title: The effect of obesity on pathological complete response and survival in breast cancer patients receiving uncapped doses of neoadjuvant anthracycline-taxane-based chemotherapy.
abstract: OBJECTIVE
  The effect of obesity in breast cancer patients undergoing neoadjuvant chemotherapy (NAC) remains controversial. The aim of this study was to determine the obesity-related effect on pathological complete response (pCR) and survival in women receiving full uncapped doses of NAC.
  
  
  METHODS
  We retrospectively analyzed the data of all consecutive women who underwent anthracycline-taxane-based NAC for primary breast cancer between 2005 and 2015 at the Department of Obstetrics and Gynecology, Medical University of Vienna. Following the WHO criteria, women with a body mass index (BMI) ≥30 kg/m2at baseline were considered obese, whereas those with a BMI <30 kg/m2were considered non-obese. Those with dose reductions or dose capping were not eligible for study inclusion. Cox regression and logistic regression were performed. The Kaplan-Meier method was used to analyze disease-free, progression-free, and overall survival. The pCR served as the main outcome measure.
  
  
  RESULTS
  Among 120 women who received neoadjuvant epirubicin plus cyclophosphamide and docetaxel, 28 (23.3%) were obese and 92 (76.7%) were non-obese. In the multivariate logistic regression model that adjusted for potentially confounding variables, obesity had an independent positive predictive effect on pCR (OR 4.29, 95% CI, 1.42-13.91; p = 0.011), which was significant in the postmenopausal subgroup (OR 4.72, 95% CI, 1.47-15.84; p = 0.01). When comparing non-obese with obese women, we found that obese women experienced longer progression-free survival (HR 0.10, 95% CI, 8.448 × 10-4-0.81; p = 0.025).
  
  
  CONCLUSIONS
  Obese women receiving full uncapped doses of anthracycline-taxane-based NAC have increased pCR and favorable progression-free survival. This could result from increased dose intensity with increased efficacy and toxicity.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria. Electronic address: alex.farr@meduniwien.ac.at.
authors.forename: Alex
authors.initials: A
authors.lastname: Farr
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Myriam
authors.initials: M
authors.lastname: Stolz
authors.affiliation: Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Baumann
authors.affiliation: Clinical Institute for Pathology, Medical University of Vienna, Vienna, Austria.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Bago-Horvath
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Oppolzer
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Pfeiler
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Seifert
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Breast Health Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Singer
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015992:Body Mass Index; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D001952:Bridged-Ring Compounds / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D043823:Taxoids; D000077143:Docetaxel; C080625:taxane; D015251:Epirubicin; D003520:Cyclophosphamide
keywords: Breast cancer; Chemotherapy; Obesity; Outcome; Pathological complete response; Survival