Neoadjuvant therapy-induced sarcopenia, reduced OS linked in pancreatic ductal adenocarcinoma
Neoadjuvant therapy-induced sarcopenia in patients who underwent neoadjuvant therapy for pancreatic ductal adenocarcinoma correlated with increased disease recurrence and overall mortality, and reduced overall survival, according to a presentation from Digestive Disease Week.
“Patients who have pancreatic cancer are being preferentially treated with chemotherapy and/or radiation before surgery to ensure complete delivery while they are healthy,” Motaz Qadan, MD, PhD, from Massachusetts General Hospital in Boston, told Healio Gastroenterology and Liver Disease. “However, we found that this type of treatment can decondition patients and result in substantial muscle loss and weakening in over one-third of pancreatic cancer patients. [We] showed that this degree of deconditioning was associated with worse oncologic outcomes, including a higher proportion of disease recurrence and lower overall survival, thus highlighting the potential detrimental effect of any such weakening and deconditioning that occurs while on treatment.”
Qadan and colleagues identified 346 patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant chemotherapy and/or radiation then underwent a pancreatomy. They measured cross-sectional areas of skeletal muscle at the L4 vertebra with CT scans. Age-related sarcopenia was defined as 5% to 8% loss of skeletal mass area over a decade.
Of the patients who underwent neoadjuvant therapy, 146 had imaging available for review. Before the start of therapy, men on average had a skeletal mass area (SMA) of 162.7cm2 and women had an average SMA of 102.7cm2. Investigators reported 63 patients experienced at least a 5% SMA loss and 44% lost 8% or more SMA over the duration of neoadjuvant therapy. This led to a mean SMA loss of 3.5 cm2.
The researchers observed an association between a decreased 2-year overall survival among patients who had an 8% or more loss of SMA vs. the rest of the group (45.5% vs. 63.3%; P = .04) as well as among those with a 5% or greater loss of SMA (42.9% vs. 68.3%; P = .001).
Study results also showed a correlation between increased disease recurrence and patients who lost 5% or more SMA (63.5% vs. 45.0%; P = .02). Further, increased lymphovascular invasion rates (32.6% vs. 16.7%; P = .03) and positive-margin resections (30.2% vs. 15.1%; P = .03) were seen in patients who lost 8% or more SMA. Results from logistic regression demonstrated a 5% or more loss of SMA correlated with increased overall mortality (OR = 2.42, 955 CI, 1.11-5.27; P = .026) and disease recurrence (OR = 6.23; 95% CI 2.91-13.3; P < .001).
“There is a unique opportunity that exists to optimize patients, which can be achieved with prehabilitation,” he said. “This ideally would include multimodal programs that enhance physical strength and nutrition with the goal of preventing the documented decline seen in our study from chemotherapy and/or radiation in preparation for major pancreatic surgery. Prehabilitation may, thus, provide an opportunity for improved oncologic outcomes, including reduction in disease recurrence and extending overall survival, based on our data.” – by Monica Jaramillo
Reference: Sell MN, et al. Abstract 795. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
Disclosure: Qadan reports no relevant financial disclosures.