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Body composition and anti-neoplastic treatment in adult and older subjects - A systematic review

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The journal of nutrition, health & aging

Abstract

Background

The estimation of the risk of poor tolerance and overdose of antineoplastic agents protocols represents a major challenge in oncology, particularly in older patients. We hypothesize that age-related modifications of body composition (i.e. increased fat mass and decreased lean mass) may significantly affect tolerance to chemotherapy.

Method

We conducted a systematic review for the last 25 years (between 1990 and 2015), using US National library of Medicine Medline electronic bibliographic database and Embase database of cohorts or clinical trials exploring (i) the interactions of body composition (assessed by Dual X-ray Absorptiometry, Bioelectrical Impedance Analyses, or Computerized Tomography) with pharmacokinetics parameters, (ii) the tolerance to chemotherapy, and (iii) the consequences of chemotherapies or targeted therapies on body composition.

Results

Our search identified 1504 articles. After a selection (using pre-established criteria) on titles and abstract, 24 original articles were selected with 3 domains of interest: impact of body composition on pharmacokinetics (7 articles), relationship between body composition and chemotoxicity (14 articles), and effect of anti-cancer chemotherapy on body composition (11 articles). The selected studies suggested that pharmacokinetic was influenced by lean mass, that lower lean mass could be correlated with toxicity, and that sarcopenic patients experienced more toxicities that non-sarcopenic patients. Regarding fat mass, results were less conclusive. No studies specifically explored the topic of body composition in older cancer patients.

Conclusions

Plausible pathophysiological pathways linking body composition, toxicity, and pharmacokinetics are sustained by the actual review. However, despite the growing number of older cancer patients, our review highlighted the lack of specific studies in the field of anti-neoplastic agents toxicity regarding body composition conducted in elderly.

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Authors and Affiliations

  1. Department of internal medicine and geriatrics, Toulouse University Hospital, Toulouse, France

    Stéphane Gérard, D. Bréchemier, A. Lefort, S. Lozano, G. Abellan Van Kan, V. Soler, B. Vellas, M. Cesari, Y. Rolland & L. Balardy

  2. Cancer center, Claudius Regaud Institute, Toulouse, France

    T. Filleron & L. Mourey

  3. Oncology unit, Clinique Pasteur, Toulouse, France

    C. Bernard-Marty

  4. Department of Family Medicine, University of Toulouse III Paul Sabatier, Toulouse, France

    M. E. Rougé-Bugat

  5. INSERM UMR 1027, University of Toulouse III Paul Sabatier, Toulouse, France

    B. Vellas, M. Cesari & Y. Rolland

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  1. Stéphane Gérard
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Gérard, S., Bréchemier, D., Lefort, A. et al. Body composition and anti-neoplastic treatment in adult and older subjects - A systematic review. J Nutr Health Aging 20, 878–888 (2016). https://doi.org/10.1007/s12603-015-0653-2

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