Significance of skeletal muscle measurement in cancer-associated cachexia screening

BackgroundCancer-associated cachexia (CAC) screening for trials and interventions primarily relies on assessment of weight loss (WL). Current ESMO guidelines also mention muscle mass evaluation for CAC screening, but data on its actual impact remain scarce.MethodsPatients (≥18 years) with solid tumors receiving antineoplastic therapy and available computed tomography (CT) images for disease monitoring were retrospectively analyzed. Skeletal muscle index (SMI) at third lumbar vertebra was measured in the CT images. Modified Glasgow Prognostic Score (mGPS), WL according to ESMO CAC guidelines, and the EORTC QLQ-C30 questionnaire examining physical functioning (PF2 <80) and appetite loss (AP ≥2) were assessed at last clinical visit prior to CT. Sarcopenic SMI thresholds (men <55 cm2/m2, women <39 cm2/m2) and SMI decrease >5% within 6 months were considered clinically relevant. Only patients and time points with all variables available and an mGPS ≥1 were included.ResultsSufficient data were available at least once in 176 patients (43% female, 57% male, median age 63 years) with a total of 247 time points (median 1, range 1-4 per patient). CAC determined by WL was found in 44% of patients and 36% of time points. Low SMI identified 83% of patients and time points as cachectic. A clinically relevant SMI decrease over time was present in 59% of patients and 50% of time points. Significant WL combined with SMI decrease was found in 30% of patients and 24% of time points. Low SMI coupled with >2% WL was detected in 51% of patients and 45% of time points, while low SMI and >5% WL occurred in 35% of patients and 28% of time points. The highest overlap with 50% of affected patients and 43% of time points was found in SMI decrease alongside low SMI. All 3 criteria were fulfilled in 27% of patients and 21% of time points simultaneously. PF2 <80 and AP ≥2 were present in 52% of patients and 45% of time points. They achieved the highest overlap with WL CAC (68% of patients, 65% of time points) and the lowest with CAC based on low SMI (55% of patients, 48% of time points). Among those meeting all criteria, PF2 <80 and AP ≥2 were observed in 72% of patients and 70% of time points.ConclusionsMuscle mass evaluation may facilitate CAC screening and should be given more consideration in updated clinical practice guidelines.Legal entity responsible for the studyThe authors.FundingThe financial support by the Austrian Federal Ministry for Digital and Economic Affairs, the National Foundation for Research, Technology and Development and the Christian Doppler Research Association is gratefully acknowledged.DisclosureH.C. Puhr: Financial Interests, Personal, Other, Travel support + lecture honoraria: Eli Lilly; Financial Interests, Other, Travel support: MSD, Novartis, Pfizer, Pierre Fabre, Roche. A.M. Starzer: Financial Interests, Personal, Other, Lecture: AstraZeneca; Financial Interests, Other, Travel and congress support: PharmaMar, MSD, Lilly. M. Mair: Financial Interests, Other, Research support: Bristol Myers Squibb; Financial Interests, Other, Travel support: Pierre Fabre. J. Furtner: Financial Interests, Personal, Other, Lecture/consultations: Novartis; Financial Interests, Personal, Other, Lecture/consultation: Seagen, Sanova, Servier. A.S. Berghoff: Financial Interests, Other, Research support: Daiichi Sankyo, Roche ; Financial Interests, Personal, Other, Lectures/consultation/advisory board participation: Roche, Bristol Myers Squibb, Merck, Daiichi Sankyo, AstraZeneca, CeCaVa, Seagen, Alexion, Servier; Financial Interests, Other, Travel support: Roche, Amgen, AbbVie. M. Preusser: Financial Interests, Personal, Other, Lectures/consultation/advisory board participation: Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GSK, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen, Servier. All other authors have declared no conflicts of interest.