Body composition change during neoadjuvant chemotherapy for breast cancer

Abstract

BackgroundSarcopenia is receiving attention in oncology as a predictor of increased chemotherapy toxicities. Research into body composition change during neoadjuvant chemotherapy for breast cancer is both urgently needed and generally lacking. This study assessed sarcopenia prevalence before and after neoadjuvant chemotherapy using CT imaging, evaluated body composition changes during neoadjuvant chemotherapy, and determined predictors of sarcopenia status after neoadjuvant chemotherapy for breast cancer.Materials and MethodsIn this retrospective, descriptive study, we used data collected from 2017 to 2020 to measure body composition parameters on cross-sectional CT slices for 317 Korean women with breast cancer patients before and at completion of neoadjuvant chemotherapy. Changes in skeletal muscle index, visceral fat index, subcutaneous fat index, and sarcopenia were assessed and correlated, and multivariate logistic regression was conducted to identify predictive factors associated with sarcopenia status at completion of neoadjuvant chemotherapy.ResultsOf the 80 breast cancer patients (25.2%) who had sarcopenia before beginning neoadjuvant chemotherapy, 64 (80.0%) retained their sarcopenia status after chemotherapy. Weight, body mass index, body surface area, and visceral fat index showed significant increases after neoadjuvant chemotherapy; notably, only skeletal muscle index significantly decreased, showing a reduction of 0.44 cm2/m2 (t (316) = 2.15, p <.5). Lower skeletal muscle index at baseline was associated with greater loss of muscle mass during neoadjuvant chemotherapy (r = −.24, p <.001). Multivariate logistic regression showed that baseline sarcopenia status was the only significant predictor of sarcopenia status after neoadjuvant chemotherapy (p <.001). Specifically, the log odds of sarcopenia after neoadjuvant chemotherapy were 3.357 higher in the baseline sarcopenia group than in the group without baseline sarcopenia (β = 3.357, p <.001).ConclusionSarcopenia during neoadjuvant chemotherapy can be obscured by an increasing proportion of fat in body composition if clinical assessment focuses on only body mass index or body surface area rather than muscle mass. For breast cancer patients who have sarcopenia when they begin neoadjuvant chemotherapy, the risk of muscle mass loss during treatment is alarmingly high. To reduce masking of muscle mass loss during treatment, comprehensive evaluation of body composition, beyond body surface area assessment, is clearly needed.

Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

“…This serial biopsy approach allowed the investigators to record changes in mitochondrial biogenesis, mitochondrial dynamics and mitophagy [49 ▪▪ ] as well as fatty infiltration [50], specific to a treatment plan that includes anthracycline, cyclophosphamide and taxane. Although muscle mass loss was undetectable by CT when patients received this regimen [12,13 ▪ ,14] (see above), microscopic and biochemical tests reveal important changes.…”

“…Significant loss of skeletal muscle was observed in all investigated disease sites, settings and regimens (range À3.8 to À13.7%/100 days), with the exception of neoadjuvant chemotherapy for breast cancer (regimens including anthracycline/cyclophosphamide/taxane) in three studies, which were uniformly negative for muscle loss [11,12,13 ]. This is perhaps unsurprising, as weight gain not weight loss is associated with this treatment.…”

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

“…These results concur with our previous study in which we monitored 70 patients with breast cancer for 6 months and reported a significant reduction in muscle mass and an increase in fat mass at 6 months when there was no exercise intervention. Many patients with breast cancer who receive chemoradiation therapy experienced changes in body composition . Our intervention led to minimal changes in body composition in the exercise group despite no additional intervention after 1 month.…”

“…Axillary web syndrome 0 tients with breast cancer who receive chemoradiation therapy experienced changes in body composition. [46][47][48] Our intervention led to minimal changes in body composition in the exercise group despite no additional intervention after 1 month. Based on our findings, we can speculate that providing exercise rehabilitation would reduce medical expenses and lower the economic burden on the health care system.…”

A real-world clinicopathological model for predicting pathological complete response to neoadjuvant chemotherapy in breast cancer

“…It has shown notable efficacy in enhancing event-free survival (EFS) and overall survival (OS) rates, particularly among patients who achieve pathological complete response (pCR) during treatment ( 6 – 8 ). Additionally, the customization of post-neoadjuvant treatments has been promising in augmenting long-term outcomes for patients who do not attain pCR ( 9 , 10 ). This underscores the importance of accurately predicting pCR in breast cancer patients, a critical factor in optimizing treatment strategies and improving survival prospects.…”