Gabriel Aleixo, MD from the Cleveland Clinic speaks about the SABCS Abstract – P1-08-04 The impact of sarcopenia and sarcopenic obesity detected by bioelectrical impedance analysis in patients with early breast cancer.
Background:
Sarcopenia, or a loss of muscle mass, is linked to toxicity from chemotherapy and a shorter life expectancy in women with breast cancer (BC). Sarcopenic obesity, a condition in which patients lose muscle mass and gain adipose tissue, is linked to a slew of comorbidities and poor outcomes in British Columbia. To date, the majority of research have relied on computed tomography (CT) to gather the data needed to determine sarcopenia and sarcopenic obesity. CT scans, on the other hand, are not frequently performed in women with early breast cancer. Bioelectrical impedance analysis (BIA) is a noninvasive, simple-to-use technology for determining several body composition characteristics; it does not expose patients to radiation and provides immediate findings. Both sarcopenia and sarcopenic obesity can be detected with BIA. Our goal is to see how BIA-measured sarcopenia and sarcopenic obesity affect treatment-related adverse events in patients with early-stage breast cancer who underwent (neo)adjuvant chemotherapy.
Methods:
361 patients with stage I-III breast cancer were treated with chemotherapy from a cohort of 713 patients who had had BIA analyses around the time of their initial cancer diagnosis and treatment. The Skeletal Muscle Area (SMA), Fat Mass (FM), and Fat-Free Mass (FFM) were calculated using BIA (FFM). To determine if a person has sarcopenia, the Skeletal Muscle Index (SMI) was calculated: SMI=(SMA, cm2)/ (patient height, m2). Normal sarcopenia (SMI > 6.75 kg/m2), moderate sarcopenia (SMI between 6.75 and 5.76 kg/m2), and severe sarcopenia (SMI 5.75 kg/m2) patients were classified. An increased FM to FFM ratio indicates sarcopenic obesity. We compared patients with FM/FFM at or above the median to those with FM/FFM below the median because there is no specific cut-point for sarcopenic obesity. To link patient features and toxicity results to sarcopenia and sarcopenic obesity status, Fisher’s exact test was used.
Results:
The average age was 60 years old (range: 26 to 88). Moderate sarcopenia was seen in 28% of patients, whereas severe sarcopenia was found in 6%. Early chemotherapy termination was linked with the prevalence of sarcopenia in 17 percent and 38 percent of individuals with moderate or severe sarcopenia, respectively, compared to 8% of those without sarcopenia (p=0.0006). Patients with moderate (17%) and severe (15%) sarcopenia had more hospitalizations related to chemotherapy than those who did not have sarcopenia (8%; p=0.02). Furthermore, individuals with moderate or severe sarcopenia (38 percent and 12 percent, respectively) had higher grade 3-4 neuropathy than those without sarcopenia (9 percent; p=0.006). Patients with sarcopenic obesity also had a significantly greater risk of early treatment termination (16 percent versus 7%; p=0.004), chemotherapy-related hospitalization (15 percent against 7%; p=0.008), and grade 3-4 neuropathy (17 percent versus 6%; p=0.0004). There were no significant differences between the groups in terms of dose delay or dose decrease.
Conclusion:
Patients with early-stage breast cancer who had BIA measured sarcopenia or sarcopenic obesity had a worse response to (neo)adjuvant treatment. Future research should look into whether body composition-based dosage regimens can help patients get better results.