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Rounis K, Makrakis D, Tsigkas AP, et al. Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study. Transl Lung Cancer Res. 2021;10(8):3538-3549doi: 10.21037/tlcr-21-460.
Rounis, K., Makrakis, D., Tsigkas, A. P., Georgiou, A., Galanakis, N., Papadaki, C., Monastirioti, A., Vamvakas, L., Kalbakis, K., Vardakis, N., Kontogianni, M., Gioulbasanis, I., Mavroudis, D., & Agelaki, S. (2021). Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study. Translational lung cancer research, 10(8), 3538-3549. https://doi.org/10.21037/tlcr-21-460
Rounis, Konstantinos, et al. "Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study." Translational lung cancer research vol. 10,8 (2021): 3538-3549. doi: https://doi.org/10.21037/tlcr-21-460
Rounis K, Makrakis D, Tsigkas AP, Georgiou A, Galanakis N, Papadaki C, Monastirioti A, Vamvakas L, Kalbakis K, Vardakis N, Kontogianni M, Gioulbasanis I, Mavroudis D, Agelaki S. Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study. Transl Lung Cancer Res. 2021 Aug;10(8):3538-3549. doi: 10.21037/tlcr-21-460. PMID: 34584855; PMCID: PMC8435387.
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Transl Lung Cancer Res. 2021 Aug;10(8):3538-3549. doi: 10.21037/tlcr-21-460.

Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study.

Translational lung cancer research

Konstantinos Rounis, Dimitrios Makrakis, Alexandros-Pantelis Tsigkas, Alexandra Georgiou, Nikolaos Galanakis, Chara Papadaki, Alexia Monastirioti, Lambros Vamvakas, Konstantinos Kalbakis, Nikolaos Vardakis, Meropi Kontogianni, Ioannis Gioulbasanis, Dimitrios Mavroudis, Sofia Agelaki

Affiliations

  1. Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece.
  2. Division of Oncology, University of Washington Medical School, Seattle, WA, USA.
  3. Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
  4. Department of Medical Imaging, University General Hospital, Heraklion, Crete, Greece.
  5. Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece.
  6. Department of Medical Oncology, Animus Kyanus Stavros General Clinic, Larissa, Greece.

PMID: 34584855 PMCID: PMC8435387 DOI: 10.21037/tlcr-21-460

Abstract

BACKGROUND: Cancer cachexia syndrome (CCS) is an adverse prognostic factor in cancer patients undergoing chemotherapy or surgical procedures. We performed a prospective study to investigate the effect of CCS on treatment outcomes in patients with non-oncogene driven metastatic non-small cell lung cancer (NSCLC) undergoing therapy with programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors.

METHODS: Patients were categorized as having cancer cachexia if they had weight loss >5% in the last 6 months prior to immunotherapy (I-O) initiation or any degree of weight loss >2% and body mass index (BMI) <20 kg/m

RESULTS: Eighty-three patients were included in the analysis and the prevalence of cancer cachexia at the beginning of I-O was 51.8%. The presence of CCS was associated with inferior response rates to ICIs (P≤0.001) and consisted an independent predictor of increased probability for developing disease progression as best response to treatment, OR =8.11 (95% CI: 2.95-22.40, P≤0.001). In the multivariate analysis, the presence of baseline cancer cachexia consisted an independent predictor for inferior survival, HR =2.52 (95% CI: 1.40-2.55, P=0.002). Reduction of LSMI >5% during treatment did not affect overall survival (OS; P=0.40).

CONCLUSIONS: CCS is associated with reduced PD-1/PD-L1 inhibitor efficacy in NSCLC patients and should constitute an additional stratification factor in future I-O clinical trials. Further research at a translational and molecular level is required to decipher the mechanisms of interrelation of metabolic deregulation and suppression of antitumor immunity.

2021 Translational Lung Cancer Research. All rights reserved.

Keywords: Cancer cachexia; PD-1/PD-L1 inhibitors; immunotherapy; non-small cell lung cancer (NSCLC); outcome; response rate; survival

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tlcr-21-460). The authors have no conflicts of interest to declare.

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