Obese patients with breast cancer receiving unadjusted, dose-dense chemotherapy may be at risk of severe toxicities, according to a study published in Annals of Oncology.1

Researchers retrospectively analyzed data from 555 patients with a body mass index (BMI) of at least 30 from the phase 3 adjuvant GAIN trial, which compared epirubicin, docetaxel, and cyclophosphamide with epirubicin and cyclophosphamide, followed by docetaxel plus capecitabine, to evaluate safety and outcome.

Eighteen percent of patients were obese, and 31% received chemotherapy according to an unadjusted body surface area (BSA). BSA was adjusted for others to ideal weight or was capped at 2.0m2.

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Fifteen percent of obese patients with an unadjusted dose of chemotherapy and 6% of obese patients with an adjusted BSA experienced febrile neutropenia.

Nine percent of patients in the unadjusted dose group and 3% in the adjusted dose group experienced high grade thrombopenia, as well as 17% and 10% who had a thromboembolic event, respectively. Dizziness was higher in the adjusted group, at 5% compared to 11%, as well as diarrhea at 19% compared to 27%, and an increase in serum creatinine at 7% compared to 14%.

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The study found no differences in disease-free or overall survival between non-obese or obese patients receiving full dose chemotherapy, or according to adjusted BSA.


  1. Furlanetto J, Eiermann W, Marme F, et al. Higher rate of severe toxicities in obese patients receiving dose-dense (dd) chemotherapy according to unadjusted body surface area– results of the prospectively randomized GAIN study. Ann Oncol. 2016 Aug 8. doi: 10.1093/annonc/mdw315 [Epub ahead of print]