BMI: Overgewicht en obesitas hebben geen negatieve invloed op overleving bij vrouwen met hormoongevoelige vormen van borstkanker die ook CDK 4/6 remmers gebruikten

Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij borstkanker van arts-bioloog drs. Engelbert Valstar

Zie ook in gerelateerde artikelen

30 december 2023: Bron: Epidemiology Published: 25 October 2023

Uit het deelonderzoek uitgevoerd via het SONABRE register blijkt dat overgewicht (BMI >25.0-29.9 kg/m2) en obesitas (BMI ≥ 30.0 kg/m²) geen negatieve invloed hebben op de resultaten wat betreft ziekteprogressie vrije overleving en overall overleving bij vrouwen met uitgezaaide hormoongevoelige borstkanker (HR+ en HER2 negatieve expressie) die ook CDK 4/6 remmers zoals palbociclib, ribociclib en abemaciclib gebruikten samen met hormoontherapie tijdens hun behandeling.

Patiënten met ondergewicht vertoonden echter een kortere overlevingsduur vergeleken met patiënten met een normaal gewicht. De progressievrije overlevingsresultaten waren vergelijkbaar voor alle BMI-classificatiegroepen.

Daarbij moet worden aangetekend dat naast de bevindingen van dit onderzoek het ook belangrijk is om de comorbide aandoeningen (meerdere aandoeningen dan alleen de hoofdziekte borstkanker) van een patiënt die verband houden met obesitas in overweging te nemen en hun impact op verschillende behandelopties in de toekomst te bepalen. Bovendien beschikken patiënten met ondergewicht over lagere vetreserves waarop ze kunnen vertrouwen als hun toestand verslechtert, vergeleken met degenen met overgewicht of obesitas die relatief hogere vetreserves hebben. Omdat vrouwen vrouwelijke hormonen in hun lichaamsvet opslaan, werken medicamenteuze therapieën blijkbaar, ondanks dat ze misschien harder moeten werken, bij patiënten met een hoger percentage lichaamsvet.

Deze analyse kwam voort uit deze eerste analyse:

Flowchart of included patients

Eerder is een studie gepubliceerd over de overleving van alle borstkankerpatiënten, zie deze publicatie:

Dit zijn de resultaten uit de BMI studie:

Aan dit onderzoek namen 1456 patiënten deel, van wie er maar 35 (2%) ondergewicht hadden, 580 (40%) een normaal gewicht, 479 (33%) overgewicht en 362 (25%) zwaarlijvig waren.

Alle patiënten met HR+/HER2−ABC kregen hormoontherapie / endocriene therapie + een cycline-afhankelijke kinase 4/6-remmer als eerste systemische therapie in 2007-2020 in Nederland, en werden anoniem geselecteerd uit het Southeast Netherlands Advanced Breast Cancer (SONABRE) register.

Er werden geen verschillen in overall overleving (OS) waargenomen tussen patiënten met een normaal gewicht en respectievelijk overgewicht (HR 0,99; 95% BI 0,85–1,16; p = 0,93) en patiënten met obesitas (HR 1,04; 95% BI 0,88–1,24; p = 0,62).
De OS van patiënten met ondergewicht (HR 1,45; 95% BI 0,97–2,15; p = 0,07) was echter doorgaans slechter dan de OS van patiënten met een normaal gewicht.
Vergeleken met patiënten met een normaal gewicht was de PFS vergelijkbaar bij patiënten met ondergewicht (HR 1,05; 95% BI 0,73–1,51; p = 0,81), overgewicht (HR 0,90; 95% BI 0,79–1,03; p = 0,14) en patiënten met obesitas ( HR 0,88; 95% BI 0,76–1,02; p = 0,10).

Grafisch ziet de overlevingsgrafiek er zo uit:

Overall survival (a) and first-line progression-free survival (b) according to BMI class at diagnosis of HR+/HER2− ABC

Conclusie:

In deze studie onder 1456 patiënten met HR+/HER2− ABC kwamen overgewicht en obesitas veel voor, terwijl ondergewicht ongebruikelijk was. In vergelijking met een normaal gewicht waren overgewicht en obesitas niet geassocieerd met OS of PFS. Ondergewicht leek echter een ongunstige prognostische factor voor OS.

