Body Composition Changes in Gastric Cancer Patients during Preoperative FLOT Therapy: Preliminary Results of an Italian Cohort Study.

Emanuele Rinninella,Maria Mele,Mariantonietta Di Salvatore,Antonio Gasbarrini,Enza Genco,Marco Cintoni,Carmelo Pozzo,Riccardo Manfredi,Antonia Strippoli,Emilio Bria,Raffaella Vivolo,Pauline Raoul,Giampaolo Tortora

doi:10.3390/nu13030960

Abstract

Background: The impact of the new chemotherapy, fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) on body composition in gastric cancer (GC) patients remains unknown. We assessed body composition changes of GC patients receiving the FLOT regimen and their impact on treatment outcomes. Methods: Preoperative pre- and post-FLOT computed tomography (CT) scans of advanced GC patients were studied. Lumbar skeletal muscle index (SMI) and adipose indices were calculated before and after FLOT. Results: A total of 26 patients were identified between April 2019 and January 2020. Nineteen patients were sarcopenic at diagnosis. The mean BMI decreased (from 24.4 ± 3.7 to 22.6 ± 3.1; p < 0.0001) as well as the SMI (from 48.74 ± 9.76 to 46.52 ± 9.98; p = 0.009) and visceral adipose index (VAI) (from 49.04 ± 31.06 to 41.99 ± 23.91; p = 0.004) during preoperative FLOT therapy. BMI, SMI, and VAI variations were not associated with toxicity, Response Evaluation Criteria in Solid Tumors (RECIST), response, delay and completion of perioperative FLOT chemotherapy, and the execution of gastrectomy; a decrease of SMI ≥ 5% was associated with a higher Mandard tumor regression grade (p = 0.01). Conclusions: Almost three-quarters (73.1%) of GC patients were sarcopenic at diagnosis. Preoperative FLOT was associated with a further reduction in SMI, BMI, and VAI. These changes were not associated with short-term outcomes.

Highlights

Gastric cancer (GC) is the fifth most common neoplasm and the third most deadly cancer, with an estimated 783,000 deaths in 2018 in the world [1]
The perioperative 5-fluorouracil/leucovorin/oxaliplatin/docetaxel (FLOT) regimen has been proved to be more effective in terms of clinical outcomes than previous anthracycline-based neoadjuvant chemotherapy schedules used in clinical practice [7]
This study reported no significant association of body composition changes (BMI, skeletal muscle index (SMI), and visceral adipose index (VAI)) with treatment outcomes in terms of delay of chemotherapeutic cycles, Response Evaluation Criteria in Solid Tumors (RECIST) response, toxicity, and completion of perioperative FLOT treatment, confirming the findings of similar studies [18,20]

Summary

Introduction

Gastric cancer (GC) is the fifth most common neoplasm and the third most deadly cancer, with an estimated 783,000 deaths in 2018 in the world [1]. GC is often diagnosed at an advanced stage and has a low 5-year survival rate. In this context, gastrectomy remains the mainstay treatment for GC. The perioperative 5-fluorouracil/leucovorin/oxaliplatin/docetaxel (FLOT) regimen has been proved to be more effective in terms of clinical outcomes than previous anthracycline-based neoadjuvant chemotherapy schedules used in clinical practice [7]. In 2019, the European Society for Medical Oncology (ESMO) recommended the FLOT regimen as a perioperative treatment for patients with locally advanced The impact of the new chemotherapy, fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) on body composition in gastric cancer (GC) patients remains unknown. We assessed body composition changes of GC patients receiving the FLOT regimen and their impact on treatment outcomes. The mean BMI decreased (from 24.4 ± 3.7 to 22.6 ± 3.1; p < 0.0001) as well as the SMI

Methods

Results

Discussion

Conclusion