Impact of taxanes on weight gain during neoadjuvant chemotherapy (Ctx) for breast cancer (BC)

Abstract

10606 Background: Weight gain after the diagnosis of BC has been associated with increased risk of recurrence and mortality. Previous studies have documented weight gain after cyclophosphamide, methotrexate, and 5-fluoruracil (CMF) and adriamycin and cyclophosphamide (AC) chemotherapy, but the impact of taxane chemotherapy has not been described. Methods: We reviewed the charts of 119 patients (pts) who completed neoadjuvant Ctx between 1997–2005. Age, baseline body mass index (BMI), tumor size, nodal status, hormone receptor status, menopausal status, co-morbid illnesses and anti-depressant use were collected. Weight was recorded at each Ctx visit and at follow-up visits for two years. Results: 22 pts received AC only. 97 pts received AC followed by a taxane - 58 docetaxel (D), 39 paclitaxel (P). Median f/u time was 26.3 months. 66/119 (55%) of pts gained weight during Ctx, with a median change of + 1 pound (range -28 to +19.5 pounds) at the end of Ctx. 49/119 (41%) of pts gained weight during AC and 76/97 (78%) of pts gained weight during the taxane. Mean weight change after AC was -1.8 pounds compared to +3.2 pounds after the taxane (p < 0.001). Age, baseline BMI, and menopausal status prior to Ctx did not predict weight gain. There was no difference in weight gain between pts who received D vs. P (p = 0.19). 8/22 (36%) patients who received AC alone recurred, and 13/95 (14%) who received both AC and T recurred; however this was not statistically significant (p = 0.23). Total weight change during neoadjuvant Ctx did not predict recurrence; however weight gain during the AC portion was associated with a higher risk of recurrence when adjusted for weight gain during taxane Ctx (p = 0.035, Cox regression). Each one pound gained was associated with an 11% increase in risk of recurrence. Conclusions: Weight gain is common during neoadjuvant Ctx for BC, particulary during treatment with taxanes. Further follow up is required to establish if weight gain is maintained over time and to determine the impact of weight change on BC outcomes and health. No significant financial relationships to disclose.

Weight Changes in Women Receiving Chemotherapy for Non-Metastatic Breast Cancer in Saudi Arabia

“…Furthermore, a higher number of taxane-based chemotherapy cycles (mean: 3.89±1.11 cycles) was significantly associated with weight gain. Another study evaluated 119 patients who completed neoadjuvant chemotherapy with at least two years of follow-up (median: 26.3 months) and revealed that, among 97 patients who received anthracycline followed by taxane, the mean weight changes were -0.8 kg after anthracycline and +3.2kg after taxane [23], which are similar to our results. Another multicenter retrospective study (2001-2010) revealed that treatment using anthracycline plus taxane was associated with more weight gain (+0.9kg) relative to anthracycline alone, which the authors attributed to the longer duration of the combination treatment [24].…”

Dexamethasone premedication for prophylaxis of taxane toxicities: Can the doses be reduced when paclitaxel or docetaxel are given weekly?

“…Since this high dose corticosteroid premedication regimen is often continued through prolonged treatment courses of weekly taxanes, Cushingoid changes, weight-gain, and other complications that arise in a dose-dependent fashion have been reported. 10 Other dose-dependent adverse effects of steroids may include flushing, acne, hyperglycemia, hypertension, epigastric distress or dyspepsia, weight gain, edema, perineal pruritus, anxiety, agitation, depression, hiccups, insomnia, increased appetite, metabolic abnormalities, mood changes, oral candidiasis, and infections. Prolonged treatment may increase the risk of osteoporosis, osteonecrosis, myopathy, glaucoma, cataracts, and impaired wound healing.…”