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Prognostic Role of Sarcopenia for Targeted Therapy in Metastatic Kidney Cancer

By: Celeste L. Dixon
Posted: Friday, April 2, 2021

Pretreatment sarcopenia, along with a lower relative dose intensity of sunitinib during first-line treatments, is a prognostic factor for poorer outcomes in patients with metastatic renal cell carcinoma, investigators have learned. However, the two factors did not appear to be unrelated, with sarcopenia occurring frequently in these patients, noted Hong Koo Ha, MD, PhD, of Pusan National University Hospital in Busan, Republic of Korea, and colleagues. In addition, those who have sarcopenia tended to experience higher mean dose reductions during the first two cycles of sunitinib treatment than those without sarcopenia. The results of the team’s retrospective study appeared in the Journal of Chemotherapy.

 Of the 78-patient study population (median age, 61.6 years), 41 (52.6%) had sarcopenia, and 16 (20.5%) had a relative dose intensity of less than 75% in their first two cycles of sunitinib treatment. Median progression-free survival was 6.9 versus 19.0 months in those with and without sarcopenia, respectively (P < .0001); in the same populations, median overall survival was 12.8 versus 36.3 months (P < .0005). The median progression-free survival of the patients who had less-intensive sunitinib treatment was 5.1 months, versus 12.9 months for those whose treatment intensity was 75% or more (P = .0037). Similarly, the median overall survival in those groups was 10.5 versus 26.8 months, respectively (P = .0016).

It’s not clear how sarcopenia physiologically affects the development of dose-limiting toxicities, necessitating decreases in relative dose intensity, wrote Dr. Ha and co-researchers. One hypothesis, they posited, “is that sarcopenia and a cancer-related vulnerable body condition may alter the distribution, metabolism, and clearance of antineoplastic agents,” leading to dose reductions and treatment interruptions. Taking a multidisciplinary approach to prevent and treat sarcopenia could be valuable, they noted, beginning with active nutritional support and exercise to maintain skeletal muscle mass during cancer therapy.

Disclosure: The study authors reported no conflicts of interest.

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