Body composition is associated with risk of toxicity-induced modifications of treatment in women with stage I–IIIB breast cancer receiving chemotherapy

• Published in: Breast cancer research and treatment Vol. 173; no. 2; pp. 475 - 481
• Main Authors: van den Berg, Maaike M. G. A., Kok, Dieuwertje E., Posthuma, Liesbeth, Kamps, Lisette, Kelfkens, Celine S., Buist, Nicole, Geenen, Maud, Haringhuizen, Annebeth, Heijns, Joan B., van Lieshout, Rianne H. M. A., Los, Maartje, Sommeijer, Dirkje W., Timmer-Bonte, Johanna N. H., de Kruif, Anja Th. C. M., van Laarhoven, Hanneke W. M., Kampman, Ellen, Winkels, Renate M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-01-2019; Springer; Springer Nature B.V
• Subjects: Body composition; Body fat; Body weight; Breast cancer; Cancer patients; Cancer research; Cancer therapies; Cancer treatment; Care and treatment; Chemotherapy; Epidemiology; Fat mass; Medical records; Medical research; Medical schools; Medicine; Medicine & Public Health; Oncology; Patients; Physiological aspects; Toxicity; Women; Chemotherapy; Breast cancer; Toxicity; Fat mass; Body composition
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-5014-5

Purpose
Initial dose of chemotherapy is planned based on body surface area, which does not take body composition into account. We studied the association between fat mass (kg and relative to total body weight) as well as lean mass (kg and relative to total body weight) and toxicity-induced modifications of treatment in breast cancer patients receiving chemotherapy.
Methods
In an observational study among 172 breast cancer patients (stage I–IIIB) in the Netherlands, we assessed body composition using dual-energy X-ray scans. Information on toxicity-induced modifications of treatment, defined as dose reductions, cycle delays, regimen switches, or premature termination of chemotherapy, was abstracted from medical records. Adjusted hazard ratios and 95% confidence intervals (95% CI) were calculated to assess associations between body composition and the risk of toxicity-induced modifications of treatment.
Results
In total, 95 out of 172 (55%) patients experienced toxicity-induced modifications of treatment. Higher absolute and relative fat mass were associated with higher risk of these modifications (HR 1.14 per 5 kg; 95% CI 1.04–1.25 and HR 1.21 per 5%; 95% CI 1.05–1.38, respectively). A higher relative lean mass was associated with a lower risk of modifications (HR 0.83 per 5%; 95% CI 0.72–0.96). There was no association between absolute lean mass and risk of toxicity-induced modifications of treatment.
Conclusions
A higher absolute and a higher relative fat mass was associated with an increased risk of toxicity-induced modifications of treatment. Absolute lean mass was not associated with risk of these treatment modifications, while higher relative lean mass associated with lower risk of modifications. These data suggest that total fat mass importantly determines the risk of toxicities during chemotherapy in breast cancer patients.