Suspicion of sarcopenia as a predictor of toxicity in older people with cancer

BACKGROUND: Functional status is considered the standard criterion prior to systemic therapy administration; however, in older adults with cancer, this criterion may lead to challenges in this group. OBJECTIVE: To evaluate the association between suspicion of sarcopenia and systemic treatment toxicity in older adults with cancer. MATERIAL AND METHODS: Prospective cohort study which included 150 older adults with recent diagnosis of cancer, candidates to systemic cancer treatment and who signed informed consent. Older adults with brain metastasis were excluded. Prior to systemic treatment, functional status variables were evaluated: skeletal muscle strength, sarcopenia screening, frailty, and chair stand test. Follow-up evaluations were performed before each systemic treatment cycle. Endpoint was considered as the clinical evidence or laboratory toxicity grade 3 or higher, using the Common Terminology Criteria for Adverse Events, version 5.0, or the completion of the treatment regimen. RESULTS: The incidence of systemic toxicity was 42.7%. In the comparison between patients without toxicity vs. patients with toxicity, the latter group showed a higher frequency of tobacco use, frailty, risk of sarcopenia, and lower grip strength. Only sarcopenia screening predicted systemic toxicity (hazard ratio [HR]: 2.13, 95% confidence interval [95% CI] 1.16-3.91). CONCLUSIONS: The suspicion of sarcopenia was the only toxicity predictor for systemic therapy in older adults with cancer.