Author of

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11979

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    P2.24-033 - The value of assessing muscle depletion in lung cancer (sarcopenia) rather than body surface area, in the work-up to chemotherapy. Reflections from a Systematic Review. (ID 2388)

    09:30 - 09:30  |  Author(s): J. Chester
    • Abstract

    Background
    Dosing of many chemotherapy drugs is currently based on body surface area (BSA), which is partly derived from body weight. However, BSA has been shown to result in large inter-patient variability in drug exposure. Another measurement of body composition is fat free mass (FFM), which includes hepatic, renal and muscle metabolic tissue. Depletion of FFM is termed sarcopenia, which in breast and renal cancer populations is associated with increased chemotherapy toxicity and time to disease progression. Sarcopenia can occur regardless of weight or BSA. In order to explore the value of FFM assessment in lung cancer patients undergoing chemotherapy, we performed a systematic review to explore this relationship. We present an analysis of relationships between sarcopenia, body weight, BSA, chemotherapy toxicities and outcomes in lung cancer patients.

    Methods
    Two search strings (‘muscle mass loss’ AND ‘lung cancer’) were used as a basis for formulating specific literature search strategies in five databases. We included all publication types and the search was limited to articles written in English. From this larger review, we then narrowed our focus to chemotherapy-specific studies.

    Results
    Our systematic review of FFM loss in lung cancer consisted of 29 studies, from which 7 studies considered specifically the relationship between FFM and chemotherapy. One study of 250 obese patients found 15% were sarcopenic, FFM poorly correlated with BSA (r[2]=0.37), and variation in FFM per unit of BSA could account for up to three-times variation of chemotherapy volume of distribution, potentially indicating increased risk of chemotherapy toxicity. A further population-based study (N=441) found 46.8% were sarcopenic, despite only 7.5% being underweight. A further two smaller studies (N=40, 41) found the prevalence of sarcopenia to be 61% and 46% (despite approximately half being overweight or obese). Prospective evaluation of the effect of chemotherapy on FFM in 3 small studies (N<22) showed no significant change. Sarcopenia was also associated with poorer performance status and reduced median survival.

    Conclusion
    A more refined understanding of body composition is needed in lung cancer patients, in order to minimise toxicities of chemotherapy, whilst ensuring optimal chemotherapy dosage. The current literature suggests that a more detailed prospective study is required in order to explore the validity and advantage of measuring FFM rather than BSA in lung cancer patients, in the work-up to chemotherapy. It also suggests that targeting sarcopenia may offer a novel approach to improving chemotherapy tolerance and overall survival.