Using body composition metrics to determine dosage of anthracyclines-taxane based chemotherapy for patients with breast cancer can reduce treatment-related toxicity, according to a study published in Clinical Cancer Research (published online January 31, 2017; doi:10.1158/1078-0432.CCR-16-2266).
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Body composition metrics are strong predictors of chemotherapy-based breast cancer treatment outcomes. However, limited evidence exists regarding body composition metrics’ impact on treatment-related toxicities.
Hyman B Muss, MD, department of medicine, University of North Carolina, and colleagues investigated associations between body composition metrics and treatment-related toxicity in patients with early breast cancer receiving anthracyclines-taxane based chemotherapy. A total of 151 patients (median age 49, range 23-75) underwent computerized tomography images for skeletal muscle area, density, and fat tissue at the 3rd lumbar vertebrae prior to chemotherapy initiation. Researchers also calculated the skeletal muscle gauge and index. Relative risks (RR) were reported for associations between body composition measures and toxicity outcomes after adjustment for age and body surface area.
Researchers found that among the 50 patients (33%) who developed grade 3 or 4 toxicity, those with a low skeletal muscle index (RR, 1.29; P = .002) and low skeletal muscle gauge (RR, 1.09; P = .01) had a greater risk of developing those toxicities. Skeletal muscle gauge was the most accurate predictor of grade 3-4 toxicity following treatment. Additionally, after adjusting for age and body surface area, low skeletal muscle gauge was significantly associated with hematological (RR, 2.12; P = .02) and gastrointestinal (RR, 6.49; P = .02) grade 3-4 toxicities as well as hospitalizations (RR, 1.91; P = .05).
Results of the study indicate that poor body composition metrics are significantly associated with increased treatment-related toxicities. Using body surface area to calculate chemotherapy dosage “doesn’t really help us predict which patients will develop treatment-related toxicity. This study supports the concept that body composition may be more sensitive than the formula that has been used for decades to dose chemotherapy,” according to the study’s first author Shlomit Strulov Shachar, MD, division of hematology oncology at UNC.
Further studies are necessary to determine how body composition metrics can be used to more precisely dose chemotherapy to reduce treatment-related toxicity while maintaining efficacy. – Zachary Bessette
