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Clinical Cancer Research
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Cancer Therapy: Clinical

Sarcopenia as a Determinant of Chemotherapy Toxicity and Time to Tumor Progression in Metastatic Breast Cancer Patients Receiving Capecitabine Treatment

Carla M.M. Prado, Vickie E. Baracos, Linda J. McCargar, Tony Reiman, Marina Mourtzakis, Katia Tonkin, John R. Mackey, Sheryl Koski, Edith Pituskin and Michael B. Sawyer
Carla M.M. Prado
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Vickie E. Baracos
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Linda J. McCargar
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Tony Reiman
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Marina Mourtzakis
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Katia Tonkin
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John R. Mackey
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Sheryl Koski
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Edith Pituskin
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Michael B. Sawyer
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DOI: 10.1158/1078-0432.CCR-08-2242 Published April 2009
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Abstract

Purpose: Body composition has emerged as an important prognostic factor in cancer patients. Severe depletion of skeletal muscle (sarcopenia) and, hence, of overall lean body mass may represent an occult condition in individuals with normal or even high body weight. Sarcopenia has been associated with poor performance status, 5-fluorouracil toxicity, and shortened survival in cancer patients. Here, we prospectively studied patients with metastatic breast cancer receiving capecitabine treatment in order to determine if sarcopenia was associated with a higher incidence of toxicity and a shorter time to tumor progression (TTP).

Experimental Design: Fifty-five women with metastatic breast cancer resistant to anthracycline and/or taxane treatment were included. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography, and sarcopenia was defined using a previously published cutoff point. Toxicity was assessed after cycle 1 of treatment, and TTP was determined prospectively.

Results: Approximately 25% of patients were classified as sarcopenic, and this feature was seen in normal weight, overweight, and obese individuals. Toxicity was present in 50% of sarcopenic patients, compared with only 20% of nonsarcopenic patients (P = 0.03), and TTP was shorter in sarcopenic patients (101.4 days; confidence interval, 59.8-142.9) versus nonsarcopenic patients (173.3 days; confidence interval, 126.1-220.5; P = 0.05).

Conclusion: Sarcopenia is a significant predictor of toxicity and TTP in metastatic breast cancer patients treated with capecitabine. Our results raise the potential use of body composition assessment to predict toxicity and individualize chemotherapy dosing.

  • body composition
  • prognostic significance
  • chemotherapy efficacy
  • chemotherapy toxicity
  • breast cancer

Footnotes

  • Grant support: Canadian Breast Cancer Foundation, AB/NWT Chapter. M.B. Sawyer is a recipient of an American Society of Clinical Oncology Career Development Award; C.M.M. Prado was supported by Alberta Cancer Board Graduate Studentship from Alberta Cancer Foundation.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted January 15, 2009.
    • Received August 28, 2008.
    • Revision received December 8, 2008.
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Clinical Cancer Research: 15 (8)
April 2009
Volume 15, Issue 8
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Sarcopenia as a Determinant of Chemotherapy Toxicity and Time to Tumor Progression in Metastatic Breast Cancer Patients Receiving Capecitabine Treatment
Carla M.M. Prado, Vickie E. Baracos, Linda J. McCargar, Tony Reiman, Marina Mourtzakis, Katia Tonkin, John R. Mackey, Sheryl Koski, Edith Pituskin and Michael B. Sawyer
Clin Cancer Res April 15 2009 (15) (8) 2920-2926; DOI: 10.1158/1078-0432.CCR-08-2242

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Sarcopenia as a Determinant of Chemotherapy Toxicity and Time to Tumor Progression in Metastatic Breast Cancer Patients Receiving Capecitabine Treatment
Carla M.M. Prado, Vickie E. Baracos, Linda J. McCargar, Tony Reiman, Marina Mourtzakis, Katia Tonkin, John R. Mackey, Sheryl Koski, Edith Pituskin and Michael B. Sawyer
Clin Cancer Res April 15 2009 (15) (8) 2920-2926; DOI: 10.1158/1078-0432.CCR-08-2242
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Clinical Cancer Research
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