Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value

Srdić, Dražena; Pleština, Sanja; Sverko-Peternac, Ana; Nikolac, Nora; Šimundić, Ana-Maria; Samaržija, Miroslav

doi:10.1007/s00520-016-3287-y

Cited by 88 publications

(61 citation statements)

References 31 publications

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“…The results did not identify any statistically significant relationships between the presence of sarcopenia and any of the chemotherapy outcomes. These findings supported by larger study which included 100 NSCLC patients [25], however, are in direct contrast to other findings that have demonstrated a reduced disease response and increased treatment toxicities with the presence of sarcopenia [9,10] although these were also relatively small studies, both with sample sizes of 55.…”

Section: Discussionsupporting

confidence: 51%

Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

White

Weekes

Grant

et al. 2020

Support Care Cancer

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Purpose Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes. Methods CC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored. Results Twenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle's dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified. Conclusions Limited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.

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Section: Discussionsupporting

confidence: 51%

Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

White

Weekes

Grant

et al. 2020

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“…For advanced NSCLC, in addition to conventional cytotoxic chemotherapy, new molecular targeted drugs and cancer immunotherapy have revolutionized treatment. Sarcopenia is still controversial as a prognostic factor of cytotoxic chemotherapy for patients with advanced NSCLC [6][7][8][9]. Skeletal muscle index (SMI), but not skeletal muscle radiodensity (SMD), was a significant prognostic factor in an Italian study [9].…”

Section: Introductionmentioning

confidence: 97%

Sarcopenia and Visceral Adiposity Did Not Affect Efficacy of Immune-Checkpoint Inhibitor Monotherapy for Pretreated Patients With Advanced Non-Small Cell Lung Cancer

Minami¹,

Ihara²,

Tanaka³

et al. 2020

World J Oncol

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Background: This study aimed to investigate the association of computed tomography (CT)-assessed sarcopenia and visceral adiposity with efficacy and prognosis of immune-checkpoint inhibitor (ICI) therapy for pretreated non-small cell lung cancer (NSCLC). Methods: We retrospectively collected 74 patients with pretreated NSCLC who had initiated programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitor monotherapy between December 2015 and November 2018 at our hospital. As CT-assessed pretreatment markers, we used psoas muscle index (PMI), intramuscular adipose tissue content (IMAC), visceral-tosubcutaneous ratio (VSR) and visceral fat area (VFA) at lumbar vertebra L3 level. We divided 74 patients into high and low groups according to each Japanese sex-specific cutoff value. Using Kaplan-Meier curves and log-rank tests, we compared overall survival (OS) and progression-free survival (PFS). Adjusted by serum albumin, neutrophil-to-lymphocyte ratio, performance status and driver mutations, multivariate Cox proportional hazard analyses evaluated various variables as independent prognostic factors of OS and PFS. Results: We could not find significant difference in response rate (RR) and disease control rate (DCR) between low and high groups according to any factors. The OS of patients with body mass index (BMI) < 18.5 was significantly shorter than that of patients with BMI ≥ 18.5 (median 3.3 vs. 15.8 months, P < 0.01), while there was no significant difference in OS and PFS according to PMI, IMAC, VSR and VFA. Multivariate analyses detected no significant prognostic factor in OS and PFS, except for low IMAC (hazard ratio 0.43, 95% confidence interval 0.18-0.998, P = 0.0496) as a favorable prognostic factor of longer OS. Conclusions: Neither PMI nor VSR, VFA might be a significant prognostic factor of PFS and OS of ICI monotherapy for pretreated NSCLC. According to our multivariate analyses, IMAC was a significant prognostic factor of OS, but not of PFS. Thus, neither sarcopenia nor visceral adiposity may be associated with the efficacy of ICI therapy.

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“…Following, Martin et al proposed SMI thresholds for sarcopenia in non-obese Caucasians according to sex and BMI (Martin et al, 2013) based on optimal stratification of SMI and survival; selected cut-off values were 43 and 53 cm²/m² in men with a BMI < and > 25 kg/m 2 , respectively, and 41 cm²/m² in women. Several further studies have demonstrated predictive value for toxicity (Sjøblom et al, 2015;Srdic et al, 2016;Stene et al, 2015;B. H. L. Tan et al, 2015), post-surgery complications (Lieffers, Bathe, Fassbender, Winget, & Baracos, 2012;P.…”

Section: Unsolved Questions Including Cut-off Issuesmentioning

confidence: 99%

“…Contrarily, eight studies showed no association between sarcopenia and chemotherapy toxicity (Blauwhoff-Buskermolen et al, Jung et al, 2015;Miyata et al, 2017;Palmela et al, 2017;Parsons, Tsimberidou, et al, 2012;Rollins et al, 2016;Srdic et al, 2016;Stene et al, 2015;Versteeg et al, 2017). One explanation could be that not all forms of chemotherapy exhibit sarcopenia-dependent toxicity, even if the studies were adequately powered to detect an association.…”

Section: Chemotherapymentioning

confidence: 99%

“…carboplatin, etoposide, cisplatin, docetaxel, paclitaxel, irinotecan) in patients with hypoalbuminemia. In a prospective cohort of 100 patients with NSCLC (Srdic et al, 2016), albumin concentration was established as a predictive factor for both chemotherapy toxicity and survival. This finding was confirmed in other studies of NSCLC (Arrieta et al, 2010;X.…”

Section: Distribution Changesmentioning

confidence: 99%

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

Hilmi

Jouinot

Burns

et al. 2019

Pharmacology & Therapeutics

111

112

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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.

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Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value

Abstract: Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are. This approach in clinical settings can be used to guide the choice of oncologic treatment.

Cited by 88 publications

References 31 publications

Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

Sarcopenia and Visceral Adiposity Did Not Affect Efficacy of Immune-Checkpoint Inhibitor Monotherapy for Pretreated Patients With Advanced Non-Small Cell Lung Cancer

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

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