Sarcopenia Shows Association to Higher Risk of Chemotherapy-Induced Peripheral Neurotoxicity

Author(s):

Key Takeaways

Pretreatment sarcopenia is associated with increased risk of CR-CIPN in cancer patients undergoing chemotherapy.
Among 94 patients, 48.9% had sarcopenia, and 40% developed CR-CIPN, with higher chemotherapy doses linked to increased risk.
Significant increases in neurofilament light chain levels and Total Neuropathy Score clinical scores were observed post-treatment.
Assessing muscle mass via CT imaging before chemotherapy could help identify high-risk patients and inform dosing strategies.

A newly presented study showed that patients with sarcopenia before starting chemotherapy had a greater likelihood of developing moderate to severe peripheral neurotoxicity.

Roser Velasco, MD, PhD

(Credit: IDIBELL)

New prospective data from a single-institution study presented at the 2025 Peripheral Nerve Society (PNS) Annual Meeting, held May 17-20, in Edinburgh, Scotland, suggested that pretreatment sarcopenia, characterized by low muscle mass, was associated with an increased risk of clinically relevant chemotherapy-induced peripheral neurotoxicity (CR-CIPN) in patients with cancer.¹

Among 94 newly diagnosed patients with cancer treated with brentuximab vedotin (Adcetris, n = 51), oxaliplatin (Eloxatin, n = 34), or paclitaxel (Abraxanen, n = 9), 48.9% had sarcopenia prior to treatment. Overall, 82% of patients developed CIPN, and 40% experienced CR-CIPN, defined as grade 2 or higher. Findings showed that patients with CR-CIPN were more likely to have sarcopenia before treatment (56% vs 25%; P = .002) and received higher cumulative chemotherapy doses (e.g., oxaliplatin group, 1332 mg vs 981 mg; P = .009).

All told, participants (n = 94; median age, 54 years; range 21–78; men, 51.1%) underwent sarcopenia analysis using the skeletal muscle index from pretreatment CT or PET/CT scans. Researchers then evaluated CIPN before (T0) and after (T1) treatment using the Total Neuropathy Score clinical (TNSc), NCI-CTCv5 criteria, and nerve conduction studies. Authors noted that blood levels of neurofilament light chain (NfL) and albumin were also measured at both time points.

Presented by lead author Roser Velasco, MD, PhD, neurologist in the Neuro-Oncology Unit at Bellvitge University Hospital in Spain, results revealed that significant increases in NfL levels (T0: 15.01 pg/mL vs T1: 87.89 pg/mL; P <.001) and TNSc scores (T0: 0 [0–3] vs T1: 6 [0–17]; P <.001) were observed after treatment. Notably, researchers observed no significant differences in pretreatment BMI or albumin levels between those with and without CR-CIPN.

These presented findings indicate that pretreatment sarcopenia may be a risk factor for developing moderate to severe CIPN in patients with cancer, which is consisted with previous studies.^2,3Thus, this study further suggests that assessing muscle mass via CT imaging before chemotherapy could potentially help to identify high-risk patients with cancer and inform dosing strategies beyond BMI-based assessments.

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REFERENCES
1. Velasco R, Bellver M, Peiro I, et al. Association of pre-treatment sarcopenia with clinically relevant chemotherapy-induced peripheral neurotoxicity. Presented at: 2025 Peripheral Nerve Society (PNS) Annual Meeting; May 17-20; Edinburgh, Scotland. P579.
2. Vega MC, Laviano A, Pimentel GD. Sarcopenia and chemotherapy-mediated toxicity. Einstein (Sao Paulo). 2016;14(4):580-584. doi:10.1590/S1679-45082016MD3740
3. Davis MP, Panikkar R. Sarcopenia associated with chemotherapy and targeted agents for cancer therapy. Ann Palliat Med. 2019;8(1):86-101. doi:10.21037/apm.2018.08.02