Sarcopenia Affects Dose in Reinduction Therapy for Metastatic Colorectal Cancer

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Sarcopenia can lead to reduced overall survival in patients with mCRC.
Sarcopenia can lead to reduced overall survival in patients with mCRC.

Sarcopenia is significantly associated with dose reductions but not with dose-limiting toxicities (DLT) at initiation of capecitabine, bevacizimab, oxaliplatin (CAPOX-B) reinduction therapy in patients with metastatic colorectal cancer (mCRC), according to a study presented at the European Society for Medical Oncology (ESMO) 2017 Congress.

Previous studies have demonstrated that sarcopenia may lead to reduced time-to-progression and overall survival in patients with mCRC. The purpose of this study was to evaluate the association of sarcopenia, a potential risk factor for reduced survival, with dose reductions at the start of CAPOX-B reinduction therapy and DLTs during CAPOX-B reinduction therapy.

Of the 254 patients with mCRC who received reinduction therapy, approximately 40% presented with sarcopenia and had no significant differences in age and sex compared with patients with regular skeletal muscle. Patients with sarcopenia had significantly lower body mass indexes, but on average, were overweight (25.9 ± 3.8 vs 27.2 ± 3.8; P =.01).

At CAPOX-B initiation, 25% of patients had already received a dose reduction and the risk of dose reduction at start was significantly higher for sarcopenic patients compared to patients with normal skeletal muscle (relative risk [RR], 1.8; 95% CI, 1.08-2.90).

Even though sarcopenic patients had more frequent dose reductions at initiation, they did not have a significantly lower risk of DLTs during CAPOX-B therapy (RR sarcopenic vs normal skeletal muscle patients, 0.86; 95% CI, 0.46-1.45).

Results showed that 67% of patients experienced one or more DLTs.

Study authors noted that “possible explanations for dose reductions at start might be more frequent toxicities during previous [therapy] including neuropathy.”


1. Kurk S, Peeters P, Stellato R, et al. Impact of sarcopenia on dose limiting toxicities in metastatic colorectal cancer patients (mCRC pts) receiving palliative systemic treatment. Oral presentation at: 2017 ESMO Congress; September 8-12, 2017; Madrid, Spain. Abstract 1546PD.

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