Deep learning-derived sarcopenia marker predicts benefit from anti-EGFR therapy in patients with RAS wild-type metastatic colorectal cancer

The benefit of treatment intensification in metastatic colorectal cancer (mCRC) may be influenced by host-related factors that are not accounted for in clinical trials or standard care. Post-hoc analysis of mCRC patients in the prospective PanaMa study and a real-world validation cohort investigated the prognostic and predictive value of muscle/bone ratio (MBR), a sarcopenia marker automatically derived for CT images. PanaMa randomized patients with RAS wild-type mCRC, following induction therapy, to maintenance therapy with fluorouracil and folinic acid (FU/FA) with or without panitumumab. Pre-maintenance CT images were available for 189 of 249 randomized patients (76.2%). In patients receiving Fu/FA plus panitumumab, high MBR was associated with longer progression-free survival (HR 0.43; p=0.002) and overall survival (HR 0,41; p=0.006); this association was not observed among patients receiving FU/FA alone. These associations were confirmed in the real world cohort. The authors conclude that the benefit of anti-EGFR therapy in mCRC is confined to patients with high MBR. Automated sarcopenia assessment holds promise for personalized treatment intensification in mCRC.