Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study

Changes in breast cancer staging trends among Egyptian women after COVID-19: A retrospective single-center study

OBJECTIVES

Since being declared a global pandemic, the SARS-CoV-2 virus had a significant impact on the entire globe. The pandemic has placed a heavy burden on healthcare systems worldwide, and cancer patients are particularly prone. Despite the fact that initial international reports suggest delays in breast cancer (BC) diagnosis and screening programs, the Egyptian context requires additional research on this topic. To examine whether COVID-19 has changed the pattern of disease presentation before and after the pandemic, focusing on the tumor, node, and metastasis (TNM) staging of the disease at the initial presentation.

METHODS

This single-center, retrospective study of female BC patients initially diagnosed at Baheya Foundation was conducted during the following time frames: from Jan 2019 to Jan 2020 (Pre COVID-19 cohort) and from Mar 2020 to Mar 2021 (post-COVID-19 cohort). We compared the two cohorts in terms of clinical characteristics, tumor characteristics, and the number of days from presentation to treatment. Our primary endpoint was the difference in the TNM stage of BC at the initial presentation.

RESULTS

This analysis included 710 BC patients, 350 from the pre-COVID cohort and 360 from the post-COVID group. We detected a 27.9% increase in late-stage BC (stages III-IV) in the post-pandemic cohort compared to the pre-pandemic (60.1% vs. 47%, p < 0.001). The time from diagnosis to commencement of treatment was significantly longer (28.34 ± 18.845 vs 36.04 ± 23.641 days, p < 0.001) in the post-COVID cohort (mean difference = 7.702, 95% CI 4.54-10.85, p < 0.001). A higher percentage of patients in the post-pandemic cohort received systemic neoadjuvant therapy (p-value for Exact's test for all treatment options = 0.001).

CONCLUSIONS

The number of patients requiring systemic neoadjuvant chemotherapy increased dramatically in the post-pandemic group with advanced stages of BC at presentation. This study highlights the need for proper management of cancer patients during any future pandemic.

Probiotics for the Treatment of Docetaxel-Related Weight Gain of Breast Cancer Patients-A Single-Center, Randomized, Double-Blind, and Placebo-Controlled Trial

Background: Docetaxel is an important chemotherapy-agent for breast cancer treatment. One of its side-effects is weight gain, which increases the all-cause mortality rate. Considering gut microbiota is one important factor for weight regulation, we hypothesized that probiotics could be potentially used to reduce the docetaxel-related weight gain in breast cancer patients. Methods: From 10/8/2018 to 10/17/2019, 100 breast cancer (Stage I-III) patients underwent four cycles of docetaxel-based chemotherapy were enrolled and randomly assigned to receive probiotics (Bifidobacterium longum, Lactobacillus acidophilus, and Enterococcus faecalis) or placebo (supplementary material of the probiotics capsule) treatment for 84 days with three capsules per time, twice/day. The primary outcome: the changes in body weight and body-fat percentage of the patients were measured by a designated physician using a fat analyzer, and the secondary outcomes: the fasting insulin, plasma glucose, and lipids were directly obtained from the Hospital Information System (HIS); The metabolites were measured using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS); The fecal microbiome was analyzed using bacterial 16S ribosomal RNA (rRNA) gene sequence. All indicators were measured 1 day before the first cycle of docetaxel-based chemotherapy and 21 days after the last cycle of docetaxel-based chemotherapy. Results: Compared with the placebo group, the probiotic group showed significantly smaller changes in body weight (Mean [SD] 0.77 [2.58] vs. 2.70 [3.08], P = 0.03), body-fat percentage (Mean [SD] 0.04 [1.14] vs. 3.86 [11.09], P = 0.02), and low density lipoprotein (LDL) (Mean [SD]-0.05[0.68] vs. 0.39 [0.58], P = 0.002). Moreover, five of the 340 detected plasma metabolites showed significant differences between the two groups. The change of biliverdin dihydrochloride (B = -0.724, P = 0.02) was inverse correlated with weight gain. One strain of the phylum and three strains of the genus were detected to be significantly different between the two groups. Also, the changes of Bacteroides (B = -0.917, P < 0.001) and Anaerostipes (B = -0.894, P < 0.001) were inverse correlated with the change of LDL. Conclusions: Probiotics supplement during docetaxel-based chemotherapy for breast cancer treatment may help to reduce the increase in body weight, body-fat percentage, plasma LDL, and minimize the metabolic changes and gut dysbacteriosis. Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=24294, ChiCTR-INQ-17014181.

