ADVERTISEMENT
Muscle quantity and quality in metastatic colorectal cancer patients during third-line therapy with regorafenib or TAS102
Background
International guidelines recommend the use of Regorafenib or TAS 102 from third line of treatment in metastatic colorectal cancer (mCRC). Retrospective analysis revealed no outcome differences between these two drugs in pretreated mCRC patients. Previous studies found significant muscle mass loss (MML) during treatment with Regorafenib, unlike with TAS-102, probably due to different toxicity profiles. The aim of our study is to analyze the prognostic role of basal sarcopenia and low basal muscle attenuation (MA), representing fat infiltration of muscles, in mCRC patients in third-line treatment with Regorafenib or TAS102 and the correlation between type of third-line therapy and MML >5% at first CT assessment.
Methods
Our retrospective analysis included 22 (11 M, 11 F) consecutive mCRC patients in third-line therapy with Regorafenib or TAS102 from 2016 to 2021 at Medical Oncology Unit of our hospital. Muscles were quantified within a Hounsfield Unit (HU) range of -29 to 150 HU evaluated on cross-sectional area at L3 by CT scans. Sarcopenia was assessed using the Skeletal Mass Index [SMI = muscle area in cm2/ (height in m)2]. We used SMI cutoffs specific to sex and BMI. Low skeletal MA was defined by HU cutoffs specific to BMI. CTs were performed before starting therapy and at first disease assessment.
Results
Median age was 69,56 years (50-85); 5/22 patients (22,73%) were ≥ 75 years old. 12/22 (54,5%) patients received Regorafenib, while 10/22 (45,5%) TAS102. 9/22 (40,9%; 6 M, 3 F) patients were sarcopenic and 7/20 (35%; 2 M, 5 F) patients had low MA before starting third-line therapy. Only one patient had basal BMI < 25 kg/m2 and was sarcopenic at basal CT. Basal sarcopenia wasn’t correlated with OS (11.9 vs 16.8 months sarcopenic vs non sarcopenic respectively; HR: 1.78 95% CI 0.69 to 4.589, p=0.236), PFS (3.37 vs 3.93 months sarcopenic vs non sarcopenic respectively; HR:1.31 95% CI 0.54 to 3.18, p=0.541) and response to treatment (p=0.644). Also MA wasn’t correlated with OS (16.8 vs 15.0 months sarcopenic vs non sarcopenic respectively; HR: 0.59 95% CI 0.2 to 1.71, p=0.331), PFS (3.5 vs 3.7 months sarcopenic vs non sarcopenic respectively; HR:0.69 95% CI 0.26 to 1.85, p=0.457) and response to treatment (p=0.613). At first disease assessment, 11/22 patients were sarcopenic: 8/11 patients were already sarcopenic at baseline, while 3/11 patients became sarcopenic and showed a MML >5%. 6/12 (50%) patients in Regorafenib group reported MML >5%, while only 2/10 (20%) patients in TAS102 group presented MML >5% (p=0.204). One patient receiving TAS102 experienced a 10% increase in muscle mass. MML wasn’t associated to OS (11.4 vs 10.9 months sarcopenic vs non sarcopenic respectively; HR: 0.56 95% CI 0.18 to 1.73, p=0.314) and response to treatment (p=0.781).
Conclusions
In our study, baseline sarcopenia, baseline MA and MML during third-line therapy with Regorafenib or TAS102 didn’t influence survival and response to treatment. MML appeared more in patients receiving Regorafenib, although this wasn’t statistically significant. These results must be interpreted with caution in consideration of the limited sample size.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
