Clinicians often reduce chemotherapy doses when treating obese patients because of concerns about altered drug disposition and toxicity in this group. However, little data are available to lend support to this policy. In this study, Marco Colleoni (European Institute of Oncology, Italy) and colleagues have found that reducing the first course of chemotherapy for obese patients with oestrogen-receptor negative breast cancer can be detrimental.
The researchers assessed the relation between BMI, chemotherapy dose reduction, oestrogen receptor expression, and outcome for premenopausal women with breast cancer by reviewing data from four randomised trials. They found that a higher proportion of obese patients (97 of 249) received less than 85% of protocol specified dose during the first course of chemotherapy compared with patients with normal and intermediate BMI. For obese patients who had oestrogen-receptor negative disease, those who received 85% or more of the first course dose had significantly better disease-free survival and overall survival than those who received less than 85%. However, obese patients with oestrogen-receptor positive breast cancer who had reduced doses of chemotherapy did not have a significant difference in their outcome compared to those given the recommended chemotherapy doses. The researchers also found that obese patients initially treated with protocol doses of chemotherapy did not have more toxicity than patients who received reduced doses.
Dr Marco Colleoni concludes: "Our findings suggest that for women with ER-absent or ER-low tumours, reduction in chemotherapy dose should be avoided."
In an accompanying comment Lars Holmberg (University Hospital, Uppsala, Sweden) states: "As with all interesting scientific investigations, the report raises several stimulating questions…Why is there an interaction with hormone receptor status? Does obesity modify the response to chemotherapy within the oestrogen-receptor-negative subset?…The only way to know more is if scientists find new and ingenious ways to address the intriguing hypotheses raised by Gelber's data."
Contact: Dr Marco Colleoni, Division of Medical Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. T) +39 2 57 48 94 39 marco.colleoni@ieo.it
Comment: Professor Lars Holmberg, Regional Oncologic Centre, University Hospital S-751 85 Uppsala, Sweden. T) +46 18 15 19 10 lars.holmberg@lul.se
Notes to editors: *no receptors for the hormone oestrogen have been found on the breast cancer cells
Journal
The Lancet