[ad_1]
The so-called ‘obesity paradox’ – improved survival in patients with high body mass index (BMI) – reported in other genitourinary malignancies has now also been observed in patients with genitourinary malignancies. metastatic castration-resistant prostate cancer (mCRPC), according to retrospective results. presented at the 36th Annual Congress of the European Urological Association (EAU).1.2
In an analysis of nearly 1,600 patients included in three phase 3 trials, the overall survival rate (OS) at 36 months was approximately 30% in obese patients (BMI> 30) compared with 20% in patients with obesity. overweight (25
The investigators also determined that the benefit of OS was not caused by the higher dose of chemotherapy received by patients with a higher BMI. They found no interaction between BMI subgroups and chemotherapy dose (P > .05 for the 3 BMI categories).
“By examining patients with prostate cancer metastases, we found that obese patients lived longer. This means that BMI could be used to predict the survival of these patients,” the investigator said. study Nicola Fossati, MD, urologist at the University of San Raffaele. Press release.
“This obesity paradox has been observed in other cancers, possibly due to the relationship between tissue fat and cancer genomes, and more research is needed in this area. It is also possible that the improvement in survival is due to the interaction of chemotherapy with other drugs. Obese patients in this older age group tend to take drugs for other conditions and we do not fully understand how these drugs interconnect, “Fossati added.” Nonetheless, we would not recommend putting on weight anyone with this or any other disease. Obesity is a risk factor for many cancers and other diseases and patients should always aim for a healthy BMI of 18-24. “
The study included 1577 mCRPC patients enrolled in 3 phase 3 randomized controlled trials: ASCENT2, MAINSAL and VENICE. The median age of the patients was 69 years (IQR, 63-74) and the median BMI was 28 mg / m2 (IQR, 25-31). The median follow-up of survivors was 12 months.
Beyond overall survival, the “obesity effect” has also been observed with cancer-specific survival. Statistical modeling showed that the risk of cancer-related death was 6% (RR: 0.94; P = 0.002) lower in obese patients when assessing BMI as a continuous variable, and 35% lower (HR: 0.65, P = .018) with BMI as a categorical variable.
“There are many possible explanations for the association of body weight with positive results in metastatic cancers. Patients with a higher BMI may be able to better tolerate the toxicity of the treatments and their side effects; in prostate cancer, it could be due to the protective impact of hormones present in adipose tissue; and it is known that healthy men with a slightly higher BMI have a higher overall life expectancy than very thin men, ”Peter Albers, MD, University of Düsseldorf, who chairs the scientific congress office of the UAE, stated in the press release.
“However, at this time, these are only hypotheses. More research is needed to identify the biological mechanism behind these different findings. Until this mechanism is proven, we cannot recommend any change in treatment for patients. with advanced prostate cancer, ”added Albers.
The references
1. Cirulli GO, Martini A, Sfakianos JP, et al. The obesity paradox in metastatic castration-resistant prostate cancer. Presented at the 36th Annual UAE Congress (virtual). July 8-12, 2021. P0855.
2. Obesity increases survival in advanced prostate cancer. Published online July 10, 2021. Accessed July 11, 2021. https://bit.ly/3kbHO7h.
Source link
