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Published on: October 2, 2015
[Sarcopenia and immune-related toxicity in patients with malignant melanoma undergoing immune checkpoint inhibition]
Christian Holtorf1,2, Miriam Mengoni2, Thomas Tüting2
1Hautarztpraxis Dr. med. Anke Raschke, Magdeburg, Deutschland.
Background And Objectives:
Sarcopenia is the generalized loss of muscle strength, mass, and function. The aim was to investigate whether pretherapeutic sarcopenia, as determined by the psoas muscles, affects therapy-mediated toxicity in patients with malignant melanoma undergoing immunotherapy.
Patients And Methods:
Measurement of psoas musculature was performed pretherapeutically using computed tomography at the level of the third lumbar vertebra in the axial plane in 75 patients between January 2011 and December 2020. Sarcopenia was defined using the psoas muscle index (PMI). Immune-related toxicity was retrospectively assessed.
Results:
Treatment-related toxicity was recorded in 33 of the 75 patients (44%). Of these, 16 patients (36.2%) experienced dose-limiting severe events (DLT). Pretherapeutic sarcopenia was identified in 25 patients (33.3%). Comparative analysis showed that the patients with a DLT had lower PMI values compared with the patient group without a DLT (4.65 ± 1.33 vs. 5.79 ± 1.67 cm2m-2, p = 0.015) (odds ratio = 0.60, 95% confidence interval 0.40-0.92, p = 0.02).
Conclusions:
Pretherapeutic sarcopenia measured based on the psoas muscle is not a significant predictor of immune-mediated toxicity in patients with malignant melanoma treated with immune checkpoint inhibitors. Patients with DLT have lower values for the psoas muscle parameters PMI compared to the group of patients without DLT.
Insights
Pretherapeutic sarcopenia, identified by psoas muscle index, did not significantly predict immune-related toxicity in melanoma patients undergoing immunotherapy. However, patients experiencing severe toxicity had lower psoas muscle index values.
Area of Science:
- Oncology
- Immunology
- Geriatrics
Context:
- Sarcopenia, a loss of muscle mass and strength, is prevalent in older adults and cancer patients.
- Immune checkpoint inhibitors (ICIs) have revolutionized melanoma treatment, but can cause immune-related toxicity.
- Predicting toxicity is crucial for optimizing ICI therapy in melanoma.
Purpose:
- To investigate if pretherapeutic sarcopenia, assessed via psoas muscle measurements, correlates with therapy-mediated toxicity in malignant melanoma patients receiving immunotherapy.
- To determine the predictive value of psoas muscle index (PMI) for dose-limiting toxicities (DLTs) in this patient cohort.
Summary:
- This study assessed pretherapeutic sarcopenia using computed tomography in 75 melanoma patients undergoing immunotherapy.
- Sarcopenia was defined by psoas muscle index (PMI). Immune-related toxicity and DLTs were retrospectively analyzed.
- While pretherapeutic sarcopenia was not a significant predictor of toxicity, patients with DLTs exhibited lower PMI values compared to those without DLTs.
Impact:
- Findings suggest that while sarcopenia may not be a primary predictor, low psoas muscle index is associated with increased toxicity risk in melanoma patients on immunotherapy.
- This highlights the potential role of muscle assessment in patient stratification and management.
- Further research is warranted to elucidate the complex interplay between sarcopenia, immunotherapy, and toxicity in melanoma.
