MP08-12 SARCOPENIA PREDICTS NEOADJUVANT CHEMOTHERAPY TOLERANCE AND ASSOCIATED RENAL TOXICITY IN MUSCLE INVASIVE BLADDER CANCER PATIENTS WITH BORDERLINE RENAL FUNCTION

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP08)1 May 2024MP08-12 SARCOPENIA PREDICTS NEOADJUVANT CHEMOTHERAPY TOLERANCE AND ASSOCIATED RENAL TOXICITY IN MUSCLE INVASIVE BLADDER CANCER PATIENTS WITH BORDERLINE RENAL FUNCTION Eiftu Haile, Zaeem Lone, David Shin, Andrew Wood, Rebecca Campbell, Christopher Weight, Samuel Haywood, Mohamed Eltemamy, Georges-Pascal Haber, Steven Campbell, Hadley Wood, Nima Almassi, and Erick M. Remer Eiftu HaileEiftu Haile , Zaeem LoneZaeem Lone , David ShinDavid Shin , Andrew WoodAndrew Wood , Rebecca CampbellRebecca Campbell , Christopher WeightChristopher Weight , Samuel HaywoodSamuel Haywood , Mohamed EltemamyMohamed Eltemamy , Georges-Pascal HaberGeorges-Pascal Haber , Steven CampbellSteven Campbell , Hadley WoodHadley Wood , Nima AlmassiNima Almassi , and Erick M. RemerErick M. Remer View All Author Informationhttps://doi.org/10.1097/01.JU.0001008780.87855.57.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The traditional cutoff for cisplatin-eligibility is a glomerular filtration rate (GFR) ≥60 mL/min. Treatment of patients with "borderline" renal function is feasible but carries a higher toxicity risk and often requires dose reduction. Creatinine-based GFR calculations may overestimate renal function in patients with diminished muscle mass. Suspecting that sarcopenia leads to GFR overestimation by traditional calculations, we investigated whether diminished skeletal mass is associated with an increased risk of neoadjuvant chemotherapy (NAC) toxicity among muscle invasive bladder cancer (MIBC) patients with "borderline" renal function. METHODS: We identified patients with MIBC and baseline borderline renal function (GFR 40-65 ml/min) treated with NAC from 2001-2023 using a prospectively maintained database. Body composition measurements were derived from pre-treatment CT scans, and skeletal muscle and fat mass indices (SMI, FMI) were calculated using established formulas. Chemotherapy toxicity was documented using the Common Terminology Criteria for Adverse Events (CTCAE). Multivariate logistic regression was used to evaluate predictors of NAC toxicity. RESULTS: Among 112 patients with borderline GFR, sarcopenic patients were older (median age 69 vs. 65 years, p=0.03), had a higher smoking prevalence (73% vs. 47%, p=0.03), and had a higher incidence of any NAC-associated toxicity (85% vs. 68%, p=0.08). On multivariable analysis, SMI was independently associated with risk of any NAC-associated toxicity (odds ratio (OR) 0.88, p=0.006, Table 1) and NAC-associated renal toxicity (OR 8.38, p=0.047). Sarcopenia demonstrated a nearly five-fold rise in risk of NAC toxicity (OR 4.97, p=0.049). High-grade (CTCAE ≥2) NAC-associated renal toxicity was significantly more prevalent in sarcopenic vs. non-sarcopenic patients (33 v. 0, p=0.016). CONCLUSIONS: Diminished skeletal muscle mass independently predicts risk of any NAC toxicity and NAC-associated renal toxicity in patients with borderline renal function treated with NAC. With sarcopenia prevalent among MIBC patients, our findings highlight the need to use muscle mass-independent measures of renal function to determine cisplatin-eligibility in "borderline" patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e119 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Eiftu Haile More articles by this author Zaeem Lone More articles by this author David Shin More articles by this author Andrew Wood More articles by this author Rebecca Campbell More articles by this author Christopher Weight More articles by this author Samuel Haywood More articles by this author Mohamed Eltemamy More articles by this author Georges-Pascal Haber More articles by this author Steven Campbell More articles by this author Hadley Wood More articles by this author Nima Almassi More articles by this author Erick M. Remer More articles by this author Expand All Advertisement PDF downloadLoading ...