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Body Mass Index and Clinical Benefit of Fulvestrant in Postmenopausal Women with Advanced Breast Cancer. TUMORI JOURNAL 2016; 102:e11-4. [DOI: 10.5301/tj.5000515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 11/20/2022]
Abstract
Purpose Obesity is a known risk factor for breast cancer and has been linked to increased risk of recurrence and death in breast cancer patients. Little is known about the predictive value of obesity. As endocrine therapy is widely used for breast cancer treatment worldwide, we aimed at correlating baseline body mass index (BMI) with clinical benefit derived from fulvestrant in postmenopausal women with advanced breast cancer. Methods We analyzed consecutive patients treated with fulvestrant in our center between January 2009 and March 2015. Patients were categorized as normal (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29 kg/m2) and obese (BMI >30 kg/m2). The antitumor activity of fulvestrant was evaluated in terms of the clinical benefit rate (CBR). Results Seventy-five consecutive patients matched the eligibility criteria for analysis. Fulvestrant was administered as first-line therapy in 4 (5%) cases, as second line in 27 (36%) and as third line and beyond in 44 (59%) cases. According to BMI, 44 (59%) patients were classified as normal weight, 19 (25%) as overweight, and 12 (16%) as obese. No difference in estrogen receptor expression was found in relation to BMI. CBR was 53% overall, but rose to 70.5% in normal-weight patients and dropped to 31.6% and 25% in overweight and obese patients, respectively (p<0.001). Conclusions Increased BMI has a negative influence on treatment outcome. Even with the limitation of the relatively small sample size, it appears that patients of normal weight are 2.5-fold more likely to benefit from fulvestrant as overweight and obese patients.
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Allott EH, Hursting SD. Obesity and cancer: mechanistic insights from transdisciplinary studies. Endocr Relat Cancer 2015; 22:R365-86. [PMID: 26373570 PMCID: PMC4631382 DOI: 10.1530/erc-15-0400] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/11/2022]
Abstract
Obesity is associated with a range of health outcomes that are of clinical and public health significance, including cancer. Herein, we summarize epidemiologic and preclinical evidence for an association between obesity and increased risk of breast and prostate cancer incidence and mortality. Moreover, we describe data from observational studies of weight change in humans and from calorie-restriction studies in mouse models that support a potential role for weight loss in counteracting tumor-promoting properties of obesity in breast and prostate cancers. Given that weight loss is challenging to achieve and maintain, we also consider evidence linking treatments for obesity-associated co-morbidities, including metformin, statins and non-steroidal anti-inflammatory drugs, with reduced breast and prostate cancer incidence and mortality. Finally, we highlight several challenges that should be considered when conducting epidemiologic and preclinical research in the area of obesity and cancer, including the measurement of obesity in population-based studies, the timing of obesity and weight change in relation to tumor latency and cancer diagnosis, and the heterogeneous nature of obesity and its associated co-morbidities. Given that obesity is a complex trait, comprised of behavioral, epidemiologic and molecular/metabolic factors, we argue that a transdisciplinary approach is the key to understanding the mechanisms linking obesity and cancer. As such, this review highlights the critical need to integrate evidence from both epidemiologic and preclinical studies to gain insight into both biologic and non-biologic mechanisms contributing to the obesity-cancer link.
