Obesity May Influence Anthracycline Cardiotoxicity

By David Douglas

NEW YORK - Pooled data suggest that excessive body weight is significantly associated with the risk of cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab in patients with breast cancer, according to international researchers.

"The first step after this study will be to confirm with prospective data that overweight and obesity are independent risk factors of cardiotoxicity," Dr. Charles Guenancia told Reuters Health by email.

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If prospective studies find that the excess risk is not due to a higher prevalence of other risk factors in obese patients than in lean patients, then overweight patients "should certainly benefit from a careful cardiac screening and follow-up during and after chemotherapy," he added.

As reported July 26 online in the Journal of Clinical Oncology, Dr. Guenancia of CHU Dijon, France and colleagues conducted a network meta-analysis of 15 studies involving 8,745 breast cancer patients.

Being obese (BMI of 30 or more) or overweight (BMI of 25 or more) was significantly associated with a greater risk of developing cardiotoxicity after anthracyclines or a sequential anthracyclines and trastuzumab regimen.

The pooled odds ratio was 1.38. For the obese, the odds ratio was 1.47 and for the overweight it was 1.15. These associations, say the researchers, were independent of study design, year of publication, drug regimen or definitions of cardiotoxicity and of overweight or obesity.

Subgroup analysis showed a gradual increase in cardiotoxicity risk with higher BMI. Compared to normal weight patients, the overweight had an increased risk (OR, 1.13) as did the obese (OR, 1.44). The obese also had a higher risk than the overweight (OR, 1.27).

The researchers concede that in their "largely unadjusted analysis," they couldn't distinguish the contributions of obesity-related cardiovascular risk factors, such as diabetes and hypertension, from that of obesity itself.

Should the findings be confirmed, Dr. Guenancia said, "The next step would be to identify the mechanisms and the molecules involved in the interaction between obesity and the heart leading to a higher likelihood of heart failure after anthracyclines and trastuzumab."

"Indeed," he concluded, "the elucidation of the ways involved could potentially help us to develop new therapeutic strategies or targeted drugs."

SOURCE: https://bit.ly/2aPxgoA

J Clin Oncol 2016.

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