Het volledige studierapport is gratis in te zien. Klik op de titel van het abstract:

The prognostic impact of BMI in patients with HR+/HER2− advanced breast cancer: a study of the SONABRE registry

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Abstract

Purpose

This study determines the prognostic impact of body mass index (BMI) in patients with hormone receptor-positive/human epidermal growth factor receptor-2-negative (HR+/HER2−) advanced (i.e., metastatic) breast cancer (ABC).

Methods

All patients with HR+/HER2− ABC who received endocrine therapy +—a cyclin-dependent kinase 4/6 inhibitor as first-given systemic therapy in 2007–2020 in the Netherlands were identified from the Southeast Netherlands Advanced Breast Cancer (SONABRE) registry (NCT03577197). Patients were categorised as underweight (BMI: < 18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), or obese (≥ 30.0 kg/m²). Overall survival (OS) and progression-free survival (PFS) were compared between BMI classes using multivariable Cox regression analyses.

Results

This study included 1456 patients, of whom 35 (2%) were underweight, 580 (40%) normal weight, 479 (33%) overweight, and 362 (25%) obese. No differences in OS were observed between normal weight patients and respectively overweight (HR 0.99; 95% CI 0.85–1.16; p = 0.93) and obese patients (HR 1.04; 95% CI 0.88–1.24; p = 0.62). However, the OS of underweight patients (HR 1.45; 95% CI 0.97–2.15; p = 0.07) tended to be worse than the OS of normal weight patients. When compared with normal weight patients, the PFS was similar in underweight (HR 1.05; 95% CI 0.73–1.51; p = 0.81), overweight (HR 0.90; 95% CI 0.79–1.03; p = 0.14), and obese patients (HR 0.88; 95% CI 0.76–1.02; p = 0.10).

Conclusion

In this study among 1456 patients with HR+/HER2− ABC, overweight and obesity were prevalent, whereas underweight was uncommon. When compared with normal weight, overweight and obesity were not associated with either OS or PFS. However, underweight seemed to be an adverse prognostic factor for OS.

Breast Cancer: Current Perspectives on the Disease Status

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Article 04 September 2015

SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022)

Article Open access16 June 2023

Data availability

Data will be shared with interested researchers who are able to provide a methodologically sound proposal with well-defined research questions. Researchers are welcome to contact the corresponding author for more information at vcg.tjan.heijnen@mumc.nl.

References

NCD Risk Factor Collaboration (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 387:1377–1396. https://doi.org/10.1016/s0140-6736(16)30054-x

Article Google Scholar
Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D (2007) Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 335:1134. https://doi.org/10.1136/bmj.39367.495995.AE

Article PubMed PubMed Central Google Scholar
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578. https://doi.org/10.1016/s0140-6736(08)60269-x

Article PubMed Google Scholar
Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, Ochs-Balcom HM, Thomson CA, Caan BJ, Tinker LF, Urrutia RP, Knudtson J, Anderson GL (2015) Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the Women’s Health Initiative Randomized Clinical Trials. JAMA Oncol 1:611–621. https://doi.org/10.1001/jamaoncol.2015.1546

Article PubMed PubMed Central Google Scholar
Lohmann AE, Soldera SV, Pimentel I, Ribnikar D, Ennis M, Amir E, Goodwin PJ (2021) Association of obesity with breast cancer outcome in relation to cancer subtypes: a meta-analysis. J Natl Cancer Inst 113(11):1465–1475. https://doi.org/10.1093/jnci/djab023

Article PubMed PubMed Central Google Scholar
Ewertz M, Jensen MB, Gunnarsdóttir K, Højris I, Jakobsen EH, Nielsen D, Stenbygaard LE, Tange UB, Cold S (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29:25–31. https://doi.org/10.1200/jco.2010.29.7614

Article PubMed Google Scholar
Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM (2017) Obesity and adverse breast cancer risk and outcome: mechanistic insights and strategies for intervention. CA Cancer J Clin 67:378–397. https://doi.org/10.3322/caac.21405

Article PubMed PubMed Central Google Scholar
Pan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P, Peto R, Pritchard KI, Bergh J, Dowsett M, Hayes DF (2017) 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med 377:1836–1846. https://doi.org/10.1056/NEJMoa1701830

