BACKGROUND: Sunitinib is a standard first-line option for metastatic renal cell carcinoma (mRCC).
Body composition is a prognostic factor in cancer patients and patients with loss of skeletal muscle mass and fat-free mass (FFM) are prone to dose-limiting toxicity (DLT) during targeted drug therapy. We investigated whether body composition by computed tomography predicted DLT from sunitinib in mRCC.
METHODS: Patients with clear cell mRCC receiving sunitinib (50 mg) were included. Skeletal muscle cross-sectional area at L3 was measured by computed tomography. Sarcopenia was defined using published cutoffs. Toxicity was assessed after 4 cycles of the drug.
RESULTS: Fifty-five patients (43 male), mean age 64 years were included. Overall, 33% (N=18) of all patients were sarcopenic and of these 12.7% (N=7) were sarcopenic and overweight or obese. DLT occurred in < 6 months in 53% of patients (44% male vs. 83% female) and those who experienced DLT were older (68 vs. 60 y), had a lower skeletal muscle index (51.7 vs. 59.4 cm2/m2), a lower FFM (51.4 vs. 57.7 kg), and received a higher drug dose in mg/kg FFM (0.9 vs. 0.8). Patients with the lowest compared with the highest measurements of skeletal muscle mass experienced more DLT, respectively, 92% versus 57% and experienced on average 5 toxicities versus 2.
CONCLUSIONS: Sarcopenia is prevalent in patients with mRCC, is an occult condition in patients with normal/high body mass index, and is a significant predictor of DLT in patients receiving sunitinib. Our results highlight the potential use of baseline body composition to predict toxicity.
Written by:
Cushen SJ, Power DG, Teo MY, Maceneaney P, Maher MM, McDermott R, O'Sullivan K, Ryan AM. Are you the author?
Department of Food & Nutritional Sciences; School of Mathematical Science, University College Cork; Department of Medical Oncology, Mercy & Cork University Hospitals; Department of Radiology, Mercy University Hospital, Cork; Department Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Ireland.
Reference: Am J Clin Oncol. 2014 Apr 21. Epub ahead of print.
doi: 10.1097/COC.0000000000000061
PubMed Abstract
PMID: 24685884
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