Skeletal Muscle Loss during Tyrosine Kinase Inhibitor Treatment for Advanced Hepatocellular Carcinoma Patients

Introduction: The measurement of body composition such as the skeletal muscle index (SMI) has been reported to be useful for predicting prognosis in hepatocellular carcinoma (HCC). In this study, we analyzed skeletal muscle change during sorafenib and lenvatinib therapy and the association between SMI and prognosis. Methods: A total of 67 patients with advanced HCC and Child-Pugh grade A status treated with tyrosine kinase inhibitors (TKIs) at Hiroshima University between September 2009 and December 2018 were enrolled in this retrospective cohort study. Patients underwent computed tomography (CT) imaging before starting sorafenib treatment and 1-3 months after treatment initiation. Results: In all patients, the median SMI was 45.3 cm(2)/m(2) before TKI treatment and 42.1 cm(2)/m(2) after treatment; 54 of 67 (80.6%) patients experienced SMI loss. The median Delta SMI was -1.5 cm(2)/m(2)/months, and no difference in Delta SMI was observed between patients receiving sorafenib and lenvatinib. No significant differences were observed in median Delta SMI between patients with and without progressive disease (-2.35 and -1.1 cm(2)/m(2)/months, respectively), albumin-bilirubin grade 1 and 2 group disease (-1.7 and -1.5 cm(2)/m(2)/months, respectively), and relative dose intensity <= 80 and >80 (-1.8 and -1.2 cm(2)/m(2)/months, respectively). Conclusion: This report demonstrated that patients receiving TKI treatment experienced a significant loss of skeletal muscle mass regardless of disease progression, hepatic reserve, or which TKI (sorafenib or lenvatinib) they received.