Article PubMed PubMed Central Google Scholar
Jung SY, Rosenzweig M, Sereika SM, Linkov F, Brufsky A, Weissfeld JL (2012) Factors associated with mortality after breast cancer metastasis. Cancer Causes Control 23:103–112. https://doi.org/10.1007/s10552-011-9859-8

Article PubMed Google Scholar
Gennari A, Nanni O, Puntoni M, DeCensi A, Scarpi E, Conte P, Antonucci G, Amadori D, Bruzzi P (2013) Body mass index and prognosis of metastatic breast cancer patients receiving first-line chemotherapy. Cancer Epidemiol Biomarkers Prev 22:1862–1867. https://doi.org/10.1158/1055-9965.Epi-13-0595

Article PubMed Google Scholar
Zewenghiel L, Lindman H, Valachis A (2018) Impact of body mass index on the efficacy of endocrine therapy in patients with metastatic breast cancer—a retrospective two-center cohort study. Breast 40:136–140. https://doi.org/10.1016/j.breast.2018.05.005

Article PubMed Google Scholar
Saleh K, Carton M, Dieras V, Heudel PE, Brain E, D’Hondt V, Mailliez A, Patsouris A, Mouret-Reynier MA, Goncalves A, Ferrero JM, Petit T, Emile G, Uwer L, Debled M, Dalenc F, Jouannaud C, Ladoire S, Leheurteur M, Cottu P, Veron L, Savignoni A, Courtinard C, Robain M, Delaloge S, Deluche E (2021) Impact of body mass index on overall survival in patients with metastatic breast cancer. Breast 55:16–24. https://doi.org/10.1016/j.breast.2020.11.014

Article PubMed Google Scholar
Franzoi MA, Eiger D, Ameye L, Ponde N, Caparica R, De Angelis C, Brandão M, Desmedt C, Di Cosimo S, Kotecki N, Lambertini M, Awada A, Piccart M, Azambuja E (2021) Clinical implications of body mass index in metastatic breast cancer patients treated with abemaciclib and endocrine therapy. J Natl Cancer Inst 113:462–470. https://doi.org/10.1093/jnci/djaa116

Article CAS PubMed Google Scholar
Ligibel JA, Huebner L, Rugo HS, Burstein HJ, Toppmeyer DL, Anders CK, Ma C, Barry WT, Suman V, Carey LA, Partridge AH, Hudis CA, Winer EP (2021) Physical activity, weight, and outcomes in patients receiving chemotherapy for metastatic breast cancer (C40502/Alliance). JNCI Cancer Spectr 5:pkab025. https://doi.org/10.1093/jncics/pkab025

Article PubMed PubMed Central Google Scholar
Patel R, Li Z, Zimmerman BS, Fink MY, Wells JD, Zhou X, Ayers K, Redfern A, Newman S, Schadt E, Oh WK, Chen R, Tiersten A (2022) Impact of body mass index on the efficacy of aromatase inhibitors in patients with metastatic breast cancer. Breast Cancer Res Treat 192:313–319. https://doi.org/10.1007/s10549-021-06504-0

Article CAS PubMed Google Scholar
von Drygalski A, Tran TB, Messer K, Pu M, Corringham S, Nelson C, Ball ED (2011) Obesity is an independent predictor of poor survival in metastatic breast cancer: retrospective analysis of a patient cohort whose treatment included high-dose chemotherapy and autologous stem cell support. Int J Breast Cancer 2011:523276. https://doi.org/10.4061/2011/523276

Article Google Scholar
Pizzuti L, Natoli C, Gamucci T, Mauri M, Sergi D, Di Lauro L, Paoletti G, Ruggeri E, Iezzi L, Sperduti I, Mentuccia L, Fabbri A, Maugeri-Saccà M, Moscetti L, Barba M, Vici P (2017) Anthropometric, clinical and molecular determinants of treatment outcomes in postmenopausal, hormone receptor positive metastatic breast cancer patients treated with fulvestrant: results from a real word setting. Oncotarget 8:69025–69037. https://doi.org/10.18632/oncotarget.16982

