The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial

M Gnant, G Pfeiler, H Stöger, B Mlineritsch, F Fitzal, M Balic, W Kwasny, M Seifert, M Stierer, P Dubsky, R Greil, G Steger, H Samonigg, C Fesl, R Jakesz, M Gnant, G Pfeiler, H Stöger, B Mlineritsch, F Fitzal, M Balic, W Kwasny, M Seifert, M Stierer, P Dubsky, R Greil, G Steger, H Samonigg, C Fesl, R Jakesz

Abstract

Background: We investigated whether body mass index (BMI) can be used as a predictive parameter indicating patients who benefit from extended aromatase inhibitor (AI) treatment.

Methods: The ABCSG-6a trial re-randomised event-free postmenopausal hormone receptor-positive patients from the ABCSG-6 trial to receive either 3 additional years of endocrine therapy using anastrozole vs nil. In this retrospective analysis, we investigated the prognostic and predictive impact of BMI on disease outcome and safety.

Results: In all, 634 patients (177 normal weight, 307 overweight, and 150 obese) patients were included in this analysis. Normal weight patients with additional 3 years of anastrozole halved their risk of disease recurrence (disease-free survival (DFS) HR 0.48; P=0.02) and death (HR 0.45; P=0.06) and had only a fifth of the risk of distant metastases (HR 0.22; P=0.05) compared with normal weight patients without any further treatment. In contrast, overweight+obese patients derived no benefit from additional 3 years of anastrozole (DFS HR 0.93; P=0.68; distant recurrence-free survival HR 0.91; P=0.78; and OS HR 0.9; P=0.68). The possible predictive impact of BMI on extended endocrine treatment could be strengthened by a Cox regression interaction model between BMI and treatment (P=0.07).

Conclusion: Body mass index may be used to predict outcome benefit of extended AI treatment in patients with receptor-positive breast cancer.

Trial registration: ClinicalTrials.gov NCT00300508.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
(A) DFS: Anastrozole vs Control, normal weight patients and (B) OS: Anastrozole vs Control, normal weight patients.
Figure 3
Figure 3
(A) DFS: Anastrozole vs Control, overweight+obese patients and (B) OS: Anastrozole vs Control, overweight+obese patients.

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