Neoadjuvant therapy for pancreatic cancer induces positive changes in body composition
medwireNews: Patients with borderline resectable or locally advanced pancreatic cancer experience a significant loss of adipose tissue along with an increase in muscle mass during neoadjuvant therapy that may improve the odds for resection, researchers report.
Carlos Fernández-del Castillo (Harvard Medical School, Boston, Massachusetts, USA) and colleagues found that patients who underwent resection experienced a 5.9% increase in skeletal muscle area during neoadjuvant treatment, whereas those who underwent surgical exploration had a 1.7% decrease, a difference that was statistically significant.
Overall, 136 (70.5%) of 193 patients (mean age 64 years, 49.7% women) with borderline resectable or locally advanced pancreatic cancer underwent resection following neoadjuvant therapy, typically with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (64.2%). Almost half (44.6%) of patients also received chemoradiotherapy.
The researchers report that measures of total adiposity, visceral adiposity, and lean mass all changed significantly during the median 6-month interval between imaging pre- and post-neoadjuvant therapy.
Specifically, median total adipose tissue area decreased from 284.0 cm2 to 250.0 cm2, while median visceral adipose tissue area decreased from 115.2 cm2 to 97.7 cm2.
By contrast, median skeletal muscle increased from 122.1 cm2 to 123.7 cm2.
Fernández-del Castillo and team found that patients who underwent resection had a significantly higher skeletal mass normalized for height (TAMA) after neodjuvant therapy than those with tumors that could not be resected, at 45.1 cm2/m2 versus 42.0 cm2/m2.
Furthermore, the rate of sarcopenia in the unresected group increased, albeit non-significantly, from 36.8% at baseline to 52.8% after neoadjuvant therapy, whereas it fell from 46.3% to 36.8% in resected group.
On multivariate analysis, the researchers showed that an increase in TAMA over 4.0 cm2/m2 was associated with a 3.7-fold increased likelihood for resection.
They conclude in JAMA Surgery that neoadjuvant therapy “had an overall positive association with body composition in patients with [pancreatic cancer].”
In an accompanying comment, Kevin Conlon and colleagues, from Trinity College Dublin in Ireland, describe the findings as “provocative” and “important for 2 reasons.”
They say the data indicate “that anabolic potential exists among patients with borderline resectable and locally advanced pancreatic cancer who are undergoing neoadjuvant treatment and that the ability to improve muscle indices is associated with response to treatment.”
However they add that larger scale, prospective studies as well as those investigation nutritional interventions are needed.
Conlon et al conclude: “The limited success to date in improving outcomes for patients with pancreatic cancer highlights the need to explore any strategy that may improve patient prognosis and treatment delivery.”
By Laura Cowen
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