Article PubMed PubMed Central Google Scholar
Krasniqi E, Pizzuti L, Barchiesi G, Sergi D, Carpano S, Botti C, Kayal R, Sanguineti G, Marchetti P, Botticelli A, Marinelli D, Gamucci T, Natoli C, Grassadonia A, Tinari N, Tomao S, Tonini G, Santini D, Michelotti A, Mentuccia L, Vaccaro A, Magnolfi E, Gelibter A, Magri V, Cortesi E, D’Onofrio L, Cassano A, Cazzaniga M, Moscetti L, Fabbri A, Scinto AF, Corsi D, Carbognin L, Bria E, La Verde N, Garufi C, Di Stefano P, Mirabelli R, Veltri E, Paris I, Giotta F, Lorusso V, Landucci E, Ficorella C, Roselli M, Adamo V, Ricciardi G, Russo A, Valerio MR, Berardi R, Pistelli M, Cannita K, Zamagni C, Garrone O, Baldini E, Livi L, Meattini I, Del Medico P, Generali D, De Maria R, Risi E, Ciliberto G, Villa A, Sperduti I, Mazzotta M, Barba M, Giordano A, Vici P (2020) Impact of BMI on HER2+ metastatic breast cancer patients treated with pertuzumab and/or trastuzumab emtansine. Real-world evidence. J Cell Physiol 235:7900–7910. https://doi.org/10.1002/jcp.29445

Article CAS PubMed Google Scholar
Alarfi H, Salamoon M, Kadri M, Alammar M, Haykal MA, Alseoudi A, Youssef LA (2017) The impact of baseline body mass index on clinical outcomes in metastatic breast cancer: a prospective study. BMC Res Notes 10:550. https://doi.org/10.1186/s13104-017-2876-2

Article PubMed PubMed Central Google Scholar
Bhaskaran K, dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L (2018) Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3·6 million adults in the UK. Lancet Diabetes Endocrinol 6:944–953. https://doi.org/10.1016/S2213-8587(18)30288-2

Article PubMed PubMed Central Google Scholar
Cheng FW, Gao X, Mitchell DC, Wood C, Still CD, Rolston D, Jensen GL (2016) Body mass index and all-cause mortality among older adults. Obesity (Silver Spring) 24:2232–2239. https://doi.org/10.1002/oby.21612

Article PubMed Google Scholar
Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA (2014) BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 99:875–890. https://doi.org/10.3945/ajcn.113.068122

Article CAS PubMed Google Scholar
Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P (2020) Body mass index and all-cause mortality in older adults: a scoping review of observational studies. Obes Rev 21:e13035. https://doi.org/10.1111/obr.13035

Article PubMed Google Scholar
Reeves KW, Faulkner K, Modugno F, Hillier TA, Bauer DC, Ensrud KE, Cauley JA (2007) Body mass index and mortality among older breast cancer survivors in the Study of Osteoporotic Fractures. Cancer Epidemiol Biomarkers Prev 16:1468–1473. https://doi.org/10.1158/1055-9965.Epi-07-0051

Article PubMed Google Scholar
Meegdes M, Geurts SME, Erdkamp FLG, Dercksen MW, Vriens BEPJ, Aaldering KNA, Pepels MJAE, van de Winkel LMH, Peters NAJB, Tol J, Heijns JB, van de Wouw AJ, de Fallois AJO, van Kats MACE, Tjan-Heijnen VCG (2023) Real-world time trends in overall survival, treatments and patient characteristics in HR+/HER2− metastatic breast cancer: an observational study of the SONABRE Registry. Lancet Reg Health Eur 26:100573. https://doi.org/10.1016/j.lanepe.2022.100573

Article PubMed PubMed Central Google Scholar
Tjan-Heijnen VCG (2018) Southeast Netherlands Advanced Metastatic Breast Cancer Registry (SONABRE), clinicaltrials.gov. National Library of Medicine, Bethesda, MD
Meegdes M, Geurts SME, Erdkamp FLG, Dercksen MW, Vriens B, Aaldering KNA, Pepels M, van de Winkel LMH, Teeuwen NJA, de Boer M, Tjan-Heijnen VCG (2022) The implementation of CDK 4/6 inhibitors and its impact on treatment choices in HR+/HER2- advanced breast cancer patients: a study of the Dutch SONABRE Registry. Int J Cancer 150:124–131. https://doi.org/10.1002/ijc.33785

