---
title: "Body Composition and Drug Tolerance in Cancer Therapy: Impact of Sarcopenia and Myosteatosis"
id: "pubmed-42832117"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42832117"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42832117/"
doi: "10.1007/s13668-026-00801-0"
published_at: "2026-10-05T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Body Composition and Drug Tolerance in Cancer Therapy: Impact of Sarcopenia and Myosteatosis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42832117
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42832117/)
- **DOI:** [10.1007/s13668-026-00801-0](https://doi.org/10.1007%2Fs13668-026-00801-0)
- **Published At:** 2026-10-05T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The review examines how **body composition** parameters—principally low muscle mass (commonly termed **sarcopenia**) and low muscle quality (**myosteatosis**)—relate to drug tolerance and adverse events during cancer therapy across malignancies. - Standard dosing using weight or body-surface area may not reflect differences in skeletal muscle or adipose tissue, prompting investigation of body composition as a contributor to toxicity. - Evidence is heterogeneous: in non-small-cell lung cancer (NSCLC) treated with platinum-based chemotherapy, low muscle mass was associated with about a 2.5-fold higher risk of severe hematological toxicity; for immunotherapy, low muscle mass predicted severe immune-related toxicities with agents such as **nivolumab**. - In ovarian cancer, low skeletal muscle radiodensity and low subcutaneous adipose tissue index independently predicted severe adverse events and treatment modifications. - Contrastingly, some studies (for example in pancreatic and thyroid cancer) found no significant association between baseline low muscle mass and short-term dose modifications or adverse outcomes. - Proposed biological rationale: reduced skeletal muscle may lower distribution volume for hydrophilic agents (e.g., platinum compounds) and for some monoclonal antibodies, increasing peak plasma concentrations and toxicity risk; this hypothesis is plausible but not confirmed. - Major limitations across studies include differing body-composition parameters and cutoffs, variable definitions of treatment tolerance, inconsistent confounder adjustment, and marked heterogeneity in study designs and endpoints. - The current evidence should be regarded as hypothesis-generating; before routine use of body-composition assessment for dose individualization, the field needs standardized, validated assessment methods, harmonized diagnostic criteria, systematic confounder adjustment, and adequately powered prospective studies. - The authors declare no competing interests and note that further high-quality research is required before clinical implementation.
## Clinical Analysis & Structured Key Points
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Susana.castro.luaces@sergas.es.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-2 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es."), [Paula Sánchez-Sobrino](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%A1nchez-Sobrino+P&cauthor_id=42832117)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-3 "Endocrinology Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain."), [María Alfonsín-Lara](https://pubmed.ncbi.nlm.nih.gov/?term=Alfons%C3%ADn-Lara+M&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain."), [Maria Susana Fortes-González](https://pubmed.ncbi.nlm.nih.gov/?term=Fortes-Gonz%C3%A1lez+MS&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain."), [Silvia Vázquez-Blanco](https://pubmed.ncbi.nlm.nih.gov/?term=V%C3%A1zquez-Blanco+S&cauthor_id=42832117)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-5 "Pharmacy Department, Hospital Ribera Povisa, Vigo, 36211, Spain."), [Claudia Barca-Diez](https://pubmed.ncbi.nlm.nih.gov/?term=Barca-Diez+C&cauthor_id=42832117)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-6 "Pharmacy Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain."), [Noemí Martínez-López De Castro](https://pubmed.ncbi.nlm.nih.gov/?term=De+Castro+NM&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-7 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain."), [Natividad Lago-Rivero](https://pubmed.ncbi.nlm.nih.gov/?term=Lago-Rivero+N&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#full-view-affiliation-7 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain.") Affiliations Expand ### Affiliations * 1 Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es. * 2 Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es. * 3 Endocrinology Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain. * 4 Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain. * 5 Pharmacy Department, Hospital Ribera Povisa, Vigo, 36211, Spain. * 6 Pharmacy Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain. * 7 Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, 36312, Spain. * PMID: **42832117** * DOI: [ 10.1007/s13668-026-00801-0 ](https://doi.org/10.1007/s13668-026-00801-0) Item in Clipboard Review # The Role of Body Composition on Drug Tolerance in Cancer Therapy: A Structured Narrative Review Susana Castro-Luaces et al. Curr Nutr Rep. 2026. Show details Display options Display options Format Abstract PubMed PMID Curr Nutr Rep Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Curr+Nutr+Rep%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Curr+Nutr+Rep%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42832117/) . 