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. 2025 Aug 15;157(4):709-721.
doi: 10.1002/ijc.35432. Epub 2025 Apr 10.

Body mass index as a predictive factor for efficacy of adjuvant taxane-based chemotherapy in early-stage breast cancer patients: A pooled analysis from adjuvant GEICAM Spanish Breast Cancer Group and TRIO Translational Research in Oncology Group studies

José A García-Saenz  1   2 , Gonzalo Spera  3 , Marina Pollán  2   4   5 , Begoña Bermejo  2   6 , Manuel Ruiz-Borrego  2   7 , Arlene Chan  8 , Miguel Martín  2   4   9 , Ángel Guerrero-Zotano  2   10 , Lourdes Calvo  2   11 , Álvaro Rodríguez-Lescure  2   12 , María Marín  2   13 , Linnea Chap  14 , John Crown  15 , Tadeusz Pienkowski  16 , Valerie Bee  17 , Maribel Casas  2 , Óscar Polonio  2 , Susana Bezares  2 , Dennis Slamon  18
Affiliations

Body mass index as a predictive factor for efficacy of adjuvant taxane-based chemotherapy in early-stage breast cancer patients: A pooled analysis from adjuvant GEICAM Spanish Breast Cancer Group and TRIO Translational Research in Oncology Group studies

José A García-Saenz et al. Int J Cancer. .

Abstract

Adjuvant anthracyclines and taxanes reduce recurrence and death in early-stage breast cancer (EBC) patients, but toxicity is a concern. Studies show conflicting results on the correlation between body mass index (BMI) and outcomes. Limited data exist on the efficacy of adjuvant taxanes among BMI categories and the impact of different taxane-based chemotherapies (paclitaxel vs. docetaxel) on disease recurrence. Here, we present a pooled analysis of 13,486 EBC patients treated with adjuvant anthracyclines ± taxanes from seven GEICAM and TRIO trials (1996-2008) conducted. Patients were classified into four BMI categories: normal (<25.0), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (≥35.0). BMI was evaluated as a predictive factor for the efficacy and toxicity of taxane-based chemotherapy. Our results show the following findings: patients' distribution by BMI was 44% normal, 33% overweight, 16% obese, and 8% severely obese. Seventy-nine percent received taxane-based chemotherapy. Ten-year invasive disease-free survival (iDFS) was 71%, 70%, 68%, and 64% for normal, overweight, obese, and severely obese patients, respectively. Obese and severely obese patients had significantly worse outcomes (HR 1.15 and 1.29, respectively). Invasive disease-free survival with docetaxel vs. non-docetaxel was significant in the normal BMI group, while iDFS with paclitaxel was significant in the obese group. Relevant toxicity was observed in 5%, 5.5%, 5.9%, and 9.3% of normal, overweight, obese, and severely obese patients who received docetaxel. In conclusion, heavier EBC patients had a worse prognosis with adjuvant taxane-based chemotherapy. Normal BMI patients benefited more from docetaxel, while obese patients benefited more from paclitaxel.

Keywords: body mass index; docetaxel; early‐stage breast cancer; paclitaxel; pooled analysis; survival.

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Conflict of interest statement

Dr. Jose Ángel García has received consulting fees from Seagen, AstraZeneca, Daiichi Sankyo, Novartis, Gilead, and Menarini; speakers' honoraria from Celgene, Eli Lilly, EISAI, MSD, Exact Sciences, Tecnofarma, Nolver (Adium), Asofarma and Roche; institution and research funding from AstraZeneca and travel support from Gilead, AstraZeneca and Daiichi Sankyo. Dr. Begoña Bermejo has received consulting fees from AstraZeneca, Daiichi Sankyo, Lilly, Roche, MSD and Menarini; speakers' honoraria from Lilly, MSD, Pfizer, Novartis, AstraZeneca, Roche, and Gilead; and travel support from Gilead and Pfizer. Dr. Miguel Martín has received consulting fees from AstraZeneca, Amgen, Taiho Oncology, Roche/Genentech, Novartis, PharmaMar, Eli Lilly, PUMA, Taiho Oncology, and Pfizer; speakers' honoraria from AstraZeneca, Amgen, Roche/Genentech, Novartis, Daiichi Sankyo, and Pfizer; and contracted research fees from Roche, Novartis, and PUMA. Dr. Ángel Guerrero has received institutional grant by Pfizer, advisory by Novartis, Palex, Pfizer, AstraZeneca, Pierre Fabre, travel grant by Roche, Pfizer and Novartis and speaker honoraria by Novartis, Pfizer, Lilly, Pfizer, AstraZeneca. Dr. Álvaro Rodríguez‐Lescure has received speaker honoraria by Pfizer, Novartis, AstraZeneca, Daichii‐Sankyo and Seagen and advisory by Pfizer, Novartis, Roche, AstraZeneca, Daiichi‐Sankyo, Pierre Fabre and Seagen. Dr. John Crown has received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Pfizer, Pierre Fabre, and Novartis; advisory boards from MSD, Immunocore, and AstraZeneca; and travel support from MSD, Pfizer, Roche, Daiichi Sankyo, Astrazeneca, Regeneron, and Novartis. Dr. Tadeusz Pienkowski has received lecture fees from Roche. Dr. Denis Slamon declares being part of the 1200 Pharma Board of Directors, BioMarin Pharmaceutical Inc. Board of Directors, TORL Biotherapeutics Board of Directors, and receiving grant/contract and stock from AstraZeneca as a consultant, consulting fees from Amgen Inc., and stock from Merck. Novartis consultant, grant/contract, and sponsored speaking events. Pfizer Consultant, sponsored speaking engagements, Grant/contract, and stock. The other authors have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curves for invasive disease‐free survival in patients with normal BMI category.
FIGURE 2
FIGURE 2
Kaplan–Meier curves for invasive disease‐free survival in patients with obese BMI category.
See this image and copyright information in PMC

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