Abstract 328P
Background
Treatment toxicity is common among patients with colon cancer (CC) receiving adjuvant chemotherapy (ACT). In the metastatic setting, skeletal muscle mass (SMM) loss is related to increased toxicity, but data in the adjuvant setting is sparse. Therefore, we explored whether changes in SMM during ACT are associated with patient-reported treatment toxicity.
Methods
Data from the ongoing prospective PLCRC-PROTECT-Plus study were used. Patients completed an 8-item CTCAE (v3.0) based toxicity questionnaire after each ACT cycle. SMM was assessed with automatic analysis of CT scans at baseline (prior ACT), prior to the fourth cycle (during ACT) and 3 months after treatment. Based on a previously reported measurement error of 2%, SMM loss was defined as loss >2%. Occurrence of any grade ≥3 patient-reported toxicity was used as primary outcome. Poisson regression models adjusted for age and sex were applied.
Results
Currently, a total of 103 patients had a baseline and at least one follow-up CT scan (mean age 61 ± 9.8 years, 50% male). The ACT plan was 4 cycles of capecitabine and oxaliplatin, except for 2 patients (8 cycles of capecitabine monotherapy). 56% of patients experienced >2% SMM loss from baseline to the fourth ACT cycle, and 22% lost >2% SMM from baseline to 3 months post-ACT. Overall, 30% of patients reported any grade ≥3 toxicity during ACT. Anorexia (15%), nausea (11%) and fatigue (9%) occurred most often. The risk of any grade ≥3 toxicity was significantly higher for patients with >2% SMM loss between baseline and after treatment (RR 2.37 95% CI 1.04-5.25), especially for fatigue (4.24, 1.06-18.1) and nausea (4.02, 1.12-16.3). No significant increased risk was found for SMM loss between baseline and prior to the fourth cycle of ACT (1.26, 0.58-2.87). Results will be updated for the 2022 ESMO conference.
Conclusions
This prospective study of CC patients shows that SMM loss from start to 3 months post-ACT was associated with an increased risk of any patient-reported grade ≥3 toxicities, whereas loss during ACT was not significantly associated. Future studies should elucidate whether SMM reduction is causally related to treatment toxicities.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
UMC Utrecht.
Funding
Province of Utrecht, SCOPE Collaboration.
Disclosure
P. Moeskops: Financial Interests, Personal, Other, Employee at: Quantib. M. Koopman: Financial Interests, Institutional, Advisory Board, advisory board and speaker: Pierre Fabre; Financial Interests, Institutional, Advisory Board: MSD, Bayer; Financial Interests, Institutional, Advisory Board, Advisory Board, speaker: Servier; Financial Interests, Institutional, Invited Speaker: Merck, BMS, Servier; Financial Interests, Institutional, Research Grant: Servier, Roche, Bayer, Bristol Myers Squibb, Merck, Personal Genomics Diagnostics, Sirtex, Pierre Fabre; Financial Interests, Institutional, Funding: Pierre Fabre, Amgen, Nordic Farma, Novartis, Merck, Servier, BMS; Non-Financial Interests, Leadership Role, vice-chair of DCCG: Dutch Colorectal Cancer Group; Non-Financial Interests, Advisory Role, Member of KWF scientific board: KWF; Non-Financial Interests, Other, ESMO faculty member for the Gastro-Intestinal Tumours – colorectal cancer: ESMO; Non-Financial Interests, Advisory Role, expert member of committee “regie op registers dure geneesmiddelen” ZINNL: ZiNNL; Non-Financial Interests, Advisory Role, CRC expert on Kanker.nl platform for answering online CRC questions of CRC (non) patients: Patient representative organisation (Kanker.nl); Non-Financial Interests, Leadership Role, chair of RWD & DH working group: ESMO; Other, Other, PI of the Dutch Prospective Colorectal Cancer Cohort study: PLCRC project. A.M. May: Financial Interests, Institutional, Advisory Role: COMPASS. All other authors have declared no conflicts of interest.