Cytotoxic chemotherapy for testicular cancer linked to increased body fat
SAN FRANCISCO — Young men with metastatic testicular cancer who underwent cytotoxic chemotherapy experienced increases in body adipose mass with decreased muscle density, according to a retrospective study presented at Genitourinary Cancers Symposium.
However, these patients maintained stable lean muscularity following first-line treatment.
“Exposure to cytotoxic chemotherapy has been observed to be associated with significant changes in body composition, namely marked lean muscle mass losses, with implications for treatment-related toxicity and oncologic outcomes,” Karan Kumar Arora, MD, resident and member of the department of urology at Mayo Clinic in Scottsdale, Arizona, and colleagues wrote. “However, prior studies predominately included elderly patients who, a priori, are at risk for sarcopenia or severe muscle skeletal deficiency. To date, the impact of cytotoxic chemotherapy on body composition in young men with testicular cancer remains undefined.”
Arora and colleagues evaluated 19 men (median age, 28 years; 52.6% Hispanic) with metastatic testicular cancer who received cytotoxic chemotherapy (median number of cycles, 4; range, 3-6) between 2015 and 2017. The researchers calculated lumbar skeletal muscle index in addition to visceral, subcutaneous and intramuscular adipose indices, fat-free mass and fat mass using cross-sectional soft tissue area measurements on CT axial scans performed before and after cytotoxic chemotherapy.
Based on National Health and Nutrition Examination Survey classification, five patients (26.3%) had normal BMI, nine (47.4%) were overweight, four (21.1%) had class 1 obesity and one (5.3%) had class 2 obesity.
Researchers compared body composition factors before and after treatment using paired Wilcoxon signed-rank tests.
Median time between imaging assessments was 121 days.
Median BMI increased 6.2% from before to after cytotoxic chemotherapy, from 27.7 kg/m2 to 29.6 kg/m2.
Results showed significant increases from before to after treatment in median visceral fat index (+29%; 19.9 cm2/m2 vs. 30.8 cm2/m2; P = .01), subcutaneous fat index (+18.5%; 47.9 cm2/m2 vs. 58.2 cm2/m2; P = .03) and intramuscular fat index (+39.7%; 3 cm2/m2 vs. 5.2 cm2/m2; P = .002), as well as total body fat mass (+13.3%; 18.6 kg vs. 21.1 kg; P = .01).
Researchers observed decreases in median muscle density (–4.4%; 47 HU vs. 43.6 HU), skeletal muscle index (–3.1%; 63.5 cm2/m2 vs. 57.8 cm2/m2) and total body fat-free mass (–2.8%; 63.5 kg vs. 60 kg), although these differences did not reach statistical significance.
“While lean muscularity remained stable, we observed significant increases in total body adipose mass with decreased muscle density in this consecutive case series of [patients with] testicular cancer following cytotoxic chemotherapy,” the researchers wrote. “Pending validation, these results may have potential implications for concurrent nutritional and exercise interventions/education while patients undergo chemotherapy.” – by Jennifer Byrne
Arora KK, et al. Abstract 525. Presented at: Genitourinary Cancers Symposium; Feb. 14-16, 2019; San Francisco.
Disclosures: Arora reports no relevant disclosures. Please see the abstract for all other authors’ relevant financial disclosures.