Comparison of metabolic changes between neoadjuvant chemotherapy and neoadjuvant endocrine therapy in premenopausal women with ER positive, HER2 negative breast cancer

Abstract

Background: Survival of breast cancer has improved and treatment related metabolic profile deterioration after neoadjuvant systemic treatment (NST) becomes important issues in cancer survivors. We sought to compare metabolic and immune changes in patients who underwent 6months ofneoadjuvant chemotherapy (NCT) and neoadju-vant endocrine therapy (NET). Methods: Prospective, randomized, phase III trial (NEST) which compared 24 weeks of response of NCT with Adriamycin and cyclophosphamide followed by docetaxel and NET with goserelin and tamoxifen. Among them, 123 patients from NEST trial in Asan Medical Center were retrospectively reviewed to evaluate metabolic changes such as BMI, total cholesterol (TC), fasting glucose and blood pressure (BP) before/after NST and 3 years of follow up. NLR were checked before and after NST. WHO classification was used for BMI and BP was classified according to 2017 AHA guideline. Results: The mean age of patients was 42 years old. Overweight group were significantly increased after NCT and recovered after 3 year follow up (8.2%, 12.0%, 6.9% respectively, p < 0.05). BMI changes were not observed in NET group (time p value= 0.110). The mean value ofinitial TC before NCT was 184.6mg/dL, 216.0 mg/dL after NCT (p <0.05), 179.0 mg/dL after 3 years of treatment (p < 0.05, after vs 3 yrs.). In the NET group, the mean initial TC before NET was 185.0mg/dL, and decreased to 176.3 mg/dL after NET, and 179.4 mg/dL after 3 yrs follow up (p = 0.192). In the NCT group, the mean fasting glucose were significantly increased while NCT (95.2mg/dL to 108.8mg/ dL, p < 0.05), and recovered after 3 year follow up (98.0 mg/dL, p < 0.05). In the NET group, the mean fasting glucose changes were not observed (97.0mg/dL, 98.4 mg/dL and 98.4 mg/dL respectively p > 0.05, all). There are no effect on HTN during NCT and NET (p > 0.05 respectively). NLR was increased from 2.0 to 4.4 after NCT (p < 0.05) and decreased from 2.1 to 1.6(p < 0.05) after NET. Conclusions: Compared with nochanges onNET, NCT causes worsening ofmetabolic profiles such as BMI, TC, and fasting glucose, which is recovered over 3 years. NLR was increased after NCT but decreased after NET.