Adjuvant chemotherapy for breast cancer is gerontogenic, inducing cellular senescence in vivo, thereby accelerating molecular aging of hematopoietic tissues.
Purpose
Severe skeletal muscle (SM) loss (sarcopenia), is associated with poor cancer outcomes including reduced survival and increased toxicity. This study investigates SM measures in metastatic breast cancer (MBC) patients receiving first line taxane-based chemotherapy and evaluates associations with treatment toxicity and other outcomes.
Experimental Design
Using computerized tomography (CT) images taken for the evaluation of disease burden, skeletal muscle area (SMA) and density (SMD) were measured at the 3rd lumbar vertebrae. Sarcopenia was defined as Skeletal Muscle Index (SMI=SMA/height2) ≤41. Skeletal Muscle Gauge (SMG) was created by multiplying SMI x SMD. Fisher’s exact tests, t-tests, the Kaplan-Meier method, and Cox regression modeling were used.
Results
MBC patients (N=40), median age 55 (rang 34–80), 58% sarcopenic, median SMG 1296 AU (SD 522). Grade 3–4 toxicity was found in 57% of sarcopenic vs 18% of non-sarcopenic patients (p=0.02). Toxicity-related hospitalizations were also higher in sarcopenic patients (39% vs 0%, p=0.005) as were any adverse events -- defined as any grade 3–4 toxicities, hospitalizations, dose reductions, or dose delay -- (74% vs 35%, p=0.02). Low SMG was associated with grade 3–4 toxicity (p=0.04), hospitalization (p=0.01) and time to treatment failure (for progression or toxicity) (p=0.03). Low SMG had a borderline significant association with any adverse event (p=0.06) and overall survival (p=0.07).
Conclusions
SM measures are associated with toxicity outcomes and survival in MBC patients receiving first line taxane-based chemotherapy. Further studies are needed to explore how routinely obtained CT scans can be used to individualize dosing and improve treatment planning.
Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group in collaboration with the National Cancer Institute and National Institute on Aging met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.
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