title: Association of BMI with overall survival in patients with mCRC who received chemotherapy versus EGFR and VEGF-targeted therapies.
abstract: Although a raised body mass index (BMI) is associated with increased risk of colorectal cancer (CRC) and recurrence after adjuvant treatment, data in the metastatic setting is limited. We compared overall survival (OS) across BMI groups for metastatic CRC, and specifically examined the effect of BMI within the group of patients treated with targeted therapies (TT). Retrospective data were obtained from the South Australian Registry for mCRC from February 2006 to October 2012. The BMI at first treatment was grouped as underweight <18.5 kg/m(2) , Normal = 18.5 to <25 kg/m(2) , Overweight = 25 to <30 kg/m(2) , Obese I = 30 to <35 kg/m(2) , Obese II ≥35 kg/m(2) . Of 1174 patients, 42 were underweight, 462 overweight, 175 Obese I, and 77 Obese II. The OS was shorter for patients who were underweight and overweight compared to normal (OS 13.7 and 22.3 vs. 24.1 months, respectively, hazard ratio [HR] 2.21 and 1.23). The adjusted median OS was longer for normal versus overweight or obese I patients receiving chemotherapy + targeted therapy (35.7 vs 25.1 or 22.8 months, HR 1.59 and 1.63, respectively) with no difference in OS for chemotherapy alone. On breakdown by type of targeted therapy, overweight and obese I patients had a poorer outcome with Bevacizumab. The BMI is predictive of a poorer outcome for underweight and overweight patients in the whole population. Of those receiving chemotherapy and targeted therapy, BMI is an independent predictor for OS for overweight and obese I patients, specifically for those treated with Bevacizumab. Patients who are overweight or obese (group I) may be a target group for lifestyle and nutrition advice to improve OS with TT.
authors.affiliation: Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Gargi S
authors.initials: GS
authors.lastname: Patel
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Shahid
authors.initials: S
authors.lastname: Ullah
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Beeke
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Hakendorf
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.|Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-3922-2693
authors.initials: R
authors.lastname: Padbury
authors.affiliation: Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.|School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
authors.affiliation: Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.|Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013851:Thinness / Q000453:epidemiology; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A; D066246:ErbB Receptors
keywords: BMI; Bevacizumab; colorectal cancer; metastatic; targeted therapies