Reversible sarcopenia in patients with gastrointestinal stromal tumor treated with imatinib

Abstract

BackgroundImatinib is a long-term, oral, targeted therapy for high-risk resected and advanced gastrointestinal stromal tumours (GIST). It is known that sarcopenia affects prognosis and treatment tolerance in patients with various solid cancers. We analysed lumbar skeletal muscle index changes in imatinib-treated GIST patients. Imatinib tolerance was also assessed to evaluate the influence of pre-treatment sarcopenia.MethodsThirty-one patients with advanced (n = 16) or high-risk resected (n = 15) GIST treated with imatinib (400 mg/day) were analysed retrospectively. Lumbar skeletal muscle indexes were evaluated on computed tomography images obtained before starting imatinib for all patients and at 6 months for those initially sarcopenic. Sarcopenia was defined using consensual cutoffs. Imatinib-induced toxicities were assessed after 3 months of administration.ResultsTwelve (38.7%) of the 31 patients were sarcopenic, including one unassessable at 6 months. Seven (63.6%) of the 11 assessable sarcopenic patients became non-sarcopenic after 6 months of imatinib. Pre-treatment sarcopenia was not associated with grades 3–4 toxicities, but the mean number of all-grade toxicities per sarcopenic patient was significantly higher for those non-sarcopenic (4.1 vs. 1.7, respectively, p < 0.01) after 3 months of treatment. Grades 1–2 anaemia and grades 1–2 fatigue were more frequent for sarcopenic than non-sarcopenic patients (83% vs. 26%, P < 0.01 and 42% vs. 5%, P = 0.02, respectively).ConclusionsSarcopenia is reversible in some GIST patients treated with imatinib. Pre-imatinib sarcopenia is predictive of non-severe toxicities, particularly anaemia and fatigue.

Do we need a reference standard for the muscle mass measurements?

“…Surprisingly, neither physical activity nor protein level or vitamin D intake were associated with the reversibility of sarcopenia in this study . Another study, investigating 30 patients with gastrointestinal stromal tumour who were treated with imatinib, showed a reversibility of sarcopenia in 60% of the patients . A reversibility of disuse atrophy of type I and II muscle fibres 24 weeks after re‐use has been recently shown in an experimental study .…”

Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy

“…SMI was then normalized to height and expressed in cm 2 /m 2 . The muscles in the L3 region include psoas, erector spinae, quadratus lumborum, transversus abdominis, external oblique, internal obliques, and rectus abdominis muscles . After a period of training with a radiologist, a resident in gastroenterology who was unaware of the HGS values, measured TMA (cm 2 ) using manual segmentation on a dedicated posttreatment station.…”

Surgical Management in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience

“…Whereas once sarcopenia is identified, physicians should insist on treatment adherence and reinforce it with educational consultations with specifically trained stuffs. In some GIST patients treated with IM, sarcopenia was reversible [25]. Since IM administration could be safe in poor condition patients with sarcopenia, IM use might have been validated not only for adjuvant but also palliative therapy settings.…”

“…Despite dramatic responses initially, IM drug resistance continues to be the major factor for treatment discontinuation [24]. In addition, it has been recently proven that the use of IM in GIST reverses sarcopenia [25]. Since most toxicities of anti-agent drugs impair the patient's quality of life and, thus, compliance with long-term therapy, early managing those toxicities appears to be an essential therapeutic endpoint.…”