Department of Oncology, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, 140 59, Prague, Czech Republic.
Department of Oncology, Palacky University Medical and Teaching Hospital, Olomouc, Czech Republic.
Target Oncol. 2020 Oct;15(5):673-679. doi: 10.1007/s11523-020-00744-8.
Sarcopenia is common in advanced cancer and correlates with poor performance status, increased risk of treatment-related toxicity, and shortened survival. Inhibitors of the vascular endothelial growth factor pathway have been associated with development or deterioration of sarcopenia.
To assess the prevalence and impact of sarcopenia on survival in patients with metastatic renal cell carcinoma (mRCC) treated with cabozantinib, a novel, highly potent multikinase inhibitor.
Patients treated with cabozantinib for mRCC progressing on other targeted therapies with available computed tomography (CT) scans acquired at the time of initiation of cabozantinib and on the first restaging were evaluated retrospectively. Muscle mass was assessed based on striated muscle area at the level of the third lumbar vertebra.
The median muscle mass index at CT1 and CT2 was 52.2 cm/m (range 33.0-69.2 cm/m) and 49.1 cm/m (range 33.1-68.2 cm/m), respectively. Sarcopenia was initially present in 13 (44.8%) patients. The mean muscle mass change between CT1 and CT2 was - 2.2 cm/m (range - 10.1 to + 4.8cm/m). Six-month progression-free survival (PFS) was significantly shorter in patients with at least 10% muscle loss, reaching 50% (95% CI 9.9-90) versus 79.8% (95% CI 62.1-90.6) in others (p = 0.022). The presence of initial sarcopenia was not associated with grade 3-4 toxicity, which was reported in six (46.2%) and seven (46.7%) patients with and without sarcopenia, respectively.
Significant and early skeletal muscle loss occurs during treatment with cabozantinib in a high proportion of patients and is associated with poor PFS.
肌肉减少症在晚期癌症中很常见，与较差的表现状态、增加的治疗相关毒性风险和缩短的生存时间相关。血管内皮生长因子通路抑制剂与肌肉减少症的发生或恶化有关。
评估转移性肾细胞癌（mRCC）患者接受新型、高效多激酶抑制剂卡博替尼治疗时肌肉减少症的发生率及其对生存的影响。
回顾性评估了接受卡博替尼治疗 mRCC 的患者，这些患者在开始接受卡博替尼治疗时和首次重新分期时具有可获取的计算机断层扫描（CT）图像，且之前接受过其他靶向治疗。肌肉质量根据第三腰椎水平的横纹肌面积进行评估。
CT1 和 CT2 时的中位数肌肉质量指数分别为 52.2cm/m（范围 33.0-69.2cm/m）和 49.1cm/m（范围 33.1-68.2cm/m）。最初有 13 名（44.8%）患者存在肌肉减少症。CT1 和 CT2 之间的平均肌肉质量变化为-2.2cm/m（范围-10.1 至+4.8cm/m）。肌肉损失至少 10%的患者 6 个月无进展生存期（PFS）明显更短，达到 50%（95%CI 9.9-90），而其他患者为 79.8%（95%CI 62.1-90.6）（p=0.022）。最初存在肌肉减少症与 3-4 级毒性无关，分别有 6 名（46.2%）和 7 名（46.7%）患者有和没有肌肉减少症时出现该毒性。
在很大一部分患者中，卡博替尼治疗期间会出现显著且早期的骨骼肌损失，且与较差的 PFS 相关。
