Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials

Suzanne E. Dahlberg, Joan H. Schiller, Philip B. Bonomi, Alan B. Sandler, Julie R. Brahmer, Suresh S. Ramalingam, David H. Johnson

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Introduction: Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. Methods: The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Results: Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. Conclusion: Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.

Original languageEnglish (US)
Pages (from-to)1121-1127
Number of pages7
JournalJournal of Thoracic Oncology
Volume8
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Non-Small Cell Lung Carcinoma
Body Mass Index
Clinical Trials
Thinness
Obesity
Weights and Measures
Proportional Hazards Models
Disease-Free Survival
Life Style
Therapeutics
Survival
Health
Neoplasms

Keywords

  • Advanced disease
  • Bevacizumab
  • Body mass index
  • Chemotherapy
  • First-line therapy
  • Non-smallcell lung cancer
  • Obesity
  • Phase III
  • Weight

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials. / Dahlberg, Suzanne E.; Schiller, Joan H.; Bonomi, Philip B.; Sandler, Alan B.; Brahmer, Julie R.; Ramalingam, Suresh S.; Johnson, David H.

In: Journal of Thoracic Oncology, Vol. 8, No. 9, 09.2013, p. 1121-1127.

Research output: Contribution to journalArticle

Dahlberg, Suzanne E. ; Schiller, Joan H. ; Bonomi, Philip B. ; Sandler, Alan B. ; Brahmer, Julie R. ; Ramalingam, Suresh S. ; Johnson, David H. / Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials. In: Journal of Thoracic Oncology. 2013 ; Vol. 8, No. 9. pp. 1121-1127.
@article{47f496d3501a40b880d10e3648e89753,
title = "Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials",
abstract = "Introduction: Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. Methods: The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Results: Of the patients enrolled, 4.6{\%} were underweight, 44.1{\%} were normal weight, 34.3{\%} of patients were classified as overweight, and 16.9{\%} were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95{\%} CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95{\%} CI: 1.22-1.94), indicating a time effect while undergoing treatment. Conclusion: Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.",
keywords = "Advanced disease, Bevacizumab, Body mass index, Chemotherapy, First-line therapy, Non-smallcell lung cancer, Obesity, Phase III, Weight",
author = "Dahlberg, {Suzanne E.} and Schiller, {Joan H.} and Bonomi, {Philip B.} and Sandler, {Alan B.} and Brahmer, {Julie R.} and Ramalingam, {Suresh S.} and Johnson, {David H.}",
year = "2013",
month = "9",
doi = "10.1097/JTO.0b013e31829cf942",
language = "English (US)",
volume = "8",
pages = "1121--1127",
journal = "Journal of Thoracic Oncology",
issn = "1556-0864",
publisher = "International Association for the Study of Lung Cancer",
number = "9",

}

TY - JOUR

T1 - Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials

AU - Dahlberg, Suzanne E.

AU - Schiller, Joan H.

AU - Bonomi, Philip B.

AU - Sandler, Alan B.

AU - Brahmer, Julie R.

AU - Ramalingam, Suresh S.

AU - Johnson, David H.

PY - 2013/9

Y1 - 2013/9

N2 - Introduction: Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. Methods: The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Results: Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. Conclusion: Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.

AB - Introduction: Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. Methods: The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI < 18.5 kg/m), normal weight (BMI: 18.5 to < 25 kg/m), overweight (BMI: 25 to < 30 kg/m), and obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Results: Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. Conclusion: Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.

KW - Advanced disease

KW - Bevacizumab

KW - Body mass index

KW - Chemotherapy

KW - First-line therapy

KW - Non-smallcell lung cancer

KW - Obesity

KW - Phase III

KW - Weight

UR - http://www.scopus.com/inward/record.url?scp=84883402702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883402702&partnerID=8YFLogxK

U2 - 10.1097/JTO.0b013e31829cf942

DO - 10.1097/JTO.0b013e31829cf942

M3 - Article

VL - 8

SP - 1121

EP - 1127

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

IS - 9

ER -