The Effects of Neoadjuvant Axitinib on Anthropometric Parameters in Patients With Locally Advanced Non-metastatic Renal Cell Carcinoma

Abstract

Objective To examine the effect that neoadjuvant axitinib for the treatment of localized renal cell carcinoma has on body compartment composition. Patients and Methods The study was based on a single-institution, single-arm clinical trial that enrolled 24 patients with locally advanced non-metastatic biopsy-proven clear cell renal cell carcinoma. Patients received axitinib orally for up to 12 weeks. Computed tomography scans were completed before the start of treatment, after 7 weeks of treatment and at the completion of 12 weeks of treatment. Patients underwent nephrectomy after axitinib treatment. The primary outcome of the current study was change in body compartment composition. Secondary outcomes included development of new-onset sarcopenia and changes in body weight. Results A total of 23 patients had a complete set of imaging for evaluation, of which 19 (82.6%) lost weight. Median weight loss was 4.5 kg (p < 0.001). Seven patients (30.4%) had sarcopenia prior to treatment, with an additional 5 (21.7%) developing sarcopenia during treatment. Median decrease in skeletal muscle was 2.9 cm2/m2 (p < 0.001), visceral adipose tissue was 4.9 cm2/m2 (p = 0.132), and subcutaneous adipose tissue was 1.0 cm2/m2 (p = 0.043). Ten(62.5%) of the 16 patients without baseline sarcopenia achieved a partial response, while only one(14.3%) of the 7 patients with baseline pretreatment sarcopenia achieved a partial response (p=0.069). Conclusions Neoadjuvant axitinib resulted in a decrease in skeletal muscle and subcutaneous adipose tissue, as well as weight loss. Patients with baseline sarcopenia tended to have a lower response rate to neoadjuvant axitinib.

Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges

“…Our search was conducted until July 2020. Table 1 detailed the results of the eleven studies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] assessing the effect of TKI treatment on skeletal muscle mass from computerized tomography (CT) scan at the third lumbar (L3) vertebra.…”

“…It is indicated for the treatment of advanced RCC after failure of one prior systemic therapy (sunitinib or cytokines) [ 51 ]. One study [ 26 ] evaluated the effect of axitinib on muscle mass in 24 patients with advanced non-metastatic RCC ( n = 23), showing a significant decrease in SMI at 12 weeks after starting treatment compared to baseline (−2.9 cm 2 /m 2 ; IQR 1.7–6.2; p < 0.001).…”

“…A recent study found that RCC patients treated with axitinib with baseline low SMI tended to have a lower response rate to treatment [ 26 ]. Moreover, low SMI is predictive of treatment-related toxicity in patients with metastatic RCC receiving sunitinib [ 54 ] or sorafenib [ 31 , 55 ].…”

“…Some studies [ 27 , 30 , 31 ] assessed SMA, evaluating all the cross-sectional skeletal muscle area at the third lumbar vertebra (bilateral rectus abdominis, external oblique, internal oblique, transverse abdominal, psoas, quadratus lumborum, and paraspinal muscle). Other studies calculated SMI by dividing SMA by the square of the height [ 26 , 29 , 33 , 34 , 36 ] or skeletal muscle density (SMD; in Hounsfield) [ 34 ] or LBM estimated from SMA as described by Mourtzakis et al [ 73 ]. One study [ 28 ] used the bilateral psoas index (PI; in cm 2 /m 2 ) by dividing psoas muscle area by the square of the height.…”

High-intensity exercise is a risk factor for renal medullary carcinoma in individuals with sickle cell trait

“…The SM and SA cross-sectional areas were measured using axial images at the midpoint of the L3 vertebral body as performed in prior studies. 10 Cross-sectional areas were standardized to the square of height in meters for each patient. Analysis was performed using SliceOMatic v5.0 (TomoVision, Magog, Canada).…”