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ESMO World GI 2015: Low Body Mass Index Associated With Poorer Survival in Metastatic Colorectal Cancer

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Key Points

  • Patients with the lowest body mass index (BMI) from 20 to 24.9, which would be considered a healthy weight by BMI guidelines, survived an average of 21.1 months after starting treatment.
  • Patients with a BMI of 25 to 29, considered overweight, survived an average of 23.5 months. By comparison, patients with BMIs of 30 to 35, considered obese by the standards, survived an average of 24 months.
  • Researchers hypothesized that the lowest weight patients received or tolerated less treatment or received adequate treatment at first but became too sick to receive additional therapy.

Although being overweight with a high body mass index (BMI) has long been associated with a higher risk for colorectal cancer, thinner patients might not fare as well as previously expected after treatment for advanced cancer, according to a new study from Duke Medicine. The study, which was presented July 1 at the European Society for Medical Oncology World Congress on Gastrointestinal Cancer (Abstract LBA-01) in Barcelona, Spain, found that patients with advanced colorectal cancer with a low to healthy body weight lived an average of 2.5 months less than overweight and obese patients.

Analysis Background

The results surprised researchers, who expected obese patients to respond more poorly to treatments for stage 4 colorectal cancer, due to their increased risk of developing the disease and recurrence. There is some evidence that many obese patients also receive less-than-optimal dosages of cancer drugs or have other health problems that complicate recovery.

“Contrary to our hypothesis, patients who had the lowest BMI were at risk for having the shortest survival,” said lead author Yousuf Zafar, MD, Associate Professor of Medicine at Duke. “In this case, patients with the lowest body weight—a BMI of less than 25—were at the highest risk.”

According to guidelines, a healthy adult's BMI ranges from 18.5 to 24, and a BMI below 18.5 is considered underweight. The study authors examined data pooled from 6,128 patients who had previously been untreated for their metastatic colorectal cancer and who were included in four different registry studies in the United States and Europe. Their average BMI at the start of cancer treatment was 25.3, considered slightly overweight.

All patients received bevacizumab (Avastin) with chemotherapy in their treatment.

Results

The prospective observational analysis divided patients into four BMI ranges and measured overall survival rates, as well as the length of time of progression-free survival.

Patients with the lowest BMI from 20 to 24.9—considered a healthy weight by BMI guidelines—survived an average of 21.1 months after starting treatment. Patients with a BMI of 25 to 29, considered overweight, survived an average of 23.5 months, the study found. Patients with BMIs of 30 to 35, considered obese by the standards, survived an average of 24 months. Patients with BMIs of 35.1 and higher survived an average of 23.7 months.

Although the study found significant differences in how long patients lived based on their BMI ranges, patients of all weights saw similar rates of progression-free survival. Patients whose tumors stopped growing went an average of 10 months without progression; but stoppage in tumor growth does not necessarily improve chances of survival.

The study does not indicate that being overweight is in any way protective for patients undergoing cancer treatment, Dr. Zafar specified. Instead, the results suggest that there could be an aspect of biology that could put thinner patients at a higher risk for poor outcomes, he said.

“There may be a relationship between having a lower BMI and how much treatment patients can tolerate,” Dr. Zafar said. “I would hypothesize that the lowest weight patients in our analysis received or tolerated less treatment or received adequate treatment at first but became too sick to receive additional therapy. That may be where we can focus more attention on improving their outcomes.”

This study was supported by Genentech, Inc.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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