Body Composition by Computed Tomography as a Predictor of Toxicity in Patients With Renal Cell Carcinoma Treated With Sunitinib

Cushen, S.; Power, Derek G.; Teo, Min Yuen; MacEneaney, Peter; Maher, Michael M.; McDermott, Ray; O’Sullivan, Kathleen; Ryan, Aoife M.

doi:10.1097/coc.0000000000000061

Cited by 86 publications

(92 citation statements)

References 32 publications

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“…The same hypothesis holds true for studies on targeted chemotherapy agents (19,37) (Fig. 5) and for hydrophobic agents, where both muscle and adipose tissue may play a role in predicting toxicity (34) .…”

Section: Treatment Toxicitymentioning

confidence: 72%

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Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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Our understanding of body composition (BC) variability in contemporary populations has significantly increased with the use of imaging techniques. Abnormal BC such as sarcopenia (low muscle mass) and obesity (excess adipose tissue) are predictors of poorer prognosis in a variety of conditions or clinical situations. As a catabolic illness, a defining feature of cancer is muscle loss. Although the conceptual model of wasting in cancer is typically conceived as involuntary weight loss leading to low body weight, recent studies have shown that both sarcopenia and cachexia can be present with obesity. The combination of low muscle and high adipose tissue (sarcopenic obesity) is an emerging abnormal BC phenotype prevalent across the body weight, and hence BMI spectra. Sarcopenia and sarcopenic obesity in cancer are in most instances occult conditions, which have been independently associated with higher incidence of chemotherapy toxicity, shorter time to tumour progression, poorer outcomes of surgery, physical impairment and shorter survival. Although the mechanisms are yet to be fully understood, the associations with poorer clinical outcomes emphasise the value of nutritional assessment as well as the need to develop appropriate interventions to countermeasure abnormal BC. Sarcopenia and sarcopenic obesity create diverse nutritional requirements, highlighting the compelling need for a more comprehensive and differentiated understanding of energy and protein requirements in this heterogeneous population.

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Section: Treatment Toxicitymentioning

confidence: 72%

“…Using CT image analysis we, and others, were able to identify a great variability of BC in contemporary cancer patients (10,(17)(18)(19)(20) , Fig. 2.…”

Section: Defining Divergent Behaviour Of Muscle and Adipose Tissue Inmentioning

confidence: 88%

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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“…Five of these studies have confirmed the relationship for new targeted therapies, administered as flat dose; i.e. sorafenib, sunitinib and vandetanib [27][28][29][30][31]. The majority of studies have, however, addressed single or combined regimens of chemotherapy with doses estimated according to BSA.…”

Section: Discussionmentioning

confidence: 87%

“…Body mass index (BMI) (kg/m 2 ) was categorised as follows: BMI < 20 as underweight, BMI [20,25] as normal weight, BMI [25,30] as overweight and BMI ≥ 30 as obesity [5].…”

Section: Assessments Of Body Compositionmentioning

confidence: 99%

Low muscle mass is associated with chemotherapy-induced haematological toxicity in advanced non-small cell lung cancer

Sjøblom¹,

Grønberg²,

Benth³

et al. 2015

Lung Cancer

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“…Identification of those with sarcopenia is important because sarcopenia is associated with elevated toxicity to chemotherapy (38,(58)(59)(60)(61)(62) . There is mounting evidence that sarcopenia increases the risk of toxicity to many drugs including Epirubicin (58) , Capecitabine (63) , Sunitinub (59) , Sorafinib (60,61) , 5-FU and leucovorin (62) . Table 3 summarises the available evidence for sarcopenia and dose-limiting toxicity in a variety of cancers and different chemotherapy drugs.…”

Section: Impact Of Sarcopenia On Tolerance To Cytotoxic Chemotherapymentioning

confidence: 99%

Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later

et al. 2016

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An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.

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Body Composition by Computed Tomography as a Predictor of Toxicity in Patients With Renal Cell Carcinoma Treated With Sunitinib

Abstract: Sarcopenia is prevalent in patients with mRCC, is an occult condition in patients with normal/high body mass index, and is a significant predictor of DLT in patients receiving sunitinib. Our results highlight the potential use of baseline body composition to predict toxicity.

Cited by 86 publications

References 32 publications

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

Low muscle mass is associated with chemotherapy-induced haematological toxicity in advanced non-small cell lung cancer

Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later

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