Body composition and sarcopenia: The next-generation of personalized oncology and pharmacology?

Abstract

Body composition has gained increasing attention in oncology in recent years due to fact that sarcopenia has been revealed to be a strong prognostic indicator for survival across multiple stages and cancer types and a predictive factor for toxicity and surgery complications. Accumulating evidence over the last decade has unraveled the "pharmacology" of sarcopenia. Lean body mass may be more relevant to define drug dosing than the "classical" body surface area or flat-fixed dosing in patients with cancer. Since sarcopenia has a major impact on patient survival and quality of life, therapeutic interventions aiming at reducing muscle loss have been developed and are being prospectively evaluated in randomized controlled trials. It is now acknowledged that this supportive care dimension of oncological management is essential to ensure the success of any anticancer treatment. The field of sarcopenia and body composition in cancer is developing quickly, with (i) the newly identified concept of sarcopenic obesity defined as a specific pathophysiological entity, (ii) unsolved issues regarding the best evaluation modalities and cutoff for definition of sarcopenia on imaging, (iii) first results from clinical trials evaluating physical activity, and (iv) emerging body-compositiontailored drug administration schemes. In this context, we propose a comprehensive review providing a panoramic approach of the clinical, pharmacological and therapeutic implications of sarcopenia and body composition in oncology.

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

“…It has been shown that lean body mass correlates better with pharmacokinetics and drug toxicities . The measurements of body composition other than BMI using readily available CT images might help guide individualized treatment and supportive care …”

“…These cut‐offs were established from Canadian population with respiratory or gastrointestinal tract cancer. However, the body composition may be affected by the type and stage of the cancer and by demographic factors such as age, sex, and ethnicity . The BMI of the Asian population is relatively low compared with that of the Canadian population .…”

“…[52][53][54] The measurements of body composition other than BMI using readily available CT images might help guide individualized treatment and supportive care. 18,58 Skeletal muscle gauge is a recently devised metric that incorporates both SMD and SMI and has already been shown to be very useful in predicting treatment-related toxicities. [31][32][33][34] Shachar et al have shown that SMG was a better predictor of grade ≥3 chemotherapy toxicity compared with SMI or SMD in women with early-stage breast cancer undergoing anthracycline and taxane-based chemotherapy.…”

“…However, the body composition may be affected by the type and stage of the cancer and by demographic factors such as age, sex, and ethnicity. 37,58,63 The BMI of the Asian population is relatively low compared with that of the Canadian population. 64 Hence, the cut-off values of Martin et al may not be applicable to the Asian cohort, as they might skew the results.…”

“…31 The actual units for SMG are (cm 2 tissue × average HU)/(m 2 height); for simplicity, we present them as arbitrary units. 32,33 Given that the body composition varies greatly with the type and stage of the cancer, geographical regions, and ethnicities, 57,58 we defined our own cut-off values for this cohort based on previous studies with similar population sizes. 42,59 Cut-off values were set at the lowest tertile for SMI, SMD, and SMG and at the highest tertile for TATI.…”