2026 Oct 5;15(1):81. doi: 10.1007/s13668-026-00801-0. ### Authors [Susana Castro-Luaces](https://pubmed.ncbi.nlm.nih.gov/?term=Castro-Luaces+S&cauthor_id=42832117)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-1 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-2 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es."), [Paula Sánchez-Sobrino](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%A1nchez-Sobrino+P&cauthor_id=42832117)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-3 "Endocrinology Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain."), [María Alfonsín-Lara](https://pubmed.ncbi.nlm.nih.gov/?term=Alfons%C3%ADn-Lara+M&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain."), [Maria Susana Fortes-González](https://pubmed.ncbi.nlm.nih.gov/?term=Fortes-Gonz%C3%A1lez+MS&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain."), [Silvia Vázquez-Blanco](https://pubmed.ncbi.nlm.nih.gov/?term=V%C3%A1zquez-Blanco+S&cauthor_id=42832117)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-5 "Pharmacy Department, Hospital Ribera Povisa, Vigo, 36211, Spain."), [Claudia Barca-Diez](https://pubmed.ncbi.nlm.nih.gov/?term=Barca-Diez+C&cauthor_id=42832117)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-6 "Pharmacy Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain."), [Noemí Martínez-López De Castro](https://pubmed.ncbi.nlm.nih.gov/?term=De+Castro+NM&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-7 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain."), [Natividad Lago-Rivero](https://pubmed.ncbi.nlm.nih.gov/?term=Lago-Rivero+N&cauthor_id=42832117)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-4 "Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42832117/#short-view-affiliation-7 "Innovation in Clinical Pharmacy Research Group \(i-FARMA-Vigo\), Galicia Sur Health Research Institute \(IIS Galicia Sur\), SERGAS-UVIGO, Vigo, 36312, Spain.") ### Affiliations * 1 Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es. * 2 Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, 36312, Spain. Susana.castro.luaces@sergas.es. * 3 Endocrinology Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain. * 4 Pharmacy Department, University Hospital Complex of Vigo, Vigo, 36312, Spain. * 5 Pharmacy Department, Hospital Ribera Povisa, Vigo, 36211, Spain. * 6 Pharmacy Department, University Hospital Complex of Pontevedra, Pontevedra, 36007, Spain. * 7 Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, 36312, Spain. * PMID: **42832117** * DOI: [ 10.1007/s13668-026-00801-0 ](https://doi.org/10.1007/s13668-026-00801-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose of review:** The aim of the present review is to analyse the current knowledge on how body composition parameters, principally low muscle mass (frequently reported as "sarcopenia") and myosteatosis (low muscle quality), relate to drug tolerance and the occurrence of adverse events during cancer therapy across different malignancies. **Recent findings:** Because dosing based on weight or body surface area does not capture body composition, its potential limitations have increasingly been questioned. The available research spans a highly heterogeneous set of studies with inconsistent results. In non-small-cell lung cancer treated with platinum-based chemotherapy, low muscle mass has been associated with a nearly 2.5-fold increase in the risk of severe haematological toxicity, and with immunotherapy it has been reported as an independent predictor of severe immune-related toxicities with agents such as nivolumab. In ovarian cancer, low skeletal muscle radiodensity and low subcutaneous adipose tissue index independently predicted severe adverse events and treatment modifications. However, other studies-for example in pancreatic and thyroid cancer-found no significant association between baseline low muscle mass and short-term dose modifications or adverse outcomes. Studies differed markedly not only in the body-composition parameters measured and the definition of abnormal values, but also in how treatment tolerance was evaluated, which limits comparability across studies. The current literature suggests a biologically plausible but unconfirmed link between reduced skeletal muscle and treatment-related toxicity, potentially mediated by a lower distribution volume of hydrophilic agents such as platinum compounds and monoclonal antibodies, with a consequent rise in peak plasma concentrations. Nevertheless, the evidence is too heterogeneous and insufficiently standardized to draw robust conclusions and should be regarded as hypothesis-generating. Before body-composition assessment can be recommended for treatment planning or dose individualization in routine practice, the field requires standardized and validated assessment methods, harmonized diagnostic criteria, systematic adjustment for confounders, and adequately powered prospective studies. **Keywords:** Body composition; Cancer; Malnutrition. © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Informed Consent: Not applicable. Institutional Review Board: Not applicable. Competing interests: The authors declare no competing interests. ## References 1. 1. Sociedad Española de Oncología Médica (SEOM). Las cifras del cáncer en España – 2024. Madrid: SEOM. 2024. Available from: 2. 1. World Health Organization (WHO). Global cancer burden growing amidst mounting need for services. Geneva: WHO. 2024. Available from: [https://www.who.int/es/news/item/01-02-2024-global-cancer-burden-growing...](https://www.who.int/es/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services) 3. 1. Bozzetti F. Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy. Ann Oncol. 2017;28(9):2107–18. . - [DOI](https://doi.org/10.1093/annonc/mdx271) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28911059/) 4. 1. Sociedad Española de Oncología Médica (SEOM). Toxicidad de los tratamientos oncológicos. Madrid: SEOM. 2019. Available from: [https://seom.org/guia-actualizada-de-tratamientos/toxicidad-de-los-trata...](https://seom.org/guia-actualizada-de-tratamientos/toxicidad-de-los-tratamientos-oncologicos) 5. 1. van der Sijs H, Guchelaar HJ. Formulas for calculating body surface area. Ann Pharmacother. 2002;36(2):345–6. . - [DOI](https://doi.org/10.1345/aph.1a134) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/11847962/) Show all 48 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42832117/) ## MeSH terms * Antineoplastic Agents* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antineoplastic+Agents%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antineoplastic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42832117/) * Antineoplastic Agents* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antineoplastic+Agents%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antineoplastic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42832117/) * Body Composition* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Body+Composition%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh
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