Sarcopenia and chemotherapy-mediated toxicity

Abstract

This narrative review focuses on the role of sarcopenia and chemotherapy-induced toxicity in cancer patients. Consistent evidence shows that sarcopenia in cancer patients leads to decreased overall survival by influencing treatment discontinuation and dose reduction. Therefore, sarcopenia should be considered a robust prognostic factor of negative outcome as well as a determinant of increased healthcare costs. RESUMO Esta revisão narrativa descreve o papel da sarcopenia e a toxicidade mediada pela quimioterapia em pacientes com câncer. Diversas evidências consistentes mostram que a sarcopenia em pacientes com câncer induz à menor sobrevida global, por influenciar na interrupção do tratamento e na redução da dose. Portanto, a sarcopenia pode ser considerada um importante fator de prognóstico de desfecho negativo, além de um determinante de maiores custos em saúde.

Figure 1. Cancer sarcopenic patient and mechanisms that underlying the chemotherapy-mediated toxicity. Cancer individuals are affected by high-grade inflammation derived from tumor that leads to fat and muscle loss (1). The mechanisms associate with sarcopenia involves the overexpression of the muscle RING finger-containing protein 1 (MURF-1) and atrogin in the skeletal muscle (2) and an explanation of lipolysis occurs by hormone-sensitive lipase activation and free fatty acids secretion (3). Taken together, cancer subjects classified with sarcopenia and adipose tissue atrophy have increased chemotherapy toxicity, reduced cycles or interruption treatment, and poor prognostic (4). In addition, sarcopenia induces chemotherapy-mediated toxicity in cachectic patient as well as in cancer obese-sarcopenic individuals. However, the underlying mechanisms are not clear yet (5). MAFbx/atrogin: muscle atrophy F box protein