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Supportive and palliative care

4476 - Impact of sarcopenia on dose limiting toxicities in metastatic colorectal cancer patients (mCRC pts) receiving palliative systemic treatment


09 Sep 2017


Supportive and palliative care


End-of-life Care;  Colon and Rectal Cancer


Sophie Kurk


Annals of Oncology (2017) 28 (suppl_5): v543-v567. 10.1093/annonc/mdx388


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

Author affiliations

  • 1 Medical Oncology, University Medical Center Utrecht, 3508GA - Utrecht/NL
  • 2 Epidemiology, Julius Center, University Medical Center Utrecht, 3508GA - Utrecht/NL
  • 3 Nutricia Research, Nutricia Advanced Medical Nutrition, 3584 CT - Utrecht/NL
  • 4 Medical Oncology, Catharina Hospital Eindhoven, 5602 ZA - Eindhoven/NL
  • 5 Internal Medicine / Medical Oncology, Zuyderland Medical Center-Sittard-Geleen, 6130 MB - Sittard/NL
  • 6 Medical Oncology, Ikazia Hospital, 3083 AN - Rotterdam/NL
  • 7 Radiology, Amphia hospital, 4818CK - Breda/NL
  • 8 Medical Oncology, University Hospital Groningen (UMCG), 9700 RB - Groningen/NL
  • 9 Medical Oncology, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 10 Medical Oncology, Maxima Medical Center, 5631BM - Eindhoven/NL
  • 11 Internal Medicine / Medical Oncology, Groene Hart hospital, 2803 HH - Gouda/NL
  • 12 Internal Medicine / Medical Oncology, Ziekenhuis Rivierenland Tiel, 4002 WP - Tiel/NL
  • 13 Internal Medicine / Medical Oncology, Tergooi Ziekenhuizen, 1213XZ - Hilversum/NL
  • 14 Medical Oncology, Academic Medical Center, University of Amsterdam, 1100 DD - Amsterdam/NL


Abstract 4476


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.


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.


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).


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


Legal entity responsible for the study

Dutch Colorectal Cancer Group (DCCG)


Province of Utrecht, The Netherlands


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

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