A review of body composition and pharmacokinetics in oncology

Hopkins, Jessica; Sawyer, Michael B.

doi:10.1080/17512433.2017.1347503

Cited by 67 publications

(104 citation statements)

References 38 publications

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“…A decrease in SMD was independently associated with a higher chance of grade 3 or 4 toxicity. SMD is associated with strength or quality of muscle mass: a lower SMD is related to fat infiltration in muscles or myosteatosis, which is a pathological condition . Myosteatosis is hypothesized to be a preliminary state for sarcopenia and therefore a more accurate representative of muscle function than the SMI .…”

Section: Discussionmentioning

confidence: 99%

“…A characteristic of increasing interest is the loss of skeletal muscle mass. In various cancer types, the depletion of skeletal muscle mass (sarcopenia) is associated with decreased survival and increased risk of complications after surgery and systemic treatment‐related toxicity . Muscle mass can be easily determined by assessment of skeletal muscle index (SMI) using computed tomography (CT) scans that are routinely acquired for pre‐treatment staging and treatment evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

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Background Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy‐related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first‐line palliative chemotherapy. Methods A total of 88 patients with advanced esophagogastric cancer treated with standard first‐line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre‐treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m 2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. Results Of 88 patients, 75% was male, and median age was 63 (interquartile range 56–69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range −8.6–−0.4). Median progression‐free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre‐treatment and after three cycles) were neither associated with progression‐free nor overall survival. Pre‐treatment SMD was independently associated with grade 3–4 toxicity (odds ratio 0.94; 95% confidence interval 0.89–1.00) and sarcopenic obesity with grade 2–4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20–12.18). Conclusions Sarcopenia was not associated with survival or treatment‐related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre‐treatment sarcopenic obesity was independently associated with the occurrence of grade 2–4 neurotoxicity and skeletal muscle density with grade 3–4 toxicity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Dijksterhuis

Pruijt

Woude

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

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“…It has become increasingly clear that BSA and BMI do not accurately predict treatment efficacy. In a recent review of body composition and pharmacokinetics in oncology, Hopkins and Sawyer posited that chemotherapeutic toxicities are unpredictable probably because of an interaction between body composition and drug pharmacokinetics. Therefore, potential differences in treatment efficacy by body composition should be considered during trial design for randomized controlled trials of new cancer therapies.…”

Section: Challenges and Opportunities For Future Studymentioning

confidence: 99%

Obesity and cancer treatment efficacy: Existing challenges and opportunities

Ross

Gogineni

Subhedar

et al. 2019

Cancer

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“…2 Historically, oncology has appreciated the deleterious prognostic effect of involuntary weight loss. 4,5 Underscoring the critical need for the evaluation of body composition in oncology, patients with cancer are often older adults who have experienced age-related alterations in body composition that may be further exacerbated by cancer and cancer treatments. 4,5 Underscoring the critical need for the evaluation of body composition in oncology, patients with cancer are often older adults who have experienced age-related alterations in body composition that may be further exacerbated by cancer and cancer treatments.…”

Section: Introductionmentioning

confidence: 99%

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

Brown

Feliciano

Caan

2018

J cachexia sarcopenia muscle

134

115

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There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and visceral adipose tissue, such as computed tomography (CT), may offer new insights of important risk factors and improved prognostication of outcomes over alternative measures such as body mass index. In a meta‐analysis of 38 studies, low muscle area assessed from clinically acquired CT was observed in 27.7% of patients with cancer and associated with poorer overall survival [hazard ratio: 1.44, 95% CI: 1.32–1.56]. Therapeutic interventions such as lifestyle and pharmacotherapy that modify all aspects of body composition and reduce the incidence of poor clinical outcomes are needed in patients with cancer. In a meta‐analysis of six randomized trials, resistance training exercise increased lean body mass assessed from dual‐energy X‐ray absorptiometry [mean difference (MD): +1.07 kg, 95% CI: 0.76–1.37; P < 0.001] and walking distance [MD: +143 m, 95% CI: 70–216; P < 0.001] compared with usual care control in patients with non‐metastatic cancer. In a meta‐analysis of five randomized trials, anamorelin (a ghrelin agonist) significantly increased lean body mass [MD: +1.10 kg, 95% CI: 0.35–1.85; P = 0.004] but did not improve handgrip strength [MD: 0.52 kg, 95% CI: −0.09–1.13; P = 0.09] or overall survival compared with placebo [HR: 0.99, 95% CI: 0.85–1.14; P = 0.84] in patients with advanced or metastatic cancer. Early screening to identify individuals with occult muscle loss, combined with multimodal interventions that include lifestyle therapy with resistance exercise training and dietary supplementation combined with pharmacotherapy, may be necessary to provide a sufficient stimulus to prevent or slow the cascade of tissue wasting. Rapid, cost‐efficient, and feasible methods to quantify muscle and adipose tissue distribution are needed if body composition assessment is to be integrated into large‐scale clinical workflows. Fully automated analysis of body composition from clinically acquired imaging is one example. The study of body composition is one of the most provocative areas in oncology that offers tremendous promise to help patients with cancer live longer and healthier lives.

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A review of body composition and pharmacokinetics in oncology

Cited by 67 publications

References 38 publications

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Obesity and cancer treatment efficacy: Existing challenges and opportunities

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

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