Body composition and anti-neoplastic treatment in adult and older subjects - A systematic review

Gérard, Stéphane; Bréchemier, Delphine; Lefort, Amandine; Lozano, S.; Kan, Gabor Abellán van; Filleron, Thomas; Mourey, Loïc; Bernard-Marty, Chantal; Rougé‐Bugat, Marie‐Ève; Soler, V.; Vellas, Bruno; Cesari, Matteo; Rolland, Yves; Balardy, L.

doi:10.1007/s12603-015-0653-2

Cited by 34 publications

(27 citation statements)

References 81 publications

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“…This could result in overdosing in patients with sarcopenic obesity because of their high body surface area and decreased muscle mass, as reported in previous studies. 10,20,34,36 In our study, we found that BMI did not differ between CT 1 and CT 2 although muscle mass decreased significantly, which supports earlier findings stating that muscle mass is not necessarily associated with BMI and that loss of muscle mass could be accompanied by growth of adipose tissue. 13,35 Accordingly, there were significantly more patients with sarcopenia and sarcopenic obesity at the time of the evaluation CT scan than at the pre-treatment scan.…”

Section: Discussionsupporting

confidence: 90%

“…A possible explanation is that oxaliplatin is a lipophilic agent and accumulates in the fat tissue compartments. In patients with excess fat, this may result in longer exposure to the drug that could lead to increased risk of neuropathy in sarcopenic obesity patients . Currently, dosing chemotherapy is performed base on body surface area, which is based on a patient's height and weight and used as an index for chemotherapy dosing, without taken body composition into account.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with excess fat, this may result in longer exposure to the drug that could lead to increased risk of neuropathy in sarcopenic obesity patients. 34,35 Currently, dosing chemotherapy is performed base on body surface area, which is based on a patient's height and weight and used as an index for chemotherapy dosing, without taken body composition into account. This could result in overdosing in patients with sarcopenic obesity because of their high body surface area and decreased muscle mass, as reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

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Background Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy‐related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first‐line palliative chemotherapy. Methods A total of 88 patients with advanced esophagogastric cancer treated with standard first‐line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre‐treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m 2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. Results Of 88 patients, 75% was male, and median age was 63 (interquartile range 56–69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range −8.6–−0.4). Median progression‐free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre‐treatment and after three cycles) were neither associated with progression‐free nor overall survival. Pre‐treatment SMD was independently associated with grade 3–4 toxicity (odds ratio 0.94; 95% confidence interval 0.89–1.00) and sarcopenic obesity with grade 2–4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20–12.18). Conclusions Sarcopenia was not associated with survival or treatment‐related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre‐treatment sarcopenic obesity was independently associated with the occurrence of grade 2–4 neurotoxicity and skeletal muscle density with grade 3–4 toxicity.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

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“…Malnutrition is associated with increased chemotherapy toxicity in various malignancies, including breast cancer, colorectal cancer, renal cancer, and other solid tumors [3, 11, 13-15, 17, 19, 22]. However, limited data are available on the role of BMI as a risk factor for toxicity in patients with STS treated with trabectedin.…”

Section: Discussionmentioning

confidence: 99%

“…The balance of evidence from these studies suggests that low BMI and/or low lean body mass and sarcopenia are associated with dose-limiting toxicity [3, 11, 13-15, 17, 19, 22]. …”

Section: Introductionmentioning

confidence: 99%

Body Mass Index as a Risk Factor for Toxicities in Patients with Advanced Soft-Tissue Sarcoma Treated with Trabectedin

et al. 2018

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Objectives: Low body mass index (BMI) and/or low lean body mass have been shown to be risk factors for chemotherapy-related toxicities in a number of different cancers. However, no data are available regarding the role of BMI as a risk factor for developing toxicities related to the novel anticancer agent, trabectedin, in patients with soft-tissue sarcoma (STS). We evaluated the role of BMI as a risk factor for trabectedin-related toxicity in patients with STS. Methods: Data from 51 patients with metastatic/advanced STS treated with trabectedin after progression on ≥1 anthracycline ± ifosfamide regimen were retrospectively reviewed. Results: Eighteen patients (35.3%) were underweight, and the remainder were of normal bodyweight (45.1%) or overweight (19.6%). Neutropenia of any grade (77.8 vs. 33.3%) and grade 3–4 neutropenia (50.0 vs. 18.2%) occurred more frequently in the underweight versus normal/overweight patients (p = 0.025). Febrile neutropenia also occurred more frequently in underweight patients. Differences remained statistically significant after adjusting for other predictors of toxicity. There were no significant differences in other hematological and nonhematological toxicities between the groups. Conclusions: The data suggest for the first time that BMI should be considered a risk factor for neutropenia in patients with STS treated with trabectedin.

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Chemotherapy dosing and toxicity in a patient with muscular dystrophy

Lomma

Ransom

2018

Cancer Reports

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BackgroundChemotherapy dosing has traditionally been based on a body surface area (BSA) calculation despite BSA dosing being problematic in a number of conditions, such as renal failure, liver failure, obesity, and sarcopenia. This case highlights another condition in which BSA dosing is problematic.CaseA 57‐year‐old man with limb‐girdle muscular dystrophy presents with stage IIA inoperable squamous cell carcinoma of the lung. He is treated with chemotherapy and radiotherapy with curative intent but develops significant chemotherapy related toxicity affecting chemotherapy scheduling and dosing. Later, his cancer progresses, and he is commenced on palliative chemotherapy resulting in further significant chemotherapy toxicity.ConclusionSarcopenia is known to increase risk of chemotherapy toxicity. This case postulates that changes in muscle mass seen in muscular dystrophy increases risk of chemotherapy toxicity, similar to sarcopenia.

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Body composition and anti-neoplastic treatment in adult and older subjects - A systematic review

Cited by 34 publications

References 81 publications

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Body Mass Index as a Risk Factor for Toxicities in Patients with Advanced Soft-Tissue Sarcoma Treated with Trabectedin

Chemotherapy dosing and toxicity in a patient with muscular dystrophy

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