Article CAS PubMed Google Scholar
Lennon H, Sperrin M, Badrick E, Renehan AG (2016) The obesity paradox in cancer: a review. Curr Oncol Rep 18:56. https://doi.org/10.1007/s11912-016-0539-4

Article PubMed PubMed Central Google Scholar
Li Y, Li C, Wu G, Yang W, Wang X, Duan L, Niu L, Chen J, Zhang Y, Zhou W, Liu J, Hong L, Fan D (2022) The obesity paradox in patients with colorectal cancer: a systematic review and meta-analysis. Nutr Rev 80:1755–1768. https://doi.org/10.1093/nutrit/nuac005

Article PubMed Google Scholar
McQuade JL, Daniel CR, Hess KR, Mak C, Wang DY, Rai RR, Park JJ, Haydu LE, Spencer C, Wongchenko M, Lane S, Lee D-Y, Kaper M, McKean M, Beckermann KE, Rubinstein SM, Rooney I, Musib L, Budha N, Hsu J, Nowicki TS, Avila A, Haas T, Puligandla M, Lee S, Fang S, Wargo JA, Gershenwald JE, Lee JE, Hwu P, Chapman PB, Sosman JA, Schadendorf D, Grob J-J, Flaherty KT, Walker D, Yan Y, McKenna E, Legos JJ, Carlino MS, Ribas A, Kirkwood JM, Long GV, Johnson DB, Menzies AM, Davies MA (2018) Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis. Lancet Oncol 19:310–322. https://doi.org/10.1016/S1470-2045(18)30078-0

Article PubMed PubMed Central Google Scholar
Simkens LH, Koopman M, Mol L, Veldhuis GJ, Ten Bokkel HD, Muller EW, Derleyn VA, Teerenstra S, Punt CJ (2011) Influence of body mass index on outcome in advanced colorectal cancer patients receiving chemotherapy with or without targeted therapy. Eur J Cancer 47:2560–2567. https://doi.org/10.1016/j.ejca.2011.06.038

Article PubMed Google Scholar
Montgomery RB, Goldman B, Tangen CM, Hussain M, Petrylak DP, Page S, Klein EA, Crawford ED (2007) Association of body mass index with response and survival in men with metastatic prostate cancer: Southwest Oncology Group trials 8894 and 9916. J Urol 178:1946–1951; discussion 1951. https://doi.org/10.1016/j.juro.2007.07.026

Article PubMed Google Scholar
Modi ND, Tan JQE, Rowland A, Koczwara B, Abuhelwa AY, Kichenadasse G, McKinnon RA, Wiese MD, Sorich MJ, Hopkins AM (2021) The obesity paradox in early and advanced HER2 positive breast cancer: pooled analysis of clinical trial data. NPJ Breast Cancer 7:30. https://doi.org/10.1038/s41523-021-00241-9

Article CAS PubMed PubMed Central Google Scholar
Moon H-G, Han W, Noh D-Y (2009) Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol 27:5899–5905. https://doi.org/10.1200/jco.2009.22.4436

Article PubMed Google Scholar
Kwan ML, Chen WY, Kroenke CH, Weltzien EK, Beasley JM, Nechuta SJ, Poole EM, Lu W, Holmes MD, Quesenberry CP Jr, Pierce JP, Shu XO, Caan BJ (2012) Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project. Breast Cancer Res Treat 132:729–739. https://doi.org/10.1007/s10549-011-1914-3

Article PubMed Google Scholar
Trestini I, Carbognin L, Monteverdi S, Zanelli S, De Toma A, Bonaiuto C, Nortilli R, Fiorio E, Pilotto S, Di Maio M, Gasbarrini A, Scambia G, Tortora G, Bria E (2018) Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer. Crit Rev Oncol Hematol 129:54–66. https://doi.org/10.1016/j.critrevonc.2018.06.011

Article PubMed Google Scholar
Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15:2920–2926. https://doi.org/10.1158/1078-0432.Ccr-08-2242

