Relation between sarcopenia and dose-limiting toxicity in patients with metastatic colorectal cancer who received regorafenib

• Published in: Clinical & translational oncology Vol. 21; no. 11; pp. 1518 - 1523
• Main Authors: Gökyer, A., Küçükarda, A., Köstek, O., Hacıoğlu, M. B., Sunal, B. S., Demircan, N. C., Uzunoğlu, S., Solak, S., İşsever, K., Çiçin, İ., Erdoğan, B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2019
• Subjects: Aged; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Disease Susceptibility; Exanthema - chemically induced; Female; Hand-Foot Syndrome - etiology; Humans; Hypertension - chemically induced; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Mucous Membrane; Oncology; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - adverse effects; Progression-Free Survival; Pyridines - administration & dosage; Pyridines - adverse effects; Research Article; Retrospective Studies; Sarcopenia - chemically induced; Sarcopenia - diagnostic imaging; Sarcopenia - mortality; Tomography, X-Ray Computed; Regorafenib; Dose-limiting toxicity; Skeletal muscle area; Colorectal cancer
• ISSN: 1699-048X; 1699-3055
• DOI: 10.1007/s12094-019-02080-4

Background
Sarcopenia is related to poor prognosis and drug toxicities in solid tumors. The aim of our study is to investigate the predisposition of patients with metastatic colorectal carcinoma who started regorafenib treatment to sarcopenia and prolonged survival.
Methods
Patients with metastatic colorectal carcinoma who receives regorafenib were search retrospectively. Dose-limiting toxicity was defined as dose reduction or toxicity requiring drug withdrawal. Sarcopenia evaluation was made with computed tomography performed within a month before treatment. Progression-free survival and overall survival were estimated.
Results
Thirty-six patients were found as suitable for the study. 63.9% of patients were found as basally sarcopenic. Dose-limiting toxicity occured 13 of 23 patients (56.5%) with basal sarcopenia, whereas only 1 of 13 patients (7.6%) with no sarcopenia exhibited dose-limiting toxicity (
p
 = 0.005). Three patients suffered from grade 3–4 toxicity. Hand–foot syndrome, hypertension, and mucosal rash were the most seen side effects. Mean regorafenib treatment duration was 3.36 months. There was no significant difference in the progression-free survival (PFS) and the overall survival (OS) between sarcopenic patients and patients with no sarcopenia. Durations were as OS 24.2 weeks in patients with sarcopenia (95% CI 16.7–31.7), 28.1 weeks in patients with no sarcopenia (95% CI 20.5–35.7) (
p
 = 0.36), and as PFS 14.2 weeks in patients with sarcopenia (95% CI 12.1–16.4), 14.8 weeks in patients with no sarcopenia (95% CI 9.7–20.1) (
p
 = 0.65).
Conclusion
Dose-limiting toxicity was significantly higher in basally sarcopenic patients who were started regorafenib as treatment of metastatic colorectal carcinoma. There was no significant relationship between overall survival and progression-free survival with sarcopenia.