Abstract
Purpose
Participation in cancer cachexia clinical trials requires a defined weight loss (WL) over time. A loss in skeletal muscle mass, measured by cross-sectional computed tomography (CT) image analysis, represents a possible alternative. Our aim was to compare WL versus muscle loss in patients who were screened to participate in a cancer cachexia clinical trial.
Methods
This was a single-center, retrospective analysis in metastatic colorectal cancer patients screened for an interventional cancer cachexia trial requiring a ≥5 % WL over the preceding 6 months. Concurrent CT images obtained as part of standard oncology care were analyzed for changes in total muscle and fat (visceral, subcutaneous, and total).
Results
Of patients screened (n = 36), 3 (8 %) enrolled in the trial, 17 (47 %) were excluded due to insufficient WL (<5 %), 3 (8 %) were excluded due to excessive WL (>20 %), and 16 (44 %) met inclusion criteria for WL. Patients who met screening criteria for WL (5–20 %) had a mean ± SD of 7.7 ± 8.7 % muscle loss, 24.4 ± 37.5 % visceral adipose loss, 21.6 ± 22.3 % subcutaneous adipose loss, and 22.1 ± 24.7 % total adipose loss. Patients excluded due to insufficient WL had 2 ± 6.4 % muscle loss, but a gain of 8.5 ± 39.8 % visceral adipose, and 4.2 ± 28.2 % subcutaneous adipose loss and 0.8 ± 28.4 % total adipose loss. Of the patients excluded due to WL <5 % (n = 17), 7 (41 %) had a skeletal muscle loss >5 %.
Conclusions
Defining cancer cachexia by WL over time may be limited as it does not capture skeletal muscle loss. Cross-sectional CT body composition analysis may improve early detection of muscle loss and patient participation in future cancer cachexia clinical trials.
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References
Barret M, Antoun S, Dalban C, et al. (2014) Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 66:583–589
Gray C, MacGillivray TJ, Eeley C, et al. (2011) Magnetic resonance imaging with k-means clustering objectively measures whole muscle volume compartments in sarcopenia/cancer cachexia. Clin Nutr 30:106–111
Prado CM, Baracos VE, McCargar LJ, et al. (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15:2920–2926
Stene GB, Helbostad JL, Amundsen T, et al. (2015) Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer. Acta Oncol 54:340–348
Utech AE, Tadros EM, Hayes TG, et al. (2012) Predicting survival in cancer patients: the role of cachexia and hormonal, nutritional and inflammatory markers. J Cachex Sarcopenia Muscle 3:245–251
von Haehling S, Anker SD (2010) Cachexia as a major underestimated and unmet medical need: facts and numbers. J Cachex Sarcopenia Muscle 1:1–5
Tisdale MJ (1997) Biology of cachexia. J Natl Cancer Inst 89:1763–1773
Temel JS, Abernethy AP, Currow DC, et al (2016) Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials. Lancet Oncol
Strasser F, Luftner D, Possinger K, et al. (2006) Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-in-Cachexia-Study-Group. J Clin Oncol 24:3394–3400
Lieffers JR, Mourtzakis M, Hall KD, et al. (2009) A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr 89:1173–1179
Roubenoff R, Kehayias JJ, Dawson-Hughes B, et al (1993) Use of dual-energy X-ray absorptiometry in body-composition studies: not yet a ‘gold standard’. Am J Clin Nutr (USA)
Mourtzakis M, Prado CMM, Lieffers JR, et al. (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006
Prado CM, Birdsell LA, Baracos VE (2009) The emerging role of computerized tomography in assessing cancer cachexia. Curr Opin Support Palliat Care 3:269–275
Shen W, Punyanitya M, Wang Z, et al. (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 97:2333–2338
Shen W, Punyanitya M, Wang Z, et al. (2004) Visceral adipose tissue: relations between single-slice areas and total volume. Am J Clin Nutr 80:271–278
Heymsfield SB, Smith R, Aulet M, et al. (1990) Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr 52:214–218
Fearon K, Strasser F, Anker SD, et al. (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495
Fearon K, Argiles J, Baracos V, et al. (2015) Request for regulatory guidance for cancer cachexia intervention trials. J Cachex Sarcopenia Muscle 6:272–274
Crawford J, Prado CM, Johnston MA, et al. (2016) Study design and rationale for the phase 3 clinical development program of enobosarm, a selective androgen receptor modulator, for the prevention and treatment of muscle wasting in cancer patients (POWER trials). Curr Oncol Rep 18:1–11
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Roeland, E.J., Ma, J.D., Nelson, S.H. et al. Weight loss versus muscle loss: re-evaluating inclusion criteria for future cancer cachexia interventional trials. Support Care Cancer 25, 365–369 (2017). https://doi.org/10.1007/s00520-016-3402-0
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DOI: https://doi.org/10.1007/s00520-016-3402-0