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Open Access 07-04-2024 | Hyperglycemia | Research

Body composition measures as a determinant of Alpelisib related toxicity

Authors: Eliya Shachar, Ari Raphael, Uriel Katz, Rivka Kessner, Shlomit Strulov Shachar

Published in: Breast Cancer Research and Treatment

Abstract

Background

Body composition has emerged as an important prognostic factor in patients treated with cancer. Severe depletion of skeletal muscle, sarcopenia, has been associated with poor performance status and worse oncological outcomes. We studied patients with metastatic breast cancer receiving alpelisib, to determine if sarcopenia and additional body composition measures accounting for muscle and adiposity are associated with toxicity.

Methods

A retrospective observational analysis was conducted, including 38 women with metastatic breast cancer and a PIK3CA mutation, treated with alpelisib as advanced line of therapy. Sarcopenia was determined by measuring skeletal muscle cross-sectional area at the third lumbar vertebra using computerized tomography. Various body composition metrics were assessed along with drug toxicity, dose reductions, treatment discontinuation, hospitalizations, time to treatment failure and overall survival.

Results

Sarcopenia was observed in half of the patients (n = 19, 50%), spanning normal weight, overweight, and obese individuals. Among the body composition measures, lower skeletal muscle density (SMD) was associated with an increased risk of treatment-related hyperglycaemia (P = 0.03). Additionally, lower visceral adipose tissue (VAT) was associated with alpelisib-induced rash (P = 0.04) and hospitalizations (P = 0.04). Notably, alpelisib treatment discontinuation was not impacted by alpelisib toxicity.

Conclusion

Body composition measures, specifically SMD and VAT may provide an opportunity to identify patients at higher risk for severe alpelisib related hyperglycemia, and cutaneous toxicity. These findings suggest the potential use of body composition assessment to caution toxicity risk, allowing for personalized therapeutic observation and intervention.

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Title: Body composition measures as a determinant of Alpelisib related toxicity
Authors: Eliya Shachar
Ari Raphael
Uriel Katz
Rivka Kessner
Shlomit Strulov Shachar
Publication date: 07-04-2024
Publisher: Springer US
Keywords: Hyperglycemia
Sarcopenia
Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-024-07315-9

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