Is sarcopenia a missed factor in the management of patients with metastatic breast cancer?

Abstract

Background: Sarcopenia has emerged as an important parameter to predict outcomes and treatment toxicity. However, limited data are available to assess sarcopenia prevalence in metastatic breast cancer and to evaluate its management. Methods: The SCAN study was a cross-sectional multicenter French study that aimed to estimate sarcopenia prevalence in a real-life sample of metastatic cancer patients. Sarcopenia was identified by low muscle mass (estimated from the skeletal muscle index at the third lumbar, via computed tomography) and low muscle strength (defined by handgrip strength). Three populations were distinguished based on EWGSOP criteria: a sarcopenic group with low muscle mass AND strength, a pre-sarcopenic group with low muscle mass OR strength and a normal group with high muscle mass AND strength. Results: Among 766 included patients, 139 patients with breast cancer and median age of 61.2 years (29.9 e97.8 years) were evaluable; 29.5% were sarcopenic and 41.0% were pre-sarcopenic. Sarcopenic patients were older (P < 0.01), had a worse PS-score (P < 0.05), and a higher number of metastatic sites (P < 0.01), the majority being hepatic and bone. A moderate agreement between the oncologist's diagnosis and sarcopenia evaluation by muscle mass and strength was recognized (Cohen's kappa ¼ 0.45). No associations were found between sarcopenia and adverse event occurrence in the 12 patients for whom these were reported. Sarcopenic patients were underdiagnosed and nutritional care and physical activity were less proposed. Conclusion: It is necessary to evaluate sarcopenia due to its impact on patient prognosis, and its utility in guiding patient management in metastatic breast cancer.

Integrated Evaluation of Inflammatory, Nutritional, and Sarcopenia Markers to Predict Survival in Metastatic Breast Cancer Patients

“…To date, there have been few reports on the association between PMI and the prognosis of MBC (30), in comparison to other solid tumors. In patients with breast cancer, the skeletal muscle index or muscle strength-other makers of sarcopenia-may be more useful for predicting the prognosis (3,31). While there have been reports on the integrated evaluation of inflammatory, nutritional, and sarcopenia markers in urologic cancer patients (32,33), this is the first report to describe an integrated evaluation of these markers for predicting the prognosis of patients with MBC.…”

Sarcopenia, adiposity, and discrepancies in cystatin C versus creatinine-based eGFR in patients with cancer: a cross-sectional study

“…Using independent sex-specific thresholds, we found that sarcopenia was common in our cohort: more than half (59%) met the imaging criteria for sarcopenia, in line with recent studies in patients with cancer, reporting a range of sarcopenia on imaging between 30 -72%. [44][45][46][47] Sarcopenia is associated with decreased survival in patients with cancer and has been associated with increased treatment-related toxicity in patients receiving antineoplastic therapies. [48][49][50][51] We hypothesize that medication overdose due to inaccurate estimation of GFR when relying on eGFRCRE in patients with sarcopenia may cause dose-related chemotherapy toxicity, particularly with chemotherapies that are renally excreted, 48 and may thereby contribute to the decreased survival in these patients.…”

Validation of bioelectrical impedance analysis in the evaluation of body composition in patients with breast cancer

“…This study evaluated 139 patients with breast cancer who had a median age of 61.2 years (29.9-97.8 years) and showed that 29.5% had sarcopenia, whereas 41.0% had presarcopenia. 22 DXA is a reliable measurement method for measuring body composition because of its high validity and reproducible properties. 23 However, DXA use is limited owing to a lack of availability and high cost.…”