Randomized trial of weight loss in primary breast cancer: Impact on body composition, circulating biomarkers and tumor characteristics

• Published in: International journal of cancer 2020-05, Vol.146 (10), p.2784-2796
• Main Authors: Demark‐Wahnefried, Wendy, Rogers, Laura Q., Gibson, Justin T., Harada, Shuko, Frugé, Andrew D., Oster, Robert A., Grizzle, William E., Norian, Lyse A., Yang, Eddy S., Della Manna, Deborah, Jones, Lee W., Azrad, Maria, Krontiras, Helen
• Format: Article
• Language: English
• Subjects: Apoptosis; Biomarkers - blood; Biopsy; Body Composition; Body fat; Body weight; Body weight loss; Breast cancer; Breast Neoplasms - complications; Caloric Restriction - methods; Cancer; Cancer Therapy and Prevention; Cell cycle; clinical trial; Counseling - methods; diet; Dietary restrictions; Energy balance; exercise; Exercise Therapy - methods; Female; Gene expression; Humans; Ki67; Leptin; Medical research; Obesity; Obesity - complications; Obesity - diet therapy; Overweight; Overweight - complications; Overweight - diet therapy; Physical activity; Physical training; Tumor markers; Tumor necrosis factor-α; Weight Loss - physiology
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.32637

Obesity adversely impacts overall and cancer‐specific survival among breast cancer patients. Preclinical studies demonstrate negative energy balance inhibits cancer progression; however, feasibility and effects in patients are unknown. A two‐arm, single‐blinded, randomized controlled weight‐loss trial was undertaken presurgery among 32 overweight/obese, Stage 0–II breast cancer patients. The attention control arm (AC) received basic nutritional counseling and upper‐body progressive resistance training whereas the weight loss intervention (WLI) arm received identical guidance, plus counseling on caloric restriction and aerobic exercise to promote 0.68–0.92 kg/week weight loss. Anthropometrics, body composition, blood and survey data were collected at baseline and presurgery ∼30 days later. Tumor markers (e.g., Ki67) and gene expression were assessed on biopsy and surgical specimens; sera were analyzed for cytokines, growth and metabolic factors. Significant WLI vs. AC differences were seen in baseline‐to‐follow‐up changes in weight (−3.62 vs. −0.52 kg), %body fat (−1.3 vs. 0%), moderate‐to‐vigorous physical activity (+224 vs. +115 min/week), caloric density (−0.3 vs. 0 kcal/g), serum leptin (−12.3 vs. −4.0 ng/dl) and upregulation of tumor PI3Kinase signaling and cell cycle‐apoptosis related genes (CC‐ARG; all p‐values