The Role of a Cachexia Grading System in Patients with Non-Small Cell Lung Cancer Treated with Immunotherapy: Implications for Survival

• Published in: Nutrition and cancer Vol. 73; no. 5; pp. 794 - 801
• Main Authors: Turcott, Jenny G., Martinez-Samano, Julio E., Cardona, Andrés F., Bassarmal, Suraj Samtani, Ramírez-Tirado, Laura Alejandra, Zatarain-Barrón, Zyanya Lucia, Barrón, Feliciano, Corrales, Luis, Martín, Claudio, Barragán-Castillo, Pablo Alan, Ruiz-Patiño, Alejandro, Flores-Estrada, Diana, Arrieta, Oscar
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 2021; Taylor & Francis Ltd
• Subjects: Body mass; Body mass index; Body size; Body weight loss; Cachexia; Clinical outcomes; Health hazards; Hemoglobin; Immunotherapy; Lung cancer; Multivariate analysis; Non-small cell lung carcinoma; Risk; Small cell lung carcinoma; Survival; Weight loss
• ISSN: 0163-5581; 1532-7914
• DOI: 10.1080/01635581.2020.1769691

The association between cancer-induced weight-loss (CIWL) and poor clinical outcomes in patients treated with immunotherapy is scarcely understood. We evaluated the use of a cachexia-grading system in IO-treated non-small cell lung cancer (NSCLC) patients in order to predict clinical outcomes. 300 patients with NSCLC, who received immunotherapy during any line of therapy, were included. All patients were graded according to a previously validated cachexia scale, which takes into consideration body mass index (BMI) and weight loss, stratifying patients into five risk categories (0 [pre-cachexia] − 4 [refractory cachexia]). Primary endpoint was overall survival (OS). Ninety-one (30.3%) patients were classified in the low risk category, 176 (58.6%) were classified in the intermediate risk category and 33 (11%) were in the high risk category. Patients classified as low-risk had a significantly longer OS compared with those with intermediate or high risk (22.4 mo, [95%CI: 16.6-NR] vs. 17.1 [95%CI: 13.5-22.4] vs. 8.0 [3.9-18.4]; p < 0.001). In the multivariate analysis, after adjusting for age, hemoglobin and ORR, hazard of death increased as per the cachexia risk scale (Hazard ratio: 1.62 [1.22-2.16]; p = 0.001). Cachexia is independently associated with worse OS in NSCLC patients who receive immunotherapy, highlighting the role for nutritional assessment.