Prognostic and Predictive Role of Body Mass Index (BMI) in Metastatic Colorectal Cancer (mCRC): A Pooled Analisys of Tribe and Tribe-2 Studies by GONO

Published:February 19, 2022DOI:



      Obesity is associated with an increased risk of development and recurrence of colorectal cancer. The role of obesity in metastatic colorectal cancer patients (pts) is still unclear, especially in those treated with triplet plus bevacizumab (bev). The aim of our study was to evaluate the prognostic and predictive role of BMI in metastatic colorectal cancer pts treated with FOLFOXIRI plus bev or FOLFIRI/FOLFOX plus bev in the TRIBE and TRIBE-2 trial.

      materials and Methods

      A total of 1160 pts enrolled in TRIBE and TRIBE-2 trials were included. Baseline height and weight were used to assign pts to one of the following BMI categories: underweight (group A = BMI <18.5 kg/m2; 52 pts), normal (group B = BMI 18.5-29.9 kg/m2; 952 pts) and obese (group C > 30 kg/m2; 156 pts).


      In our population, no differences in terms of PFS (P = .43) or OS (P = .99) resulted between 3 groups. No interaction effect between treatment arm and BMI was evident in terms of PFS (Group A HR: 0.65 [95%CI: 0.36-1.16]; Group B HR: 0.77 [95%CI: 0.67-0.88]; Group C HR: 0.67 [95%CI: 0.48-0.93]; P for interaction = .75) or OS (Group A HR: 0.57 [95%CI: 0.29-1.12]; Group B HR: 0.85 [95%CI: 0.73-0.99];Group C HR: 0.69 [95%CI: 0.48-1.01] P for interaction = .36). No statistically significant difference in terms of dose reductions due to toxicities were found according to BMI in the overall population (P = .48) and in pts treated with FOLFOXIRI plus bev (P = .57).


      BMI was neither prognostic or predictive for PFS and OS in our population. Our analyses showed that the advantage of FOLFOXIRI plus bev versus FOLFIRI/FOLFOX plus bev was independent from BMI.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Colorectal Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hales CM
        • Fryar CD
        • Carroll MD
        • Freedman DS
        • Aoki Y
        • Ogden CL.
        Differences in obesity prevalence by demographic characteristics and urbanization level among adults in the United States, 2013-2016.
        JAMA - J Am Med Assoc. 2018; 319 ( 2419-2429
        • Larsson SC
        • Wolk A.
        Obesity and colon and rectal cancer risk: A meta-analysis of prospective studies.
        Am J Clin Nutr. 2007; 86 ( 556-565
        • Sinicrope FA
        • Foster NR
        • Sargent DJ
        • O'Connell MJ
        • Rankin C
        Obesity is an independent prognostic variable in colon cancer survivors.
        Clin Cancer Res. 2010; 16 ( 1884-1893
        • Sinicrope FA
        • Foster NR
        • Yothers G
        • et al.
        Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy.
        Cancer. 2013; 119 ( 1528-1536
        • Dignam JJ
        • Polite BN
        • Yothers G
        • et al.
        Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer.
        J Natl Cancer Inst. 2006; 98 ( 1647-1654
        • Meyerhardt JA
        • Niedzwiecki D
        • Hollis D
        • et al.
        Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from cancer and leukemia group B 89803.
        J Clin Oncol. 2008; 26 ( 4109-4115
        • Pamoukdjian F
        • Aparicio T
        • Canoui-Poitrine F
        • et al.
        Obesity survival paradox in cancer patients: results from the Physical Frailty in older adult cancer patients (PF-EC) study.
        Clin Nutr. 2019; 38 ( 2806-2812
        • Lee DH
        • Giovannucci EL.
        The obesity paradox in cancer: epidemiologic insights and perspectives.
        Curr Nutr Reports. 2019; 83 (2019 175-181
        • Simkens LHJ
        • Koopman M
        • Mol L
        • et al.
        Influence of body mass index on outcome in advanced colorectal cancer patients receiving chemotherapy with or without targeted therapy.
        Eur J Cancer. 2011; 47 ( 2560-2567
        • Renfro LA
        • Loupakis F
        • Adams RA
        • et al.
        Body mass index is prognostic in metastatic colorectal cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database.
        J Clin Oncol. 2016; 34 ( 144-150
        • Aparicio T
        • Ducreux M
        • Faroux R
        • et al.
        Overweight is associated to a better prognosis in metastatic colorectal cancer: A pooled analysis of FFCD trials.
        Eur J Cancer. 2018; 98: 1-9
      1. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up | Elsevier Enhanced Reader n.d. (accessed June 15, 2021).

        • Loupakis F
        • Cremolini C
        • Masi G
        • et al.
        Initial therapy with FOLFOXIRI and Bevacizumab for metastatic colorectal cancer.
        N Engl J Med. 2014; 371 ( 1609-1618
        • Cremolini C
        • Antoniotti C
        • Lonardi S
        • et al.
        Updated results of TRIBE2, a phase III, randomized strategy study by GONO in the first- and second-line treatment of unresectable mCRC.
        J Clin Oncol. 2019; 37 (–3508 3508
        • Dell'Aquila E
        • Cremolini C
        • Zeppola T
        • et al.
        Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO.
        Ann Oncol. 2018; 29 ( 924-930
        • Cremolini C
        • Antoniotti C
        • Rossini D
        • et al.
        Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer (TRIBE2): a multicentre, open-label, phase 3, randomised, controlled trial.
        Lancet Oncol. 2020; 21 ( 497-507
      2. Obesity and overweight. June 15, 2021; (n.d.) (accessed)
        • Bray F
        • Ferlay J
        • Soerjomataram I
        • Siegel RL
        • Torre LA
        • Jemal A.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2018; 68 ( 394-424
        • Martin L
        • Birdsell L
        • MacDonald N
        • et al.
        Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index.
        J Clin Oncol. 2013; 31 ( 1539-1547