Early skeletal muscle mass decline is a prognostic factor in patients receiving gemcitabine plus nab-paclitaxel for unresectable pancreatic cancer: a retrospective observational study

Abstract

Purpose Patients with pancreatic cancer often have cancer cachexia at diagnosis. Recent studies suggested that loss of skeletal muscle mass was related to cancer cachexia, which hindered continuance of chemotherapy and could be one of prognostic factors in pancreatic cancer, however the association remains unclear in patients receiving gemcitabine and nab-paclitaxel (GnP). Methods We retrospectively studied 138 patients with unresectable pancreatic cancer receiving first-line GnP at the University of Tokyo from January 2015 to September 2020. We calculated body composition in CT images before chemotherapy and at initial evaluation, and evaluated the association of both body composition before chemotherapy and its changes at initial evaluation. Results Compared by skeletal muscle mass index (SMI) change rate between pre-chemotherapy and initial evaluation, there were statistically significantly differences in the median OS: 16.3 months (95%CI 12.3–22.7) and 10.3 months (95%CI 8.3–18.1) between SMI change rate ≥ -3.5% and < -3.5% groups (P = 0.01). By multivariate analysis for OS, CA19-9 (HR 3.34, 95%CI 2.00–5.57, P < 0.01), PLR (HR 1.68, 95%CI 1.01–2.78, P = 0.04), mGPS (HR 2.32, 95%CI 1.47–3.65, P < 0.01) and relative dose intensity (HR 2.21, 95%CI 1.42–3.46, P < 0.01) were significantly poor prognostic factors. SMI change rate (HR 1.47, 95%CI 0.95–2.28, P = 0.08) showed a trend to poor prognosis. Sarcopenia before chemotherapy was not significantly associated with PFS or OS. Conclusion Early skeletal muscle mass decline was associated with poor OS. Further investigation is warranted whether the maintenance of skeletal muscle mass by nutritional support would improve prognosis.

The role of pharmacists in multimodal cancer cachexia care

“…Cancer cachexia, skeletal muscle loss, and sarcopenia affect the efficacy and continuation of chemotherapy. 26 , 27 , 28 , 29 , 30 , 31 , 32 Conversely, chemotherapy reportedly exacerbates skeletal muscle wasting in patients having cancer. 33 This association accordingly points to the need for simultaneous monitoring and intervention in the management of chemotherapy-induced adverse events and cancer cachexia.…”

Skeletal muscle status and survival among patients with advanced biliary tract cancer

“…Sarcopenia at cancer diagnosis may serve as a surrogate for various cancer-related factors with negative impacts on survival times, including impaired nutritional status, unfavorable metabolic alterations, and sustained systemic in ammation [10]. Further research suggests that clinical outcomes of cancer patients may depend on postdiagnostic alterations in skeletal muscle status due to the invasiveness of surgery [11,12] or the toxicity of chemotherapy [13][14][15]. A better understanding of the pathogenesis of skeletal muscle alterations in the context of postdiagnostic clinical course of cancer patients would help to develop and implement new management strategies of the patients [16].…”