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Huemer, F; Schlintl, V; Hecht, S; Hackl, H; Melchardt, T; Rinnerthaler, G; Greil, R; Weiss, L.
Regorafenib Is Associated With Increased Skeletal Muscle Loss Compared to TAS-102 in Metastatic Colorectal Cancer.
Clin Colorectal Cancer. 2019; 18(2): 159-166.e3. Doi: 10.1016/j.clcc.2019.04.003
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Co-authors Med Uni Graz: Rinnerthaler Gabriel
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Abstract:: BACKGROUND: Current guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology recommend regorafenib or trifluridine/tipiracil (TAS-102) for third-line therapy of metastatic colorectal cancer (mCRC). We evaluated the impact of regorafenib and TAS-102 treatment on skeletal muscle dynamics and sarcopenia. PATIENTS AND METHODS: This retrospective analysis was based on unselected, consecutive mCRC patients treated with regorafenib and/or TAS-102 during third or later line of therapy at our tertiary-care cancer center in Salzburg, Austria. The skeletal muscle index (SMI, cm²/m²) and sarcopenia were evaluated from cross-sectional computed tomographic images at the level of the third lumbar vertebra. RESULTS: Between January 2013 and April 2018, a total of 45 patients had received regorafenib and/or TAS-102. At initial mCRC diagnosis and at initiation of third-line therapy, 24% and 54% of patients presented with sarcopenia. A statistically significant skeletal muscle loss was observed during regorafenib treatment (median SMI change: -2.75 cm²/m² [-6.3%]; P < .0001), which was not the case during TAS-102 therapy (-1.5 cm²/m² [-3.5%]; P = .575). Furthermore, subclassification of patients into 3 groups-normal muscle mass, stable sarcopenia, and new-onset sarcopenia-at initiation of third-line therapy permitted discrimination of overall survival, with 1-year overall survival rates of 61%, 29%, and 16%, respectively (P = .04). CONCLUSION: The frequency of sarcopenia increases during the course of mCRC and negatively affects survival. In contrast to TAS-102, regorafenib is associated with increased skeletal muscle loss during mCRC treatment and should therefore be used with caution in mCRC patients with preexisting sarcopenia or a history of recent weight loss.
Find related publications in this database (using NLM MeSH Indexing): Adult - administration & dosage; Aged - administration & dosage; Aged, 80 and over - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage, adverse effects; Austria - administration & dosage; Colorectal Neoplasms - complications, drug therapy, mortality; Drug Combinations - administration & dosage; Female - administration & dosage; Follow-Up Studies - administration & dosage; Humans - administration & dosage; Lumbar Vertebrae - administration & dosage; Male - administration & dosage; Middle Aged - administration & dosage; Muscle, Skeletal - diagnostic imaging, drug effects; Phenylurea Compounds - administration & dosage, adverse effects; Pyridines - administration & dosage, adverse effects; Pyrrolidines - administration & dosage, adverse effects; Retrospective Studies - administration & dosage; Salvage Therapy - adverse effects, methods; Sarcopenia - diagnosis, epidemiology, etiology; Severity of Illness Index - administration & dosage; Survival Rate - administration & dosage; Thymine - administration & dosage; Tomography, X-Ray Computed - administration & dosage; Trifluridine - administration & dosage, adverse effects; Uracil - administration & dosage, adverse effects, analogs & derivatives
Find related publications in this database (Keywords): Cross-sectional image; mCRC; Sarcopenia; Third-line therapy; Trifluridine/tipiracil