title: High fat mass associates with occurrence of targeted therapy-induced left ventricular ejection fraction reduction in patients with renal cell carcinoma.
abstract: Recent research suggests that variations of skeletal muscle (SM) and fat predict the severity of chemotherapy-induced toxicities in patients with renal cell carcinoma (RCC). Cardio-toxicity has not been evaluated in this context.
  
  
  
  In this study we considered 47 RCC patients who participated in randomized clinical trials of sorafenib or sunitinib (i.e., targeted therapy). To capture cardio-toxicity, multi gated acquisition (MUGA) scan-defined left ventricular ejection fraction (LVEF) tests (at least 3 tests over 1 year of treatment) were abstracted. Computed tomography (CT) cross-sectional images were analyzed before start of targeted therapy and at 1 year to define SM and fat at baseline and changes over time concurrent with MUGA-defined LVEF measurement.
  
  
  
  MUGA-defined cardio-toxicity (usually fall in LVEF >10% to an absolute LVEF<55%) occurred in 8/47 (17%) patients over 1 year of targeted therapy (all were male). Percentage of patients with high fat mass (baseline CT-defined total adipose tissue/indexed by height2greater than the gender-specific median value) was higher among patients with cardio-toxicity versus patients without cardio-toxicity [7 (87.5%) versus 16 (41.0%); p = 0.02]. The percentage of SM loss in patients with cardio-toxicity was higher than the patients without cardio-toxicity [median of loss (%) -7 versus 0 respectively; p = 0.04].
  
  
  
  Cardio-toxicity in RCC patients might be associated with high fat mass. This finding is distinct from prior observations that low body weight and sarcopenia associated with non-cardiac toxicities of targeted therapies. Concurrence of SM loss over time and development of cardio-toxicity is reported for the first time.
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: Seyyed Mohammad Reza
authors.initials: SMR
authors.lastname: Kazemi-Bajestani
authors.affiliation: Department of Medicine, Division of Cardiology, Alberta Cardiovascular and Stroke Research Centre, University of Alberta, Edmonton, Canada.
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Venner
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: North
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Canada. Electronic address: vickie.baracos@ualberta.ca.
authors.forename: Vickie
authors.initials: V
authors.lastname: Baracos
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D001823:Body Composition; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000077157:Sorafenib / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity*; D000077210:Sunitinib / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity*; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D000077157:Sorafenib; D000077210:Sunitinib
keywords: Body composition; Cardio-toxicity; Fat; Skeletal muscle