A personalized approach to obesity treatment may help breast cancer survivors improve their long-term health by identifying early which patients need more than behavioral lifestyle intervention alone
The phase II Adaptive Nutrition and Exercise Weight Loss (A-NEW) trial found that breast cancer survivors who did not achieve clinically meaningful weight loss after 2 months of a structured nutrition and exercise program were significantly more likely to reach that goal after a U.S. Food and Drug Administration (FDA)-approved anti-obesity medication was added to their treatment plan. The findings, reported by Sheng et al in Clinical Cancer Research, suggest that assessing patients’ early response to behavioral therapy can help clinicians tailor obesity treatment—rather than relying on a one-size-fits-all approach.
Obesity affects more than one in three breast cancer survivors, and it is associated with an increased risk of cancer recurrence, cardiovascular disease, poorer quality of life, and premature death. Although nutrition and physical activity programs are the foundation of weight management, many survivors are unable to lose enough weight through lifestyle changes alone
“Many breast cancer survivors strive to lose weight after treatment because they know it can improve their long-term health, but lifestyle changes alone don’t work for everyone,” explained lead study author Jenni Sheng, MD, Assistant Professor of Oncology at Johns Hopkins Medicine. “Our study suggests we don’t have to take a one-size-fits-all approach. By identifying early who isn’t responding to behavioral therapy alone, we can personalize treatment and offer additional tools that help more survivors achieve meaningful weight loss and potentially reduce their risk of future health problems.”
A-NEW Methodology and Findings
The A-NEW study enrolled women with stage 0 to III breast cancer with overweight or obesity. All participants completed a comprehensive 6-month behavioral weight-loss program that included individualized nutrition counseling, physical activity guidance, remote coaching, and self-monitoring
After 2 months, investigators evaluated participants’ progress. Women who had already lost at least 5% of their body weight continued the lifestyle program alone; those who had not met that threshold were prescribed the FDA-approved medication naltrexone/bupropion and continued the behavioral intervention
Among the 53 participants evaluated after 2 months, nearly 72% had not achieved the 5% weight-loss benchmark through lifestyle intervention alone. After medication was added, 42% of those early nonresponders achieved clinically meaningful weight loss by 6 months. Participants who responded to behavioral intervention alone lost an average of 10.8% of their body weight, while those receiving the adaptive combination approach lost an average of 5.1%
Beyond weight loss, participants who achieved at least a 5% reduction in body weight reported improvements in physical function and pain. Investigators also observed improvements in important cardiometabolic risk factors, including hemoglobin A1c and triglyceride levels, among participants receiving the adaptive treatment strategy
Researchers found that Black participants, younger women, and premenopausal women were more likely to experience slower initial weight loss, underscoring the need for individualized obesity treatment strategies and additional research to better understand barriers to successful weight management in these populations
The medication was generally well tolerated. Gastrointestinal side effects, including constipation and nausea, were the most common adverse events, and only one participant discontinued treatment because of medication-related side effects.
Although the study was relatively small and not designed as a randomized comparison, investigators believe it is the first prospective clinical trial to evaluate an adaptive treatment strategy that uses early weight-loss response to guide the addition of an FDA-approved anti-obesity medication in breast cancer survivors. Larger randomized studies will be needed to confirm the findings and determine whether similar approaches using newer obesity medications can further improve outcomes
DISCLOSURE: The ANEW study was funded by the NCCN Foundation, the American Institute for Cancer Research, the Breast Cancer Research Foundation, the Maryland Cigarette Restitution Fund, the National Capital Cancer Research Fund, the National Institutes of Health grant P30 CA006973, and Under Armour. For full disclosures of the study authors, visit aacrjournals.org/clincancerres
