Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/932190

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Title
Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial
Author/Creator
Sestak, Ivana;  Distler, Wolfgang;  Forbes, John F.;  Dowsett, Mitch;  Howell, Anthony;  Cuzick, Jack
Institution
The University of Newcastle. Faculty of Health, School of Medicine and Public Health
Description
Purpose: Third-generation aromatase inhibitors have been widely used in postmenopausal women for the adjuvant treatment of hormone receptor–positive breast cancer. As aromatase inhibitors work by inhibiting the conversion of androgens to estrogens in adipose tissue, we hypothesized that anastrozole may be more effective in women with a high body mass index (BMI). Patients and Methods: The Arimidex, Tamoxifen Alone or in Combination (ATAC) study was a double-blind randomized clinical trial in which postmenopausal women with early-stage breast cancer were randomly assigned to receive oral daily anastrozole (1 mg) alone, tamoxifen (20 mg) alone, or the combination in a double-blind fashion. Analyses were based on the 100-month median follow-up for women with hormone receptor–positive breast cancers (estrogen [ER] and/or progesterone [PgR] positive). Here, we investigate the impact of BMI on recurrence and the relative benefit of anastrozole versus tamoxifen according to baseline BMI. Results: Overall, women with a high BMI (BMI > 35 kg/m2) at baseline had more recurrences than those women with a low BMI (BMI < 23 kg/m2; adjusted hazard ratio [HR], 1.39; 95% CI, 1.06 to 1.82; Pheterogeneity = .03) and significantly more distant recurrences (adjusted HR, 1.46; 95% CI, 1.07 to 1.61; Pheterogeneity = .01). Overall, the relative benefit of anastrozole versus tamoxifen was nonsignificantly better in thin women compared to overweight women. Conclusion: These results confirm the poorer prognosis of obese women with early-stage breast cancer. Recurrence rates were lower for anastrozole than tamoxifen for all BMI quintiles. Our results suggest that the relative efficacy of anastrozole compared to tamoxifen is greater in thin postmenopausal women and higher doses or more complete inhibitors might be more effective in overweight women, but this requires independent confirmation.
Relation
Journal of Clinical Oncology Vol. 28, Issue 21, p. 3411-3415
Publisher Link
http://dx.doi.org/10.1200/jco.2009.27.2021
Date
2010
Publisher
American Society of Clinical Oncology
Keyword(s)
body mass index (BMI);  aromatase inhibitors;  tamoxifen;  anastrozole;  women;  breast cancer
Resource Type
journal article
Identifier
http://hdl.handle.net/1959.13/932190
Identifier
ISSN:0732-183X
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Subject
"Journal of Clinical Oncology"
 
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