Effect of the Lifestyle, Exercise, and Nutrition (LEAN) Study on Long-Term Weight Loss Maintenance in Women with Breast Cancer

Lifestyle interventions among breast cancer survivors with obesity have demonstrated successful short-term weight loss, but data on long-term weight maintenance are limited. We evaluated long-term weight loss maintenance in 100 breast cancer survivors with overweight/obesity in the efficacious six-month Lifestyle, Exercise, and Nutrition (LEAN) Study (intervention = 67; usual care = 33). Measured baseline and six-month weights were available for 92 women. Long-term weight data were obtained from electronic health records. We assessed weight trajectories between study completion (2012-2013) and July 2019 using growth curve analyses. Over up to eight years (mean = 5.9, SD = 1.9) of post-intervention follow-up, both the intervention (n = 60) and usual care (n = 32) groups declined in body weight. Controlling for body weight at study completion, the yearly weight loss rate in the intervention and usual care groups was -0.20 kg (-0.2%/year) (95% CI: 0.06, 0.33, p = 0.004) and -0.32 kg (-0.4%/year) (95% CI: 0.12, 0.53, p = 0.002), respectively; mean weight change did not differ between groups (p = 0.31). It was encouraging that both groups maintained their original intervention period weight loss (6% intervention, 2% usual care) and had modest weight loss during long-term follow-up. Breast cancer survivors in the LEAN Study, regardless of randomization, avoided long-term weight gain following study completion.

Weight Gain during Neoadjuvant Chemotherapy is Associated with Worse Outcome among the Patients with Operable Breast Cancer

Purpose

This study was aimed at identifying the influence of initial weight and weight change during neoadjuvant chemotherapy (NAC) on pathologic complete response (pCR) and long-term survival in Chinese patients with operable breast cancer.

Methods

We conducted a retrospective study using data from 409 female patients who received NAC for stage II or III breast cancer and had complete record of body mass index (BMI) before and after NAC. BMI of < 25 kg/m² was categorized as normal weight/underweight (NW/UW); 25.0–29.9 kg/m² was categorized as overweight (OW); ≥30 kg/m² was categorized as obese (OB). BMI change was defined as the difference in BMI between day 1 of the first cycle of NAC and the day before surgery. A BMI gain or loss of > 2 kg/m² following NAC was considered to be significant, else was considered stable. The study end points included pCR rates, disease-free survival (DFS), and overall survival (OS).

Results

The median follow-up time was 43.2 (8.9–93.6) months. The average BMI was 23.40 ± 3.04 kg/m² before NAC and 23.66 ± 3.02 kg/m² after NAC (t = −3.604, p < 0.001). The pCR rate was 25.3% in the NW/UW group and 24.1% in the OW/OB group (p = 0.811), and was similar between the BMI-gain (23.3%) and the BMI-stable/loss (25.1%) groups (p = 0.787). Initial BMI was an independent prognostic factor for DFS (hazard ratio, 1.69; 95% confidence interval [CI], 1.13–2.53; p = 0.011) but not for OS, while BMI-gain was an independent prognostic factor for both DFS (hazard ratio, 2.09; 95% CI, 1.28–3.42; p = 0.003) and OS (hazard ratio, 1.97; 95% CI, 1.04–3.74; p = 0.039).

Conclusion

BMI increased after NAC in Chinese breast cancer patients. Initial BMI and BMI change during NAC were not associated with pCR but were reversely associated with survival.

The relationship between body mass index changes during chemotherapy and prognosis of patients with advanced colorectal cancer: A retrospective cohort study

We investigated the relationships between body mass index change (ΔBMI) and prognoses and clinical effects of patients with advanced colorectal cancer (CRC).From January 2008 to December 2012, 224patients with stage IV CRC were diagnosed in our hospital, and their clinical and pathological data were collected for this retrospective study. These patients were divided into lowΔ BMI group (ΔBMI ≤-0.45 kg/m) and high ΔBMI (ΔBMI >-0.45 kg/m) group.After 2 cycles of chemotherapy, there were no significant differences between prediagnosis BMI, ΔBMI, and clinical effects (P = .196; P = .59).There was also no significant difference in median progression-free survival of the high ΔBMI and low ΔBMI groups (P = .530). The overall survival (OS) time of the high ΔBMI group was significantly longer than that of the low ΔBMI group (P = .002). Family history (P = .041), eastern cooperative oncology group performance status (ECOG PS) score (P = .001), ΔBMI (P = .023), and carcinoembryonic antigen, (P = 0.02) were independent predictive factors of OS rates in patients with CRC. The relative risk was 0.72-fold for patients with CRC patients with high ΔBMI levels, relative to those with lower ΔBMI levels.Our results demonstrate that ΔBMI decreases predict poor prognoses for patients with advanced CRC, and elevated ΔBMI was a predictive factor for high survival rate. Thus, ΔBMI appears to be an independent predictive factor of CRC survival rates.