151751-Najiba-Chargi

250 CHAPTER 13 Besides the distribution of anti-cancer drugs, many other treatment characteristics could be influenced by changes in SMM. To further investigate this, studies would be needed that observe similar populations treated with different anti-cancer drugs, preferably as monother - apy. However, this might be challenging to accomplish as many treatment regimens consist of combined anti-cancer drugs and the possible addition of radiotherapy or surgical procedures. This review showed a large variety of treatment details such as concomitant radiotherapy, treatment intent, and the possibility to use chemotherapy as an adjuvant treatment. There is previous research on the influence of treatment details such as the research by Ganju et al. 24 , which showed that low SMM is associated with prolonged radiation breaks in head and neck cancer patients who underwent chemoradiotherapy. However, to fully investigate this association ameta-analysis should be focused on specifically chemoradiotherapy or adjuvant chemotherapy. This review is not designed to draw conclusions on those topics, and therefore, future research is needed. Another option is to further research the mechanism that causes this decrease of SMM and by that identify how low SMM influence adverse events. The studies included in this review all investigated the association between pre-treatment low SMM and the occurrence of toxicity. Several studies also investigated the relationship be - tween the change in SMM during treatment and increased toxicity. However, reverse causality could not be excluded from these observational studies. Randomized intervention studies are needed to elucidate whether diet, exercise, or supplements could reverse or prevent a decrease in SMM during systemic treatment and whether this leads to a lower risk of toxicity. Another strategy to produce better treatment outcomes is to adapt treatment regimens based on the presence or absence of low SMM, although this would require a universal cut-off value. Alternatively, the dosing of anti-cancer drugs could be adapted to be based on SMI as opposed to weight or body surface area. This would also require randomized trials to demonstrate the superiority of SMI dosing above current dosing methods. CONCLUSIONS Based on the association between low SMM and toxicity ≥ grade 3 according to the CTCAE, it can be concluded that the predictive value of low SMM for toxicity of anti-cancer drugs can be observed across cancer types and patient populations. This information increases the need for further research into interventions that could treat low SMM as well as the possibility to adapt treatment regimens based on the presence of low SMM. Additional research should also be done to validate measurement methods, create universal cut-off values, monitor changes in SMM during treatment, and investigate the influence of concurrent treatments. Appendix A (dose-limiting toxicity OR CDLT OR toxicity OR adverse effect OR side effect) AND (sarcopenia OR skeletal muscle mass OR SMM OR body composition) AND (chemother * OR immunotherapy OR biotherapy OR chemoradiotherapy OR radiochemother - apy OR CRT OR bioradiotherapy OR immunoradiotherapy) AND (cancer * OR tumor OR tumour)