Department of Medical Oncology, CAncer Research for PErsonalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
Department of Radiology, Henri Mondor University Hospital, Créteil, France.
Pharmacol Ther. 2019 Apr;196:135-159. doi: 10.1016/j.pharmthera.2018.12.003. Epub 2018 Dec 4.
Body composition has gained increasing attention in oncology in recent years due to fact that sarcopenia has been revealed to be a strong prognostic indicator for survival across multiple stages and cancer types and a predictive factor for toxicity and surgery complications. Accumulating evidence over the last decade has unraveled the "pharmacology" of sarcopenia. Lean body mass may be more relevant to define drug dosing than the "classical" body surface area or flat-fixed dosing in patients with cancer. Since sarcopenia has a major impact on patient survival and quality of life, therapeutic interventions aiming at reducing muscle loss have been developed and are being prospectively evaluated in randomized controlled trials. It is now acknowledged that this supportive care dimension of oncological management is essential to ensure the success of any anticancer treatment. The field of sarcopenia and body composition in cancer is developing quickly, with (i) the newly identified concept of sarcopenic obesity defined as a specific pathophysiological entity, (ii) unsolved issues regarding the best evaluation modalities and cut-off for definition of sarcopenia on imaging, (iii) first results from clinical trials evaluating physical activity, and (iv) emerging body-composition-tailored drug administration schemes. In this context, we propose a comprehensive review providing a panoramic approach of the clinical, pharmacological and therapeutic implications of sarcopenia and body composition in oncology.
近年来，由于肌肉减少症已被证实是多种癌症分期和类型的生存的有力预后指标，也是毒性和手术并发症的预测因素，因此在肿瘤学领域中，身体成分越来越受到关注。过去十年间积累的证据揭示了肌肉减少症的“药理学”。与癌症患者的“经典”体表面积或固定剂量相比，瘦体重可能更能定义药物剂量。由于肌肉减少症对患者的生存和生活质量有重大影响，因此已经开发出针对减少肌肉损失的治疗干预措施，并正在随机对照试验中进行前瞻性评估。现在人们已经认识到，肿瘤学管理的这种支持性护理维度对于确保任何抗癌治疗的成功都是至关重要的。肌肉减少症和癌症身体成分领域发展迅速，（i）新确定的定义为特定病理生理实体的肌肉减少性肥胖概念，（ii）关于影像学上定义肌肉减少症的最佳评估方式和截止值的未解决问题，（iii）评估体力活动的临床试验的初步结果，以及（iv）新兴的基于身体成分的药物给药方案。在这种情况下，我们提出了一项全面的综述，提供了肌肉减少症和癌症身体成分在临床、药理学和治疗方面的全景方法。
