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Visceral obesity and sarcopenia as predictors of efficacy and hematological toxicity in patients with metastatic breast cancer treated with CDK 4/6 inhibitors

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Abstract

Purpose

We aimed to investigate whether visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA) index are predictive for efficacy and hematological toxicity in ER + HER2—metastatic breast cancer (BC) patients who received CDK 4/6 inhibitors.

Methods

This retrospective cohort study analyzed 52 patients who were treated with CDK 4/6 inhibitors between January 2018 and February 2021. The values of VAT, SAT, SMA indices and hematological parameters were noted before the start, at the third and sixth months of this treatment. The skeletal muscle area (SMA) and adipose tissue measurements were calculated at the level of the third lumbar vertebra. A SMA-index value of <40 cm2/m2 was accepted as the threshold value for sarcopenia.

Results

Patients with sarcopenia had a worse progression-free survival (PFS) compared to patients without sarcopenia (19.6 vs. 9.0 months, p = 0.005). Patients with a high-VAT-index had a better PFS (20.4 vs. 9.3 months, p = 0.033). Only the baseline low-SMA- index (HR: 3.89; 95% CI: 1.35–11.25, p = 0.012) and baseline low-VAT-index (HR: 2.15; 95% CI: 1.02–4.53, p = 0.042) had significantly related to poor PFS in univariate analyses. The low-SMA-index was the only independent factor associated with poor PFS (HR: 3.99; 95% CI: 1.38–11.54, p = 0.011). No relationship was observed between body composition parameters and grade 3–4 hematological toxicity.

Conclusion

The present study supported the significance of sarcopenia and low visceral adipose tissue as potential early indicators of poor PFS in patients treated with CDK 4/6 inhibitors.

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Data availability

The data that support the findings of this study are available from the corresponding author, [KBY], upon reasonable request.

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Authors and Affiliations

  1. Department of Medical Oncology, Gazİ University, Ankara, Turkey

    Kadriye Bir Yücel, Osman Sütcüoglu, Nuriye Özdemir, Ahmet Özet & Ozan Yazıcı

  2. Department of Nuclear Medicine, Gazi University, Ankara, Turkey

    Uguray Aydos

  3. Department of Radiology, Gazi University, Ankara, Turkey

    Atiye Cenay Karabörk Kılıç

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All authors meet the ICMJE authorship criteria. All authors have seen and approved the final version of the manuscript and contributed significantly to the work. Material preparation, data collection and analysis were performed by KBY, OS, and OY. The first draft of the manuscript was written by KBY, OS and all authors commented on previous versions of the manuscript.

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Correspondence to Kadriye Bir Yücel.

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Yücel, K.B., Aydos, U., Sütcüoglu, O. et al. Visceral obesity and sarcopenia as predictors of efficacy and hematological toxicity in patients with metastatic breast cancer treated with CDK 4/6 inhibitors. Cancer Chemother Pharmacol 93, 497–507 (2024). https://doi.org/10.1007/s00280-024-04641-z

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