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Affiliation(s)
- Emma H Allott
- Department of EpidemiologyCB 7435, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USALineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USADepartment of NutritionUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USA Department of EpidemiologyCB 7435, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USALineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USADepartment of NutritionUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USA
| | - Stephen D Hursting
- Department of EpidemiologyCB 7435, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USALineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USADepartment of NutritionUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USA Department of EpidemiologyCB 7435, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USALineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USADepartment of NutritionUniversity of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USA
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Wei Z, Liang L, Junsong L, Rui C, Shuai C, Guanglin Q, Shicai H, Zexing W, Jin W, Xiangming C, Shufeng W. The impact of insulin on chemotherapeutic sensitivity to 5-fluorouracil in gastric cancer cell lines SGC7901, MKN45 and MKN28. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:64. [PMID: 26084465 PMCID: PMC4494778 DOI: 10.1186/s13046-015-0151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022]
Abstract
Background The role of insulin in the pathogenesis of cancer has been increasingly emphasized because of the high incidence of obesity and metabolic syndrome and their correlated complication including cancer. This study aimed to explore the impact of insulin on chemoresistance to 5-fluorouracil in gastric cancer and the possible mechanisms. Methods Tissue samples of gastric cancer and adjacent normal gastric mucosa from patients with or without obesity were performed immunohistochemical staining for P-glycoprotein. The follow-up was done after the surgical treatment. The effect of insulin on chemotherapeutic sensitivity of the three gastric cancer cell lines to 5-fluorouracil was evaluated by pre-incubation with insulin before administration of 5-fluorouracil. The expression of P-glycoprotein was determined by Western blotting. Results P-glycoprotein were overexpressed in tissues from patients who suffered gastric cancer and were higher in those simultaneously suffered gastric cancer and obesity. Addition of 1 μM insulin remarkably promoted the proliferation of SGC7901, MKN45 and MKN28 cells and decreased the cytotoxicity of 5-fluorouracil. In addition, the expression of P-glycoprotein was upregulated in SGC7901, MKN45 and MKN28 cells. Conclusion Insulin improved the proliferation of gastric cancer cell lines and contributed to chemoresistance of gastric cancer cells to 5-fluorouracil which is likely to involve upregulation of P-glycoprotein.
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Affiliation(s)
- Zhao Wei
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Li Liang
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Liu Junsong
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Chen Rui
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, P.R.China.
| | - Chang Shuai
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Qiu Guanglin
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - He Shicai
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Wang Zexing
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Wang Jin
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Che Xiangming
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
| | - Wang Shufeng
- Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China. .,Health science center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.China.
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Horowitz NS, Wright AA. Impact of obesity on chemotherapy management and outcomes in women with gynecologic malignancies. Gynecol Oncol 2015; 138:201-6. [PMID: 25870918 DOI: 10.1016/j.ygyno.2015.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/02/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the effects of obesity on the pharmacokinetics and dosing of chemotherapies and provide recommendations for chemotherapy management in obese women with gynecologic malignancies. METHODS PubMEd and MEDLINE databases were searched for articles published before June 2014. Only English-language articles were considered. 84 manuscripts were reviewed and 66 were included. Search terms included: obesity, overweight, body mass index, body surface area, glomerular filtration rate, chemotherapy, ovarian cancer, endometrial cancer, inflammation, and pharmacokinetics, RESULTS Obese cancer patients have worse clinical outcomes, compared with non-obese patients. This may be because of differences in pharmacokinetics, metabolic dysregulation, or physicians' decisions to reduce chemotherapy dose-intensity during treatment to minimize toxicities. A 2012 American Society of Clinical Oncology Clinical Practice Guideline recommends using actual body weight for chemotherapy dosing in all patients treated with curative intent, irrespective of obesity, to avoid compromising clinical outcomes, including progression free survival (PFS) and overall survival (OS). In women with gynecologic cancers most studies demonstrate no difference in PFS or OS when obese patients receive the same chemotherapy dose intensity as non-obese patients, except perhaps with bevacizumab. CONCLUSIONS Chemotherapy dose-intensity is a critical determinant of cancer outcomes and should be maintained in all patients, irrespective of obesity. Future studies should prospectively examine the impact of obesity on clinical outcomes (adverse events, survival) to improve the care of this growing population of patients who are at risk for inferior clinical outcomes.
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Affiliation(s)
- Neil S Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, USA; Division of Medical Oncology, Dana Farber Cancer Institute, USA.
| | - Alexi A Wright
- Division of Medical Oncology, Dana Farber Cancer Institute, USA
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Vassileva V, Piquette-Miller M. Inflammation: the dynamic force of health and disease. Clin Pharmacol Ther 2014; 96:401-5. [PMID: 25236660 DOI: 10.1038/clpt.2014.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Replacing "happiness" with "inflammation" in Thomas Merton's quotation holds true for the processes that govern our immune response and health. The balance between pro- and anti-inflammatory signals regulates inflammatory responses, leading to either restoration of health or the development and progression of disease, depending on whether it creates equilibrium or dysfunction. This issue of Clinical Pharmacology & Therapeutics highlights emerging research and concepts related to inflammation and its underlying role in chronic disease and variable drug response.
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Affiliation(s)
- V Vassileva
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - M Piquette-Miller
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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