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The impact of cachexia and sarcopenia in elderly pancreatic cancer patients receiving palliative chemotherapy

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Abstract

Background

Elderly pancreatic cancer (PC) patients are often considered vulnerable to treatment and standard treatment strategy for this subpopulation is uncertain. Cachexia and sarcopenia are reported to be associated with reduced physical performance, reduced anti-tumor response, increased chemotherapy toxicity, and poor prognosis in several malignancies. The aim of this study was to evaluate the impact of cachexia and sarcopenia on the clinical course of elderly PC patients receiving chemotherapy.

Methods

We retrospectively investigated consecutive elderly metastatic PC patients (≥ 75 years) treated with chemotherapy at our institution between January 2015 and April 2020. Skeletal muscle index was calculated at the third lumbar vertebra using pretreatment computed tomography. We evaluated time to treatment failure (TTF), progression-free survival (PFS), overall survival (OS), early treatment discontinuation, relative dose intensity (RDI), and severe adverse events (AEs).

Results

Among 80 patients included (gemcitabine plus nab-paclitaxel [GnP] 52; gemcitabine 21; S1 6; modified FOLFIRINOX 1), cachexia and sarcopenia were present in 48 (60%) and 61 (76%) patients, respectively. Cachexia was associated with older age, worse performance status, higher level of neutrophil to lymphocyte ratio, worse nutritional status, and shorter TTF and PFS. Furthermore, it was also associated with early treatment discontinuation, reduced RDI of nab-paclitaxel, and increased incidence of grade 4 neutropenia in patients receiving GnP. On the other hand, sarcopenia had less impact on the clinical course of elderly PC patients.

Conclusions

In our experience, cachexia was considered an effective tool in the management of elderly PC patients receiving palliative chemotherapy.

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Abbreviations

PC:

Pancreatic cancer

FFX:

FOLFIRINOX

GnP:

Gemcitabine plus nab-paclitaxel

PS:

Performance status

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

AEs:

Adverse events

HU:

Hounsfield unit

SMI:

Skeletal muscle index

BMI:

Body mass index

ACCI:

Age-adjusted Charlson comorbidity index

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

mGPS:

Modified Glasgow prognostic score

CRP:

C-reactive protein

NLR:

Neutrophil to lymphocyte ratio

PNI:

Prognostic nutritional index

RDI:

Relative dose intensity

OS:

Overall survival

PFS:

Progression-free survival

TTF:

Time to treatment failure

BSC:

Best supportive care

WBC:

White blood cell

HR:

Hazard ratio

CI:

Confidence interval

OR:

Odds ratio

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Acknowledgements

We have no funds and grants in this study.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan

    Tsuyoshi Takeda, Takashi Sasaki, Chisaki Suzumori, Takafumi Mie, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka & Naoki Sasahira

Authors
  1. Tsuyoshi Takeda
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  2. Takashi Sasaki
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  3. Chisaki Suzumori
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  4. Takafumi Mie
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  5. Takaaki Furukawa
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  6. Yuto Yamada
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  7. Akiyoshi Kasuga
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  8. Masato Matsuyama
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  9. Masato Ozaka
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  10. Naoki Sasahira
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Contributions

Study concept and design: TT, TS, MO, NS. Acquisition of data: all authors. Analysis and interpretation of data: TT, TS, MO, NS. Drafting of the article: TT. Critical revision of the article for important intellectual content: all authors. Final approval of the article: all authors.

Corresponding author

Correspondence to Takashi Sasaki.

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Conflict of interest

All authors declare no conflicts of interests for this article. Conflicts of interests outside this work are as follows; Naoki Sasahira received research funding from Zeria, Eisai, Kyowa Hakko Kirin, Baxalta and Taiho Pharmaceutical. Masato Ozaka received honoraria from Taiho Pharmaceutical, Yakult, Bayer, Pfizer, Novartis, Takeda Pharmaceutical Company Limited, Eisai, EA pharma and Mitsubishi Tanabe Pharma Corporation and research funding from Merck & Co., Inc., Incyte, ASLAN Pharmaceuticals, Taiho Pharmaceutical and Yakult. Takashi Sasaki received honoraria from Taiho Pharmaceutical and Eisai.

Ethics approval

This study was approved by the ethics committee of our institution (Institutional Review Board number: 2020-1210).

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Takeda, T., Sasaki, T., Suzumori, C. et al. The impact of cachexia and sarcopenia in elderly pancreatic cancer patients receiving palliative chemotherapy. Int J Clin Oncol 26, 1293–1303 (2021). https://doi.org/10.1007/s10147-021-01912-0

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  • DOI: https://doi.org/10.1007/s10147-021-01912-0

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