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

Vincenzi, Bruno; Badalamenti, Giuseppe; Armento, Grazia; Silletta, Marianna; Ceruso, Mariella Spalato; Catania, Giovanna; Napolitano, Andrea; Maltese, Giuseppa; Valeri, Sergio; Incorvaia, Lorena; Santini, Daniele; Tonini, Giuseppe

doi:10.1159/000487266

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…Consequentially, the DCR is significantly lower in sarcopenic patients (P = 0.032). Studies on other solid tumors have found an association between sarcopenia and toxicity, and there is another body composition marker, namely the body mass index (BMI), that has been identified as a risk factor for toxicity in a/mSTS [28,29]. However, this correlation could not be found in our cohort (Data not shown).…”

Section: Discussioncontrasting

confidence: 64%

Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

et al. 2021

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Introduction Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively. Methods 181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered. Results 28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032). Conclusion This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.

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Section: Discussioncontrasting

confidence: 64%

Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

et al. 2021

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“…Hematological toxicities induced by chemotherapy, such as leukopenia, were not defined as the primary outcome of this study, and probably the small sample size was not sufficient to eliminate type 1 error. In addition, individuals undergoing multiple types of treatment or who have compromised nutritional status, especially in the presence of changes in body composition, such as sarcopenia and cachexia, tend to have higher degrees of toxicity during chemotherapy, [4,[32][33][34][35] which was not observed in the studied population, who, for the most part, were overweight, without significant changes in CC, which is consistent with the literature about the nutritional status of women with breast cancer [32,33]. In addition, the participants in the present study were submitted to a unique therapeutic modality, without having undergone other types of cancer treatments, which may contribute to the long-term impairment of nutritional status.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Intervention Contributes to the Improvement of Symptoms Related to Quality of Life in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Randomized Clinical Trial

Souza

Silva²,

Fayh

2021

Nutrients

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During breast cancer treatment, worsening quality of life (QoL) and the presence of toxicities are common, but healthy eating practices are associated with better clinical results. Thus, this study aims to evaluate the effect of a nutritional intervention on QoL and on gastrointestinal and hematological toxicities resulting from chemotherapy in women with breast cancer. A randomized clinical trial was performed at the beginning of neoadjuvant chemotherapy treatment for women with breast cancer. All participants received nutritional advice on healthy eating practices, but only the intervention group (IG) received an individualized diet plan. The study enrolled 34 women, 19 in the IG and 15 in the control group (CG). During the study, the CG significantly presented a reduction (from 21.6 ± 5.9 kg to 18.8 ± 4.0 kg, p = 0.009) in handgrip strength (HGS), while the IG did not present changes in this variable. Regarding QoL, the IG preserved the role function during treatment and presented better results for nausea/vomiting and loss of appetite compared to the CG. In gastrointestinal and hematological toxicities, the IG had lower frequencies of leukopenia and abdominal pain. The nutritional intervention preserved the role function of QoL and HGS, reduced the occurrence of nausea/vomiting, loss of appetite and the frequency of leukopenia and abdominal pain.

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“…The risk factors for the incidence of FN in the low GNRI group were advanced age, poor PS, and poor nutritional status. In addition, low body weight and hypoalbuminemia are risk factors for FN in several chemotherapy regimens (19)(20)(21)(22)(23)(24). In this study, the low GNRI group also had significantly lower serum albumin levels and body weight at treatment initiation (Table I) and significantly more FN (Table II).…”

Section: Discussionmentioning

confidence: 55%

Influence of Geriatric Nutritional Risk Index on Occurrence of Adverse Events and Duration of Treatment in Patients With Lymphoma Receiving R-CHOP Therapy

Kikuchi¹,

Sawada²,

Takeda³

et al. 2023

In Vivo

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Background/Aim: No studies have examined the association between the Geriatric Nutritional Risk Index (GNRI) at the initiation of chemotherapy for malignant lymphoma and the occurrence of adverse events. Therefore, we investigated the impact of GNRI at treatment initiation on the occurrence of side effects and time to treatment failure (TTF) in patients with malignant lymphoma undergoing initial rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Patients and Methods: This study included 131 patients who underwent initial R-CHOP therapy between March 2016 and October 2021. Patients were stratified into those with high (GNRI ≥92; n=56) or low (GNRI <92; n=75) GNRI status. Results: Comparing the High GNRI group and Low GNRI group, the incidence of febrile neutropenia (FN) and Grade ≥3 creatinine increase, alkaline phosphatase (ALP) increase, albumin decrease, hemoglobin decrease, neutropenia, and thrombocytopenia were significantly higher in the Low GNRI group. TTF in the High GNRI group was significantly longer than that in the Low GNRI group (p=0.045). Multivariate analysis showed that the factors influencing the duration of treatment were PS (≥2) at the start of treatment, serum albumin level, and GNRI. Conclusion: In patients undergoing R-CHOP therapy, GNRI <92 at regimen initiation increased the risks of developing FN and hematologic toxicity. Multivariate analysis revealed that performance status, albumin levels, and GNRI at regimen initiation were the factors influencing treatment duration. Nutritional status at treatment initiation may influence the development of hematologic toxicity and TTF.Malignant lymphomas are histologically classified into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), and many patients in Japan have NHL. The male-to-female ratio is 3:2, with a peak incidence at the age between 70-80 years (1). Diffuse large B-cell lymphoma (DLBCL) accounts for more than 30% of all NHL cases in Japan (2). Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy is the first-line treatment of choice for DLBCL. In addition to hematologic toxicity, R-CHOP is highly emetogenic risk (3); therefore, patients are prone to nausea, vomiting, and anorexia, and 50%, 89%, 24%, and 19% of patients experience nausea and vomiting, leukopenia, thrombocytopenia, and anemia, respectively (4). Furthermore, nutritional disorders and weight loss occur in patients with malignant lymphoma undergoing cancer chemotherapy (5, 6), suggesting poor nutritional status and weight loss due to decreased food intake are associated with adverse events. Weight loss prior to the initiation of cancer chemotherapy is associated with a lower median survival (5) and nutritional status before and during treatment is associated with resistance to treatment, incidence of adverse events, and poor prognosis (5-7). Therefore, the nutritional status of patients undergoing chemotherapy must be assessed to ensure the safety and continuity of treatment, maintain the qual...

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

Cited by 9 publications

References 33 publications

Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

Nutritional Intervention Contributes to the Improvement of Symptoms Related to Quality of Life in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Randomized Clinical Trial

Influence of Geriatric Nutritional Risk Index on Occurrence of Adverse Events and Duration of Treatment in Patients With Lymphoma Receiving R-CHOP Therapy

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