Isabelle Fresard1, Marc Licker2, Dan Adler3, Alban Lovis4, John Robert5, Wolfram Karenovics6, John Diaper2, Jean-Paul Janssens3, Frederic Triponez6, Frederic Lador3, Thierry Rochat3, Vicente Espinosa3, Chetna Bhatia3, Bengt Kayser7, Pierre-Olivier Bridevaux8. 1. Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. Division of Pulmonary Medicine, Hôpital de La Tour, Geneva, Switzerland. isabelle.fresard@latour.ch. 2. Division of Anaesthesiology, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. 3. Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. 4. Division of Pulmonary Medicine, University Hospital of Lausanne, Lausanne, Switzerland. 5. Division of Thoracic Surgery, Hôpital de La Tour, Geneva, Switzerland. 6. Division of Thoracic and Endocrine Surgery, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. 7. Institute of Sport Sciences and Department of Physiology, University of Lausanne, Lausanne, Switzerland and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 8. Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. Division of Pulmonary Medicine, Hôpital du Valais, Sion, Switzerland.
Abstract
BACKGROUND: In non-small-cell lung cancer patients, high peak oxygen uptake (peak V̇O2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V̇O2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC-, n = 15). RESULTS: Adjusted peak V̇O2 was lower in NAC + compared with NAC- subjects (-5.3 mL/min/kg [95% CI -8.3 to -2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak V̇O2 (r(2) = 0.56). Adjustment for DLCO reduced the effect of NAC on peak V̇O2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V̇O2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
BACKGROUND: In non-small-cell lung cancerpatients, high peak oxygen uptake (peak V̇O2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V̇O2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC-, n = 15). RESULTS: Adjusted peak V̇O2 was lower in NAC + compared with NAC- subjects (-5.3 mL/min/kg [95% CI -8.3 to -2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak V̇O2 (r(2) = 0.56). Adjustment for DLCO reduced the effect of NAC on peak V̇O2 without suppressing it. CONCLUSIONS:NAC was associated with lower preoperative peak V̇O2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
Authors: Seyyed Mohammad Reza Kazemi-Bajestani; Harald Becher; Charles Butts; Naveen S Basappa; Michael Smylie; Anil Abraham Joy; Randeep Sangha; Andrea Gallivan; Peter Kavsak; Quincy Chu; Vickie E Baracos Journal: J Cachexia Sarcopenia Muscle Date: 2019-07-10 Impact factor: 12.910
Authors: Justin M Canada; Elisabeth Weiss; John D Grizzard; Cory R Trankle; Leila Rezai Gharai; Franklin Dana; Leo F Buckley; Salvatore Carbone; Dinesh Kadariya; Anthony Ricco; Jennifer H Jordan; Ronald K Evans; Ryan S Garten; Benjamin W Van Tassell; W Gregory Hundley; Antonio Abbate Journal: Cardiooncology Date: 2022-01-18