502P - Impact of sarcopenia on the outcome of patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy followed by durvalumab

Background

Sarcopenia is a negative prognostic factor in malignant tumors, including lung cancer. The impact of radiologically quantified sarcopenia on the efficacy of chemoradiotherapy (CRT) followed by durvalumab for locally advanced non-small cell lung cancer (LA-NSCLC) remains unclear.

Methods

Patients undergoing CRT followed by durvalumab for LA-NSCLC were retrospectively reviewed at the National Cancer Center Hospital (Tokyo, Japan) between July 2018 and September 2021. At the level of the 3rd lumbar vertebra on CT scans, the psoas muscle was semi-automatically extracted using SYNAPSE VINCENT (FUJIFILM, Tokyo, Japan), and the psoas muscle index (PMI) was calculated by dividing it by the square of the height. Sarcopenia was defined below the cutoff values for PMI, previously proposed in Japan (6.36 cm²/m² for men and 3.92 cm²/m² for women). The relationship between progression-free survival (PFS) and muscle mass was investigated. PFS was defined as the time from the initiation of durvalumab to progression or death.

Results

Among 172 patients who received CRT followed by durvalumab, 156 were eligible for the study. The median age was 65 years old, and 117 patients (75%) were men. The median PMI before CRT initiation was 5.32 cm²/m² for men and 3.38 cm²/m² for women. One hundred twelve patients (72%) met the criteria for sarcopenia. The median PMI before durvalumab administration was 5.18 cm²/m² for men and 3.19 cm²/m² for women. Sarcopenia constituted 117 patients (76%) of the total population before durvalumab. Patients with more than 5% loss of body weight (⊿BW≤-5) and PMI (⊿PMI≤-5) between CRT and durvalumab were observed in 36.1% and 48.0% of the overall population, respectively. The median PFS was similar in patients with or without sarcopenia before durvalumab (HR 1.06 [95%CI, 0.60-1.88]) and ⊿BW≤-5 (HR 0.87 [95%CI, 0.53-1.44]). However, the median PFS was shorter in patients with ⊿PMI≤-5 than in patients without (with ⊿PMI≤-5 vs without ⊿PMI≤-5: 23.5 months vs. not reached, HR 1.43 [95%CI 0.88-2.30]).

Conclusions

Sarcopenia was not a prognostic factor during durvalumab following CRT for patients with LA-NSCLC. Loss of muscle mass during CRT may influence the response of durvalumab.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

H. Horinouchi: Financial Interests, Personal, Invited Speaker: AstraZeneca, Eli Lilly, BMS/Ono, Merck Sharp & Dohme, Roche/Chugai, Novartis, Pfizer, Boehringer Ingelheim, Kyowa-Kirin, Nihon Kayaku, AbbVie; Financial Interests, Personal, Advisory Board: AstraZeneca, Eli Lilly, BMS/Ono, Merck Sharp & Dohme, Roche/Chugai, Amgen, Nihon Kayaku; Financial Interests, Personal, Steering Committee Member: Roche/Chugai; Financial Interests, Institutional, Research Grant: Roche/Chugai, Merck Sharp & Dohme, Daiichi Sankyo, Ono pharmaceutical, AstraZeneca; Financial Interests, Institutional, Local PI: AbbVie. Y. Okuma: Financial Interests, Personal, Invited Speaker: Astra Zenca, K. K., Nippon Boehringer Ingelheim, Chugai Phamaceutical Co., Ltd., Eli Lilly K. K., Ono Pharmaceutical Co., Ltd., Taiho Pharmacuetical Co., Ltd., Takeda Pharmacuetical Co., Ltd., Pfizer Japan Inc.; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Local PI: AbbVie, G.K., Chugai Co., Ltd.; Financial Interests, Personal, Steering Committee Member: AstraZeneca; Financial Interests, Institutional, Local PI: AstraZeneca; Financial Interests, Personal and Institutional, Research Grant: MSD. T. Yoshida: Financial Interests, Personal, Advisory Board: Pfizer, MSD, Amgen; Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai pharmaceutical, Pfizer, Takeda, Lilly, Ono pharmaceutical, BMS, Novartis, Daiichi sankyo, MSD; Financial Interests, Institutional, Local PI: AstraZeneca, Novartis, Amgen, Daiichi sankyo, BMS, MSD, Ono pharmaceutical, AbbVie, BluePrint, Chugai pharmaceutical. Y. Goto: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Guardant Health Inc., Illumina, MSD, Novartis, Ono Pharmaceutical, Pfizer, Taiho, Johnson and Johnson, D3bio; Financial Interests, Personal, Invited Speaker: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, MSD, Merck, Novartis, Ono Pharmaceutical, Pfizer, Taiho, Thermo Fischer; Financial Interests, Personal, Other, Travel Grant: Daiichi Sankyo; Financial Interests, Institutional, Local PI: Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Preferred Network; Financial Interests, Personal and Institutional, Coordinating PI: Chugai, Novartis, Pfizer; Financial Interests, Institutional, Research Grant: Prefered Network; Financial Interests, Institutional, Coordinating PI: Guardant Health; Non-Financial Interests, Personal, Member of Board of Directors: Cancer Net Japan, JAMT. N. Yamamoto: Financial Interests, Personal, Invited Speaker: Ono, Chugai, Daiichi Sankyo, Eisai; Financial Interests, Personal, Advisory Board: Eisai, Takeda, Boehringer Ingelheim, Cimic, Chugai, Healios; Financial Interests, Institutional, Local PI, Principal Investigator in industry sponsored trial: Astellas, Chugai, Eisai, Taiho, BMS, Pfizer, Novartis, Eli Lilly, AbbVie, Kyowa-Hakko Kirin, Daiichi Sankyo, Bayer, Boehringer Ingelheim, MSD, Takeda, Ono, Janssen Pharma, Merck, GSK, Sumitomo Dainippon, Chiome Bioscience, Otsuka; Financial Interests, Institutional, Local PI, Principal investigator in industry sponsored trial: TORAY, Carna Biosciences, Genmab, Shionogi; Financial Interests, Institutional, Research Grant, Principal investigator in industry sponsored trial: Rakuten Medical, InventisBio Co., Ltd. Y. Ohe: Financial Interests, Personal, Advisory Board: Amgen, AnHeart Therapeutics Inc, AstraZaneca, BMS, Celltrion, Janssen, Nippon Kayaku, Ono, Pfizer, Takeda; Financial Interests, Personal, Invited Speaker: AstraZeneca, BMS, Boehringer Ingelheim, Chugai, Eisai, Eli Lilly, MSD, Novartis, Ono, Takeda; Financial Interests, Institutional, Local PI: AstraZeneca, Janssen, Amgen; Financial Interests, Personal and Institutional, Coordinating PI: Takeda, Ono; Non-Financial Interests, Personal, Leadership Role: JSMO, JLCS, JCOG; Non-Financial Interests, Personal, Member: ASCO. All other authors have declared no conflicts of interest.