Abstract P3-02-08: Comparison of metabolic changes after neoadjuvant endocrine and chemotherapy in ER positive, HER2 negative premenopausal women with breast cancer
Authors: Ryu Ho-Hyun , Kim Ji-Seon , Chung Il-Yong , Lee Jong-Won , Ko Beom-Seok , Son Byung-Ho , Ahn Sei-Hyun , Kim Hee-Jeong 
Published: March 2020

Abstract
Background Survival of breast cancer has improved and treatments related changes and long term effect regarding weight gain and metabolic profile deterioration after neoadjuvant systemic treatment (NST) become important issues in cancer survivor especially young women. We sought to compare changes in body mass index (BMI), metabolic profiles and neutrophil lymphocyte ratio (NLR) in patients who underwent 6 months of neoadjuvant chemotherapy (NCT) and neoadjuvant endocrine therapy (NET) before/ after NST and 3 years after treatment. Methods Prospective, randomized, phase III trial (NEST) which compared 24 weeks of response of NCT with Adriamycin and cyclophosphamide(AC) followed by docetaxel (T) 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, blood pressure (BP), total cholesterol (TC), fasting glucose, and NLR.BP was classified according to 2017 AHA guideline such as normal, elevated, HTN stage I and HTN stage II. NLR was calculated from the differential leukocyte count by dividing neutrophil percentage by lymphocyte percentage in routine blood cell counts. Results
The mean age of patients was 42 years old. BMI were significantly increased during NCT (22.6 to 23.7, p&lt;0.05), and recovered after 3 year follow up. BMI change were not observed before and after NET and 3 year follow up (23.2, 22.0 and 23.2 respectively p&gt;0.05, all) In the NCT group, the normal group of BP increased from 35 (58%) patients to 40(67%) patients and the elevated group decreased from 12 patients (20%) to 2 patients (3.3%). HTN stage I group was increased from 8 (13%) to 12 (20%) and HTN stage II group increased from 5 (8%) to 6 (10%) after NCT (p=0.001). There were no significant changes of BP during NET.
The mean value of initial total cholesterol before NCT was 184.6mg/dL, 215.98 mg/dL after NCT (p&lt;0.05, before vs after), 179 mg/dL after 3 years of treatment (p&lt;0.05, after vs 3 yrs.). In the NET group, the mean initial cholesterol before NET was 185mg/dL, 176.3 mg/dL (p=0.04, before vs after) after NET, and 179.4 mg/dL after 3 yrs. follow up (p=0.23, before vs after 3years). In the NCT group, the mean fasting glucose were significantly increased while NCT (95.75mg/dL to 111.61mg/dL, p&lt;0.05), and recovered after 3 year follow up (95.78 mg/dL, p&lt;0.05). In the NET group, the mean fasting glucose changes were not observed before and after NET and 3 year follow up (97.78mg/dL, 99.04mg/dL and 99.06mg/dL respectively p&gt;0.05, all). NLR was increased from 2.02 to 4.43 after NCT (p&lt;0.05) and decreased from 2.13 to 1.57(p&lt;0.05) after NET. Conclusion
NCT causes worsening of metabolic profiles such as BMI, blood pressure, TG, and fasting glucose, which is recovered over 3 years. In the NET group, there were no significant changes in BMI, BP and fasting glucose but total cholesterol was significantly decreased after NET treatment. NLR was increased after NCT but decreased after NET.
Citation Format: Ho-Hyun Ryu, Ji-Seon Kim, Il-Yong Chung, Jong-Won Lee, Beom-Seok Ko, Byung-Ho Son, Sei-Hyun Ahn, Hee-Jeong Kim. Comparison of metabolic changes after neoadjuvant endocrine and chemotherapy in ER positive, HER2 negative premenopausal women with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-02-08.