1546PD - Impact of sarcopenia on dose limiting toxicities in metastatic colorectal cancer patients (mCRC pts) receiving palliative systemic treatment

Date 09 September 2017
Event ESMO 2017 Congress
Session Supportive and palliative care
Topics Palliative Care
Colon Cancer
Rectal Cancer
Palliative and Supportive Care
Presenter Sophie Kurk
Citation Annals of Oncology (2017) 28 (suppl_5): v543-v567. 10.1093/annonc/mdx388
Authors S. Kurk1, P. Peeters2, R. Stellato2, B. Dorresteijn3, M. Jourdan3, G. Creemers4, F. Erdkamp5, F. de Jongh6, P. Kint7, B. Poppema8, S. Radema9, L. Simkens10, B. Tanis11, M. Tjin-A-Ton12, A. Van der Velden13, C.J.A. Punt14, M. Koopman1, A. May2
  • 1Medical Oncology, University Medical Center Utrecht, 3508GA - Utrecht/NL
  • 2Epidemiology, Julius Center, University Medical Center Utrecht, 3508GA - Utrecht/NL
  • 3Nutricia Research, Nutricia Advanced Medical Nutrition, 3584 CT - Utrecht/NL
  • 4Medical Oncology, Catharina Hospital Eindhoven, 5602 ZA - Eindhoven/NL
  • 5Internal Medicine / Medical Oncology, Zuyderland Medical Center-Sittard-Geleen, 6130 MB - Sittard/NL
  • 6Medical Oncology, Ikazia Hospital, 3083 AN - Rotterdam/NL
  • 7Radiology, Amphia hospital, 4818CK - Breda/NL
  • 8Medical Oncology, University Hospital Groningen (UMCG), 9700 RB - Groningen/NL
  • 9Medical Oncology, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 10Medical Oncology, Maxima Medical Center, 5631BM - Eindhoven/NL
  • 11Internal Medicine / Medical Oncology, Groene Hart hospital, 2803 HH - Gouda/NL
  • 12Internal Medicine / Medical Oncology, Ziekenhuis Rivierenland Tiel, 4002 WP - Tiel/NL
  • 13Internal Medicine / Medical Oncology, Tergooi Ziekenhuizen, 1213XZ - Hilversum/NL
  • 14Medical Oncology, Academic Medical Center, University of Amsterdam, 1100 DD - Amsterdam/NL

Abstract

Background

Evidence is increasing that severe skeletal muscle (SM) loss (sarcopenia) is associated with reduced overall survival (OS) in mCRC pts. We recently found, using data of the randomized phase 3 CAIRO3 study (Lancet, 2015), that SM loss was related to shorter time to progression during first line maintenance treatment (Tx) with capecitabine+bevacizumab (CAP-B) or observation. Subsequently, SM loss during more intensive reinduction Tx by adding oxaliplatin (CAPOX-B) was associated to shorter overall survival (ASCO, 2017). As a potential risk factor for reduced survival we explored whether sarcopenia was associated with dose reductions at start of CAPOX-B reinduction Tx and dose limiting toxicities (DLT) during CAPOX-B reinduction Tx.

Methods

Here, CAIRO3 pts were included who received CAPOX-B reinduction Tx. DLT were defined as any dose delay, reduction, or discontinuation of systemic treatment because of reported CTCAE (v3.0) toxicities at start or during Tx. Poisson regression models adjusted for relevant confounders were used to study the association between sarcopenia and DLT.

Results

A total of 254 pts received CAPOX-B reinduction Tx. 39% of pts were sarcopenic and compared to normal SM pts we found no statistically significant differences in age and sex (sarcopenic vs normal SM: mean age 63.6±9.1 vs 61.9±8.5 yrs, p=.20 and 39% vs 31% females p=.31). BMI was significantly lower in sarcopenic pts, but pts were on average still overweight (25.9±3.8 vs 27.2±3.8 p=.01). Overall, 67% experienced ≥1 DLT. At start of CAPOX-B, 25% had already received a dose reduction and the risk of dose reduction at start was significantly higher for sarcopenic compared to normal SM pts (RR 1.8 95%CI 1.08-2.90). Despite more frequent dose reductions at start, sarcopenic pts did not have a significantly lower risk of DLT during CAPOX-B Tx (RR sarcopenic vs normal SM pts 0.86 95% CI 0.46-1.45).

Conclusions

Sarcopenia was significantly associated with dose reductions at start of CAPOX-B reinduction Tx, and not with DLT during CAPOX-B reinduction Tx. Possible explanations for dose reductions at start might be more frequent toxicities during previous Tx including neuropathy.

Clinical trial identification

NCT00442631

Legal entity responsible for the study

Dutch Colorectal Cancer Group (DCCG)

Funding

Province of Utrecht, The Netherlands

Disclosure

B. Dorresteijn, M. Jourdan: Employee of Nutricia Research All other authors have declared no conflicts of interest.