Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Sarcopenia and chemotherapy dosing in obese patients

Nature Reviews Clinical Oncology volume 10, page 664 (2013)Cite this article

Subjects

We read with interest the Review by Lyman and Sparreboom (Chemotherapy dosing in overweight and obese patients with cancer. Nat. Rev. Clin. Oncol. 10, 451–459; 2013)1 because obesity is an area of interest for oncologists owing to its association with increased risk of many cancer types. Compared with nonobese individuals, obese patients with cancer face a number of specific challenges related to the diagnosis and treatment of the disease. One such challenge is the optimal dosing of chemotherapy; uncertainties remain regarding toxicity and overdosing of chemotherapy in these patients.1 In their article, Lyman and Sparreboom1 discussed the evidence supporting the ASCO recommendations for chemotherapy dosing in obese and overweight patients with cancer.2 The authors acknowledged that chemotherapy dosing in adult patients with cancer is generally based on body surface area (BSA) and that obese patients receiving full chemotherapy doses do not experience more adverse events than healthy weight individuals.1 However, we feel that the recommendations by ASCO to use actual body weight for chemotherapy dosing of overweight and obese cancer patients might not completely acknowledge all the available evidence.

One of the major confounding factors in the clinical approach to treating obese patients across different settings—including medical oncology—is the discrepancy between the definition of obesity and how it is diagnosed in daily practice. The hallmark of obesity is the pathological increase of adiposity, yet obesity is generally diagnosed using BMI, which is calculated using only weight and height.3 Thus, the complexity of body composition changes is overlooked and lost. It should be noted that BMI was originally developed for epidemiological studies and its clinical relevance must be cautiously assessed when used for the assessment of individual patients.3 Further complicating the clinical scenario in many obese patients is the observation that increased fat mass is associated with sarcopenia, the loss of muscle mass.4 The pathogenesis of sarcopenia is complex and related to the ageing process and to disease-associated muscle wasting.5 In the clinical setting, sarcopenia is prevalent among obese patients with cancer and negatively impacts on clinical outcome. Prado et al.6 showed that sarcopenic obesity is an independent predictor of survival in obese adult patients with cancer. In the same study, the researchers observed that fat-free mass (FFM) has a poor association with BSA and estimated that variation in FFM among obese patients could result in up to threefold more variation in the effective volume of distribution for chemotherapy administered on the basis of BSA.6 This variation suggests that sarcopenic obesity is an unrecognized factor that can contribute to chemotherapy-associated toxic effects in obese patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Lyman, G. H. & Sparreboom, A. Chemotherapy dosing in overweight and obese patients with cancer. Nat. Rev. Clin. Oncol. 10, 451–459 (2013).

    Article  CAS  Google Scholar 

  2. Griggs, J. J. et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology practice guideline. J. Clin. Oncol. 30, 1553–1561 (2012).

    Article  Google Scholar 

  3. Dulloo, A. G., Jacquet, J., Solinas, G., Montani, J. P. & Schutz, Y. Body composition phenotypes in pathways to obesity and metabolic syndrome. Int. J. Obes. (Lond.) 34 (Suppl. 2), S4–S17 (2010).

    Article  Google Scholar 

  4. Prado, C. M., Wells, J. C., Smith, S. R., Stephan, B. C. & Siervo, M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin. Nutr. 31, 583–601 (2012).

    Article  CAS  Google Scholar 

  5. Laviano, A., Meguid, M. M., Inui, A., Muscaritoli, M. & Rossi Fanelli, F. Therapy insight: cancer anorexia-cachexia syndrome—when all you can eat is yourself. Nat. Clin. Pract. Oncol. 2, 158–165 (2005).

    Article  CAS  Google Scholar 

  6. Prado, C. M. et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 9, 629–635 (2008).

    Article  Google Scholar 

  7. Mir, O. et al. Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS ONE 7, e37563 (2012).

    Article  CAS  Google Scholar 

  8. Lieffers, J. R., Bathe, O. F., Fassbender, K., Winget, M. & Baracos, V. E. Sarcopenia is associated with postoperative infction and delayed recovery from colorectal cancer resection surgery. Br. J. Cancer 107, 931–936 (2012).

    Article  CAS  Google Scholar 

  9. Montano-Loza, A. J. et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin. Gastroenterol. Hepatol. 10, 166–173 (2012).

    Article  Google Scholar 

  10. Silver, H. J., Welch, E. B., Avison, M. J. & Niswender, K. D. Imaging body composition in obesity and weight loss: challenges and opportunities. Diabetes Metab. Syndr. Obes. 3, 337–347 (2010).

    Article  Google Scholar 

  11. Baracos, V. & Kazemi-Bajestani, S. M. Clinical outcomes related to muscle mass in humans with cancer and metabolic illnesses. Int. J. Biochem. Cell Biol. 45, 2302–2308 (2013).

    Article  CAS  Google Scholar 

  12. Smith, T. J. et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J. Clin. Oncol. 30, 880–887 (2012).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy

    Alessandro Laviano, Serena Rianda & Filippo Rossi Fanelli

Authors
  1. Alessandro Laviano
    View author publications

    Search author on:PubMed Google Scholar

  2. Serena Rianda
    View author publications

    Search author on:PubMed Google Scholar

  3. Filippo Rossi Fanelli
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Laviano.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laviano, A., Rianda, S. & Fanelli, F. Sarcopenia and chemotherapy dosing in obese patients. Nat Rev Clin Oncol 10, 664 (2013). https://doi.org/10.1038/nrclinonc.2013.108-c1

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/nrclinonc.2013.108-c1

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing