Two faces of drug therapy in cancer: drug-related lean tissue loss and its adverse consequences to survival and toxicity.
ABSTRACT A common feature of cancer patients is loss of lean tissue, specifically skeletal muscle, which may be the result of the tumor or a side-effect of chemotherapy or other drugs. Lean tissue loss in turn has important adverse implications for toxicity of antineoplastic therapy and, hence, cancer prognosis.
Contemporary cancer populations have heterogeneous proportions of lean tissue, regardless of body weight. Wasting of lean tissue during the cancer trajectory has been associated with tumor progression. Lean tissue depletion is an independent predictor of severe toxicity in patients treated with chemotherapeutic agents of diverse classes. Patients with lean tissue depletion behave as if overdosed and have toxicity of sufficient magnitude to require dose reductions, treatment delays or definitive termination of treatment. Muscle loss may occur due to a specific effect of a chemotherapy agent (i.e. sorafenib), androgen suppression therapy or other drugs (i.e. statins such as atorvastatin).
Lean tissue wasting occurs due to cancer progression and may be exacerbated by several drug classes. This loss of lean tissue is not proportional to changes in body weight and is prognostic of enhanced treatment toxicity and reduced survival.
Article: Progressive resistance training and cancer testis (PROTRACT) - efficacy of resistance training on muscle function, morphology and inflammatory profile in testicular cancer patients undergoing chemotherapy: design of a randomized controlled trial.[show abstract] [hide abstract]
ABSTRACT: Standard treatment for patients with disseminated germ cell tumors is combination chemotherapy with bleomycin, etoposide and cisplatin (BEP). This treatment is highly effective, but the majority of patients experience severe adverse effects during treatment and are at risk of developing considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, and pulmonary toxicity. One neglected side effect is the significant muscular fatigue mentioned by many patients with testicular cancer both during and after treatment. Very limited information exists concerning the patho-physiological effects of antineoplastic agents on skeletal muscle. The primary aim of this study is to investigate the effects of BEP-treatment on the skeletal musculature in testicular cancer patients, and to examine whether the expected treatment-induced muscular deterioration can be attenuated or even reversed by high intensity progressive resistance training (HIPRT). The PROTRACT study is a randomized controlled trial in 30 testicular cancer patients undergoing three cycles of BEP chemotherapy. Participants will be randomized to either a 9-week HIPRT program (STR) initiated at the onset of treatment, or to standard care (UNT). 15 healthy matched control subjects (CON) will complete the same HIPRT program. All participants will take part in 3 assessment rounds (baseline, 9 wks, 21 wks) including muscle biopsies, maximum muscle strength tests, whole body DXA scan and blood samples. Primary outcome: mean fiber area and fiber type composition measured by histochemical analyses, satellite cells and levels of protein and mRNA expression of intracellular mediators of protein turnover. Secondary outcomes: maximum muscle strength and muscle power measured by maximum voluntary contraction and leg-extensor-power tests, body composition assessed by DXA scan, and systemic inflammation analyzed by circulating inflammatory markers, lipid and glucose metabolism in blood samples. Health related Quality of Life (QoL) will be assessed by validated questionnaires (EORTC QLQ-C30, SF-36). This study investigates the muscular effects of antineoplastic agents in testicular cancer patients, and furthermore evaluates whether HIPRT has a positive influence on side effects related to chemotherapy. A more extensive knowledge of the interaction between cytotoxic-induced physiological impairment and exercise-induced improvement is imperative for the future development of optimal rehabilitation programs for cancer patients. Current Controlled Trials ISRCTN32132990.BMC Cancer 08/2011; 11:326. · 3.01 Impact Factor