Body Mass Index and Its Association with Clinical Outcomes for Advanced Non-Small-Cell Lung Cancer Patients Enrolled on Eastern Cooperative Oncology Group Clinical Trials

• Type of Material: Article
• Authors: Suzanne E. Dahlberg, Dana Farber Cancer Institute; Joan H. Schiller, University of Texas Southwestern Medical Center; Philip B. Bonomi, Rush University; Alan B. Sandler, Oregon Health and Science University; Julie R. Brahmer, Johns Hopkins University; Suresh S Ramalingam, Emory University; David H. Johnson, University of Texas Southwestern Medical Center
• Language: English
• Date: 2013-09-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the International Association for the Study of Lung Cancer.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/JTO.0b013e31829cf942
• Title of Journal or Parent Work: Journal of Thoracic Oncology
• ISSN: 1556-0864
• Volume: 8
• Issue: 9
• Start Page: 1121
• End Page: 1127
• Grant/Funding Information: This study was coordinated by the Eastern Cooperative Oncology Group (Robert L. Comis, M.D., Chair); and supported in part by Public Health Service Grants CA23318, CA66636, CA21115, CA49957, CA21076, CA49883, CA16116; and from the National Cancer Institute, National Institutes of Health and the Department of Health and Human Services.
• Keywords: Phase III; US ADULTS; WEIGHT-LOSS; RISK; HAZARDS REGRESSION-MODEL; First-line therapy; Obesity; Science & Technology; Bevacizumab; Body mass index; Life Sciences & Biomedicine; Chemotherapy; Respiratory System; COHORT; EPIDEMIOLOGIC EVIDENCE; Advanced disease; MEN; MORTALITY; Weight; SURVIVAL; Oncology; OBESITY; Non-small-cell lung cancer
• Research Categories: Health Sciences, Oncology

Abstract

Introduction: Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. Methods: The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Results: Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. Conclusion: Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.