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Observational Study
. 2025 Feb;210(1):205-213.
doi: 10.1007/s10549-024-07553-x. Epub 2024 Dec 4.

The role of body composition in neurological and hematologic toxicity in a retrospective analysis of 120 breast cancer patients undergoing neoadjuvant chemotherapy: the COMBOTOX study

A Di Leone  1 , A Filippone  2 , C Maggiore  2 , M M Rossi  2 , C Rossi  2 , A Di Micco  2 , Luana Forcina  2 , A Franco  3 , L Ionta  1 , A Fabi  4 , I Paris  5 , L Scardina  1 , A M Sanchez  1 , P C Pafundi  6 , G Franceschini  1 , R Masetti  1 , S Magno  1   2
Affiliations
Observational Study

The role of body composition in neurological and hematologic toxicity in a retrospective analysis of 120 breast cancer patients undergoing neoadjuvant chemotherapy: the COMBOTOX study

A Di Leone et al. Breast Cancer Res Treat. 2025 Feb.

Abstract

Purpose: Neoadjuvant chemotherapy (NAC) has a well-established role in locally advanced or chemoresponsive breast cancers (BC). Chemotherapic regimens are effective when patients receive the optimal doses. Toxicities are common in overweight/obese patients but may occur also in normal weight counterparts. This leads to delays, reductions, or discontinuation of treatment, with impact on outcomes. Current dosing is based on body weight and predicted Body Surface Area (BSA). These parameters do not take into consideration the individual variations of fat mass (FM) and fat-free mass (FFM) that affect pharmacokinetics. Assessment of body composition (BoCo), rather than Body Mass Index (BMI), could help to better plan chemotherapy and reduce drug-related toxicities. Our aim was to analyze the correlations between body weight, anthropometric measures, BoCO, and toxicities related to NAC in non-metastatic BC patients.

Methods: This is a retrospective observational cohort study that includes 120 consecutive BC patients undergoing NAC, enrolled between May 2018 and December 2020. All patients received an evaluation of anthropometric parameters (height, weight, waist and hip circumference, BMI) and an assessment of BoCo using Segmental Multi-Frequency-Bioelectrical Impedance Analysis.

Results: A logistic regression models confirmed that a higher FM was associated with a higher rate of neurological and hematologic toxicities in protocols containing Platinum. Moreover, patients with a low FFM% have a higher risk for hematologic toxicity in protocols containing Platinum.

Conclusion: A routine assessment of BoCo, in addition to evaluation of anthropometric measures and BMI, could allow to personalize chemotherapy doses, in order to reduce chemotherapy-related toxicities.

Keywords: Body composition; Breast cancer; Neoadjuvant chemotherapy; Personalized medicine; Toxicity.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Polyclinic University A. Gemelli, IRCCS with the number 5357 and it was retrospectively registered.

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