Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study

Autoři: Elisé G. Kaboré aff001;  Charles Guenancia aff002;  Ines Vaz-Luis aff003;  Antonio Di Meglio aff003;  Barbara Pistilli aff003;  Charles Coutant aff004;  Paul Cottu aff005;  Anne Lesur aff006;  Thierry Petit aff007;  Florence Dalenc aff008;  Philippe Rouanet aff009;  Antoine Arnaud aff010;  Olivier Arsene aff011;  Mahmoud Ibrahim aff012;  Johanna Wassermann aff013;  Geneviève Boileau-Jolimoy aff014;  Anne-Laure Martin aff015;  Jérôme Lemonnier aff015;  Fabrice André aff003;  Patrick Arveux aff001
Působiště autorů: “Health across Generations” Team, Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France aff001;  Cardiology Department, University Hospital Dijon Bourgogne, Dijon, France aff002;  Institut Gustave Roussy, Villejuif, France aff003;  Centre Georges-François Leclerc, Dijon, France aff004;  Institut Curie, Paris, France aff005;  Centre Alexis Vautrin, Vandoeuvre les Nancy, France aff006;  Centre Paul Strauss, Strasbourg, France aff007;  Institut Claudius Regaud, Toulouse, France aff008;  Institut du Cancer de Montpellier, Montpellier, France aff009;  Clinique Sainte Catherine, Avignon, France aff010;  Centre Hospitalier de Blois, Blois, France aff011;  Centre Hospitalier Régional d’Orléans, Orléans, France aff012;  AP-HP Pitié-Salpêtrière, Paris, France aff013;  Polyclinique du Parc Drevon, Dijon, France aff014;  Unicancer, Paris, France aff015
Vyšlo v časopise: Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1002989
Kategorie: Research Article



In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast cancer (BC) was recently suggested. However, due to meta-analysis design, it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline (antineoplastic antibiotic) and trastuzumab (monoclonal antibody) cardiotoxicity.

Methods and findings

Using prospective data collected from 2012–2014 in the French national multicenter prospective CANTO (CANcer TOxicities) study of 26 French cancer centers, we aimed to examine the association of body mass index (BMI) and cardiotoxicity (defined as a reduction in left ventricular ejection fraction [LVEF] > 10 percentage points from baseline to LVEF < 50%). In total, 929 patients with stage I–III BC (mean age 52 ± 11 years, mean BMI 25.6 ± 5.1 kg/m2, 42% with 1 or more cardiovascular risk factors) treated with anthracycline (86% epirubicin, 7% doxorubicin) and/or trastuzumab (36%), with LVEF measurement at baseline and at least 1 assessment post-chemotherapy were eligible in this interim analysis. We analyzed associations between BMI and cardiotoxicity using multivariate logistic regression. At baseline, nearly 50% of the study population was overweight or obese. During a mean follow-up of 22 ± 2 months following treatment completion, cardiotoxicity occurred in 29 patients (3.2%). The obese group was more prone to cardiotoxicity than the normal-weight group (9/171 versus 8/466; p = 0.01). In multivariate analysis, obesity (odds ratio [OR] 3.02; 95% CI 1.10–8.25; p = 0.03) and administration of trastuzumab (OR 12.12; 95% CI 3.6–40.4; p < 0.001) were independently associated with cardiotoxicity. Selection bias and relatively short follow-up are potential limitations of this national multicenter observational cohort.


In BC patients, obesity appears to be associated with an important increase in risk-related cardiotoxicity (CANTO, registry ID: NCT01993498).

Trial registration NCT01993498.

Klíčová slova:

Body Mass Index – Breast cancer – Cancer chemotherapy – Cancer risk factors – Cancer treatment – Hypertension – Obesity


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