QUALITY OF SKELETAL MUSCLE AND ADIPOSE TISSUE PREDICTS THE RISK OF TOXICITY TO CHEMOTHERAPY IN WOMEN WITH OVARIAN ADENOCARCINOMA

Background:Chemotherapy for ovarian cancer causes several toxic effects. To date, studies that associate body composition with toxicity to treatment, especially considering the effect of drug interactions in these patients, remain absent. The presente study aimed to evaluate the association of body composition with toxicity to first-line chemotherapy in women with ovarian adenocarcinoma. Methods: This retrospective cohort included 170 women with ovarian adenocarcinoma treated with carboplatin and paclitaxel between 2008-2017, in Rio de Janeiro - RJ. Pretreatment computed tomography (CT) scans were used to quantify the tissues muscular and adipose. The following parameters were evaluated: myopenia, by the skeletal muscle index (SMI) < 38.9 cm²/m²; muscular quality, by mean muscle attenuation and high radiodensity skeletal muscle index (HRSMI), both < 75th percentile ( < p75); and adipose tissue, assessed by subcutaneous or intramuscular adipose tissue índex < p75. The study’s outcomes were grade > 3 toxicity and pharmacological toxicity management (PTT), defined as any dose reduction > 7 days, monotherapy and/or permanent discontinuation due to toxicity. Multiple logistic regression models were adjusted for age > 65 years, performance status (PS), Charlson Comorbidity Index, number of cycles, prescription of anticoagulants and antiemetics, moderate/severe drug interaction, monotherapy and dose reduction in the first cycle. We adopted a significance level of 5%. Results: Average age was 56.8 years and 36.5% had myopenia prior to treatment. More than 38.0% had PTT and 43.5% presented any grade 3 toxicity. Roughly 17.0% and 14.0% of patients presented delay and treatment discontinuation for toxicity, respectively. The most frequent toxicities were nausea (69.4%), anemia (61.2%) and leucopenia (56.5%). Moderate/severe interaction occurred in 4.1% of the patients. As for both parameters of adipose tissue, when < p75, were predictors of toxicity grade > 3. HRSMI < p75 was the only muscular parameter predictor independent of this outcome (OR 3.14; CI 1.347.39; p < 0.01). However, none of the body composition parameters were able to predict PTT, only PS > 2 and monotherapy in the first cycle were considered risk factors. Conclusion: The pre-treatment body composition, including high radiodensity muscle and adipose tissue, was able to predict grade > 3 toxicity to chemotherapy in women with ovarian cancer and, therefore, should be considered in the antitumor treatment.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019