title: Effect of Body Mass Index- and Actual Weight-Based Neoadjuvant Chemotherapy Doses on Pathologic Complete Response in Operable Breast Cancer.
abstract: The effect of body mass index (BMI) and chemotherapy dose reduction on pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for locoregional breast cancer remains unclear. Contemporary studies have reported largely on trial populations and used dose-capping.
  
  
  
  Patient registries at the University of Iowa were queried to identify patients with operable breast cancer who received NAC. Dose reductions were calculated for taxanes (T), anthracyclines (A) and non-A-T chemotherapy. Clinical-pathologic characteristics, chemotherapy dose reductions, and adverse events were compared between normal (BMI <25) and overweight/obese patients (BMI ≥25). Additionally, the synergistic effect of BMI and chemotherapy dose reduction on pCR was assessed.
  
  
  
  Of 171 eligible patients, 112 were overweight/obese. Chemotherapy dosing was capped in 2 patients; all others initiated full weight-based treatment. Overweight/obese patients required more frequent taxane (44.6% vs. 25.4%; P = .01) and any chemotherapy dose reductions (50.9% vs. 33.9%; P = .03). pCR was attained in 29.2% of patients. In a multivariable model, the interaction term for BMI as a continuous variable and any chemotherapy dose reduction was significant independent of the clinical stage and tumor receptor status (P = .04). For obese patients, any chemotherapy dose reduction was significantly associated with increased odds of not attaining pCR.
  
  
  
  During NAC, overweight/obese patients more often have chemotherapy dose reductions. Chemotherapy dose reduction in obese patients was a powerful predictor of not attaining pCR. This was not seen for normal or overweight patients. Opportunities might exist to improve pCR rates in this higher-risk group.
authors.affiliation: Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA.
authors.forename: Rachna
authors.initials: R
authors.lastname: Raman
authors.affiliation: Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Mott
authors.affiliation: Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Schroeder
authors.affiliation: Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA.
authors.forename: Sneha
authors.initials: S
authors.lastname: Phadke
authors.affiliation: Department of Internal Medicine, University of Iowa, Iowa City, IA.
authors.forename: Jad
authors.initials: J
authors.lastname: El Masri
authors.affiliation: Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA. Electronic address: alex-thomas@uiowa.edu.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001706:Biopsy; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D043823:Taxoids
keywords: BMI; Chemotherapy dosing; Dose capping; Neoadjuvant therapy; Taxane; Weight-based dosing; pCR