Samantha J Cushen1, Derek G Power, Min Y Teo, Peter MacEneaney, Michael M Maher, Ray McDermott, Kathleen O'Sullivan, Aoife M Ryan. 1. *Department of Food & Nutritional Sciences ∥School of Mathematical Science, University College Cork †Department of Medical Oncology, Mercy & Cork University Hospitals §Department of Radiology, Mercy University Hospital, Cork ‡Department Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Ireland.
Abstract
BACKGROUND: Sunitinib is a standard first-line option for metastatic renal cell carcinoma (mRCC). Body composition is a prognostic factor in cancer patients and patients with loss of skeletal muscle mass and fat-free mass (FFM) are prone to dose-limiting toxicity (DLT) during targeted drug therapy. We investigated whether body composition by computed tomography predicted DLT from sunitinib in mRCC. METHODS: Patients with clear cell mRCC receiving sunitinib (50 mg) were included. Skeletal muscle cross-sectional area at L3 was measured by computed tomography. Sarcopenia was defined using published cutoffs. Toxicity was assessed after 4 cycles of the drug. RESULTS: Fifty-five patients (43 male), mean age 64 years were included. Overall, 33% (N=18) of all patients were sarcopenic and of these 12.7% (N=7) were sarcopenic and overweight or obese. DLT occurred in <6 months in 53% of patients (44% male vs. 83% female) and those who experienced DLT were older (68 vs. 60 y), had a lower skeletal muscle index (51.7 vs. 59.4 cm/m), a lower FFM (51.4 vs. 57.7 kg), and received a higher drug dose in mg/kg FFM (0.9 vs. 0.8). Patients with the lowest compared with the highest measurements of skeletal muscle mass experienced more DLT, respectively, 92% versus 57% and experienced on average 5 toxicities versus 2. CONCLUSIONS: 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.
BACKGROUND:Sunitinib is a standard first-line option for metastatic renal cell carcinoma (mRCC). Body composition is a prognostic factor in cancerpatients and patients with loss of skeletal muscle mass and fat-free mass (FFM) are prone to dose-limiting toxicity (DLT) during targeted drug therapy. We investigated whether body composition by computed tomography predicted DLT from sunitinib in mRCC. METHODS:Patients with clear cell mRCC receiving sunitinib (50 mg) were included. Skeletal muscle cross-sectional area at L3 was measured by computed tomography. Sarcopenia was defined using published cutoffs. Toxicity was assessed after 4 cycles of the drug. RESULTS: Fifty-five patients (43 male), mean age 64 years were included. Overall, 33% (N=18) of all patients were sarcopenic and of these 12.7% (N=7) were sarcopenic and overweight or obese. DLT occurred in <6 months in 53% of patients (44% male vs. 83% female) and those who experienced DLT were older (68 vs. 60 y), had a lower skeletal muscle index (51.7 vs. 59.4 cm/m), a lower FFM (51.4 vs. 57.7 kg), and received a higher drug dose in mg/kg FFM (0.9 vs. 0.8). Patients with the lowest compared with the highest measurements of skeletal muscle mass experienced more DLT, respectively, 92% versus 57% and experienced on average 5 toxicities versus 2. CONCLUSIONS: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.
Authors: Lisly Chéry; Leonardo D Borregales; Bryan Fellman; Diana L Urbauer; Naveen Garg; Nathan Parker; Matthew H G Katz; Christopher G Wood; Jose A Karam Journal: Urology Date: 2017-07-10 Impact factor: 2.649
Authors: Shlomit Strulov Shachar; Allison M Deal; Marc Weinberg; Kirsten A Nyrop; Grant R Williams; Tomohiro F Nishijima; Julia M Benbow; Hyman B Muss Journal: Clin Cancer Res Date: 2016-08-03 Impact factor: 12.531
Authors: S Gérard; D Bréchemier; A Lefort; S Lozano; G Abellan Van Kan; T Filleron; L Mourey; C Bernard-Marty; M E Rougé-Bugat; V Soler; B Vellas; M Cesari; Y Rolland; L Balardy Journal: J Nutr Health Aging Date: 2016 Impact factor: 4.075
Authors: Elena Ongaro; Vanessa Buoro; Marika Cinausero; Riccardo Caccialanza; Annalisa Turri; Valentina Fanotto; Debora Basile; Maria Grazia Vitale; Paola Ermacora; Giovanni Gerardo Cardellino; Laura Nicoletti; Lorenzo Fornaro; Andrea Casadei-Gardini; Giuseppe Aprile Journal: Gastric Cancer Date: 2017-05-05 Impact factor: 7.370
Authors: Jemima T Collins; Simon Noble; John Chester; Helen E Davies; William D Evans; Daniel Farewell; Jason F Lester; Diane Parry; Rebecca Pettit; Anthony Byrne Journal: Support Care Cancer Date: 2017-07-18 Impact factor: 3.603