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Impact of obesity on clinical outcomes in hormone receptor-positive breast cancer: a systematic review

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Abstract

Background

The relationship between obesity and prognosis of early breast cancer is complex. Increased levels of aromatase present in adipose tissue of obese postmenopausal women may lead to suboptimal suppression of systemic estrogens. However, studies have been mixed with respect to the association between use of aromatase inhibitors (AIs) and clinical outcomes in obese women with early breast cancer.

Methods

We conducted a systematic literature review following PRISMA guidelines to examine the impact of obesity on the efficacy of AIs in early-stage hormone receptor-positive breast cancer. Primary outcome measures included disease-free survival, relapse-free survival, distant recurrence-free survival, breast cancer-free survival, and overall survival.

Results

Of 491 studies identified, eight studies met criteria for inclusion: three retrospective cohort studies, one prospective cohort study and four randomized controlled trials. Four studies limited eligibility to postmenopausal women. Percentage of obese patients in studies ranged from 10 to 30%. Two studies examined use of AIs alone while the remainder included patients treated with either AIs or tamoxifen. Five out of seven studies suggested a negative impact of obesity on AI efficacy.

Conclusions

The results of our systematic review highlight a need for further research exploring the optimal endocrine therapies for obese women. There is insufficient evidence at present to recommend tailoring adjuvant endocrine therapy with use of specific AIs or for dosing modifications of AIs in this patient population.

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Abbreviations

AI:

Aromatase inhibitor

BMI:

Body mass index

DFS:

Disease-free survival

RFS:

Relapse-free survival

DFRS:

Distant recurrence-free survival

BCFS:

Breast cancer-free survival

OS:

Overall survival

ER:

Estrogen receptor

HR:

Hormone receptor

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Funding

No external funding received for this study.

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Authors and Affiliations

  1. University of Toronto, Toronto, ON, Canada

    Melika Shirdarreh

  2. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Rossanna C. Pezo

  3. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Rossanna C. Pezo

  4. Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3N5, Canada

    Rossanna C. Pezo

Authors
  1. Melika Shirdarreh
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  2. Rossanna C. Pezo
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Correspondence to Rossanna C. Pezo.

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Conflict of interest

RCP reports receipt of speaker honoraria from Pfizer and Novartis, research funding from Merck and serves on advisory boards for Astra Zeneca, Exact Sciences, Myriad Genetics, Lilly, Pfizer and Novartis, all outside the submitted work. MS reports no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Shirdarreh, M., Pezo, R.C. Impact of obesity on clinical outcomes in hormone receptor-positive breast cancer: a systematic review. Breast Cancer 28, 755–764 (2021). https://doi.org/10.1007/s12282-020-01213-w

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  • DOI: https://doi.org/10.1007/s12282-020-01213-w

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