italy.
11
Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, UO Oncologia Medica I, S. Chiara Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
12
Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
13
Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.
14
Research Unit Phase I Trials and Oncology Unit, ASST Monza, Monza, Italy.
15
Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy.
16
Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy.
17
Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy.
18
University of Verona, Verona, Italy.
19
Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
20
Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Roma, Italy.
21
Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy.
22
Medical Oncology, "Santo Spirito" Hospital, Pescara, Italy.
23
Department of Hematology & Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
24
Oncology Unit, S. Maria Goretti Hospital, Latina, Italy.
25
Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy.
26
Department of Biotechnological and Applied Clinical Sciences, Medical Oncology, University of L'Aquila, L'Aquila, Italy.
27
Department of Systems Medicine, Medical Oncology, University of Rome "Tor Vergata", Rome, Italy.
28
Department of Human Pathology, Medical Oncology Unit A.O. Papardo, University of Messina, Messina, Italy.
29
Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
30
Oncology Clinic, Università Politecnica delle Marche, Ancona, Italy.
31
Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy.
32
Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy.
33
Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, Cuneo, Italy.
34
Department of Oncology, San Luca Hospital, Lucca, Italy.
35
Department of Clinical and Experimental Biomedical Sciences "Mario Serio," Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
36
Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy.
37
Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy.
38
Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy.
39
Department of "Sandro Pitigliani" Medical Oncology, Santo Stefano Hospital, Prato, Italy.
40
Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
41
Endocrinology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy.
42
Department of Bio-Statistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
43
Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, Pennsylvania.

Abstract

Body mass index (BMI) is a main indicator of obesity and its association with breast cancer is well established. However, little is known in the metastatic setting, especially in HER2-positive patients. We assessed the influence of BMI on clinical outcomes of patients treated with pertuzumab and/or trastuzumab emtansine (T-DM1) for HER2+ metastatic breast cancer (mBC). BMI was addressed as a categorical variable, being classified on the basis of the following ranges, that is, 18.5-24.9, 25-29.9, and 30.0-34.9, namely, normal weight, overweight, and Class I obesity. The outcomes chosen were progression-free survival to first-line chemotherapy (PFS1) and overall survival (OS). Overall (N = 709), no impact of BMI was observed on PFS1 (p = .15), while BMI ≥ 30 was associated with worse OS (p = .003). In subjects who progressed to first line (N = 575), analyzing data across PFS1 quartiles and strata of disease burden, BMI predicted lower PFS1 in patients within the I PFS1 quartile and with the lowest disease burden (p = .001). Univariate analysis showed a detrimental effect of BMI ≥ 30 on OS for women within the I PFS1 quartile (p = .03). Results were confirmed in multivariate analysis. According to PFS1 quartiles a higher percentage of patients with high BMI and low disease burden progressed within 6 months of therapy. The effect of BMI on prognosis was also confirmed in multivariate analysis of OS for overall population. In our cohort, a BMI ≥ 30 correlated with worse OS in patients with HER2+ mBC who received pertuzumab and/or T-DM1 but had no impact on PFS to first line. BMI predicted worse I PFS1 quartile.

KEYWORDS:

HER2-positive metastatic breast cancer; body mass index; pertuzumab; trastuzumab emtansine

PMID:
31943171
DOI:
10.1002/jcp.29445

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