Article CAS PubMed Google Scholar
Shachar SS, Deal AM, Weinberg M, Nyrop KA, Williams GR, Nishijima TF, Benbow JM, Muss HB (2017) Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane-based chemotherapy. Clin Cancer Res 23:658–665. https://doi.org/10.1158/1078-0432.Ccr-16-0940

Article CAS PubMed Google Scholar
Franzoi MA, Vandeputte C, Eiger D, Caparica R, Brandão M, De Angelis C, Hendlisz A, Awada A, Piccart M, de Azambuja E (2020) Computed tomography-based analyses of baseline body composition parameters and changes in breast cancer patients under treatment with CDK 4/6 inhibitors. Breast Cancer Res Treat 181:199–209. https://doi.org/10.1007/s10549-020-05617-2

Article CAS PubMed Google Scholar

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Acknowledgements

The SONABRE registry was funded by the Netherlands Organisation for Health Research and Development (ZonMw: 80-82500-98-8003), Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, AstraZeneca, and Gilead. We would like to thank all SONABRE data managers of the department of Medical Oncology of the Maastricht University Medical Centre (MUMC +), Maastricht, The Netherlands.

Funding

This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw: 80-82500-98-8003), Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, AstraZeneca, and Gilead.

Author information

Authors and Affiliations

Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

Senna W. M. Lammers, Hannah Thurisch, Ingeborg J. H. Vriens, Marissa Meegdes, Nathalie J. A. Teeuwen, Sandra M. E. Geurts & Vivianne C. G. Tjan-Heijnen
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

Sanne M. E. Engelen
Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands

Frans L. G. Erdkamp
Department of Medical Oncology, Máxima Medical Centre, Eindhoven, The Netherlands

M. Wouter Dercksen
Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands

Birgit E. P. J. Vriens
Department of Internal Medicine, Laurentius Hospital, Roermond, The Netherlands

Kirsten N. A. Aaldering
Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands

Manon J. A. E. Pepels
Department of Internal Medicine, St. Anna Hospital, Geldrop, The Netherlands

Linda M. H. van de Winkel
Department of Internal Medicine, St. Jans Gasthuis, Weert, The Netherlands

Natascha A. J. B. Peters
Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands

Jolien Tol
Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands

Joan B. Heijns
Department of Internal Medicine, Viecuri Medical Centre, Venlo, The Netherlands

Agnes J. van de Wouw

Contributions

SWML, HT, IJHV, MM, SMEG, and VCGT-H contributed to conceptualisation, methodology, and investigation; FLGE, MWD, BEPJV, KNAN, MJAEP, LMHvdW, AJvdW, NAJBP, and JT contributed to resources; SWML, HT, and SMEG performed data curation, formal analysis, and visualization; VCGT-H performed supervision; SWML, HT, IJHV, SMEG, and VCGT-H prepared the original draft of the manuscript; All authors carefully reviewed the first draft of the manuscript and provided feedback when necessary. SWML, IJHV, SMEG, and VCGT-H discussed feedback and prepared the final manuscript. All authors gave approval for publication of the final manuscript.

Corresponding author

Correspondence to Vivianne C. G. Tjan-Heijnen.

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Conflict of interest

SWML reports grants from AstraZeneca and Eli Lilly outside the submitted work. IJHV reports grants from AstraZeneca, Pfizer, and Eli Lilly outside the submitted work. MM reports institutional grants from Roche, Pfizer, Novartis, Eli Lilly, and Gilead during the conduct of the study. MWD had a consulting role for Novartis. JT had a consulting role for Amgen. NJAT reports institutional grants from Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, AstraZeneca, and Gilead during the conduct of the study. SMEG reports institutional grants from Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, AstraZeneca, and Gilead during the conduct of the study; personal fees from AstraZeneca outside the submitted work. VCGT-H reports grants and personal fees from AstraZeneca, Novartis, and Eli Lilly during the conduct of the study; grants from Roche, Pfizer, Daiichi Sankyo, and Gilead during the conduct of the study. VCGT-H has a consulting role for AstraZeneca, Eli Lilly, and Novartis. The other authors have declared no conflicts of interests.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Research Ethics Committee of the Maastricht University Medical Centre, Maastricht (METC 15-4-239).

Consent to participate

The need for informed consent was waived by the medical ethics committee.

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