Abstract
BackgroundA decrease in thermogenesis is suspected to be implicated in the energy expenditure reduction during breast cancer treatment. This study aimed to investigate the impact of chemotherapy on the metabolic activity of brown adipose tissue (BAT) and the link with weight variation.MethodsThis was an ancillary analysis of a multicentre trial involving 109 HER2+ breast cancer patients treated with neoadjuvant chemotherapy. A centralised review of 18F-FDG uptake intensity (SUVmax) in specific BAT regions (cervical and supraclavicular) was conducted on two PET-CT scans for each patient (before and after the first course of chemotherapy).ResultsOverall, after one course of chemotherapy a significant decrease of 4.4% in 18F-FDG-uptake intensity was observed. It was not correlated to initial BMI, age or season. During chemotherapy, 10.1% (n = 11) of the patients lost weight (− 7.7 kg ± 3.8 kg; ie, − 9.4% ± 3.7%) and 29.4% (n = 32) gained weight (+ 5.1 kg ± 1.7 kg; ie, + 8.5% ± 2.6%). Among these subgroups, only the patients who had gained weight underwent a significant decrease (13.42%) in 18F-FDG uptake intensity (p = 0.042).ConclusionThis study is the first to highlight in a large cohort of patients the negative impact of chemotherapy on brown adipose tissue activity. Weight gain during chemotherapy could thus potentially be explained in part by a decrease in brown adipose tissue activity.
Highlights
A decrease in thermogenesis is suspected to be implicated in the energy expenditure reduction during breast cancer treatment
Studies using fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) scans have evidenced the presence of brown adipose tissue (BAT) in adults [15,16,17,18]. Fluorine-18 fluorodeoxyglucose (18F-FDG) is currently used in oncology to mark tumours but it is not specific and has been found in high glucose metabolism organs such as BAT [19,20,21]
They showed that patients treated with taxane-based chemotherapy were those with the more significant changes on Positron emission tomography-compute tomography (PET-CT) scan compared to those treated with anthracycline-based chemotherapy [25]
Summary
A decrease in thermogenesis is suspected to be implicated in the energy expenditure reduction during breast cancer treatment. Rousseau et al studied BAT uptake variations among 33 early breast cancer patients who had 5 FDG PET scans during chemotherapy. Our previous pilot study on a small sample of patients (26 early breast cancer patients included in the AVATAXHER trial in Jean PERRIN Comprehensive Cancer Centre) showed a decrease in 18F-FDG uptake in BAT regions after one course of chemotherapy [24]. Our team found that patients gaining weight (> 5% of initial weight) during chemotherapy underwent a significant decrease in BAT activity compared to patients who remained stable or lost weight [24] One limitation of these two studies is that they were conducted on a few patients only. The secondary objectives were to assess the relationship between BAT activity variations and weight variations at the end of chemotherapy, and to study the factors influencing BAT activity
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