title: Resting energy expenditure in the risk assessment of anticancer treatments.
abstract: Alterations of nutritional and performance status (PS) are associated with higher risk of chemotherapy toxicity. Increased resting energy expenditure (REE) is frequent in cancer patients and may contribute to cachexia. We investigated whether abnormal energetic metabolism could predict early acute limiting toxicities (ELT) of anticancer treatments.
  
  
  
  In this observational monocentric study, REE was measured by indirect calorimetry before treatment initiation. Based on the ratio of measured REE to REE predicted by the Harris-Benedict formula, patients were classified as hypometabolic (<90%), normometabolic (90-110%) or hypermetabolic (>110%). Body mass index, weight loss, PS, albumin, transthyretin, C-reactive protein (CRP) and muscle mass (CT-scan) were studied. Were defined as ELT any unplanned hospitalization or any adverse event leading to dose reduction or discontinuation during the first cycle of treatment.
  
  
  
  We enrolled 277 patients: 76% had metastatic disease; 89% received chemotherapy and 11% targeted therapy; 29% were normometabolic, 51% hypermetabolic and 20% hypometabolic. Fifty-nine patients (21%) experienced an ELT. Toxicity was associated with abnormal metabolism (vs normal: OR = 2.37 [1.13-4.94], p = 0.023), PS (2-3 vs 0-1: OR = 2.04 [1.12-3.74], p = 0.023), albumin (<35 vs ≥35 g/l: OR = 2.39 [1.03-5.54], p = 0.048), and inflammation (CRP ≥10 vs <10 mg/l: OR = 2.43 [1.35-4.38], p = 0.004). To predict toxicity, the most sensitive parameter was the REE (83%) followed by PINI (63%), GPS (59%), CRP (55%), PS (41%), NRI (37%), and albumin (16%). In multivariate analysis, elevated CRP was an independent predictor of toxicity (p = 0.047).
  
  
  
  Abnormal basal energy metabolism identifies patients at higher risk of treatment-related acute complications.
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France. Electronic address: anne.jouinot@aphp.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Jouinot
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Vazeille
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Durand
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huillard
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Pascaline
authors.initials: P
authors.lastname: Boudou-Rouquette
authors.affiliation: Gastro-Enterology Department, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.affiliation: Pneumology Department, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Chapron
authors.affiliation: Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neveux
authors.affiliation: Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France.
authors.forename: Jean Pascal
authors.initials: JP
authors.lastname: De Bandt
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Alexandre
authors.affiliation: Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.affiliation: Medical Oncology Department, Cancer Research for Personalized Medicine (CARPEM), Paris Centre Teaching Hospitals, Paris Descartes University, USPC, Paris, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Goldwasser
mesh_terms: D001481:Basal Metabolism / Q000502:physiology*; D002100:Cachexia / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D002153:Calorimetry, Indirect; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D011446:Prospective Studies; D012146:Rest; D018570:Risk Assessment
keywords: Cancer cachexia; Chemotherapy; Malnutrition; Targeted therapy; Toxicity