4159 - Impact of nutritional derangement on treatment outcome in advanced non-small-cell lung cancer (A-NSCLC) patients (pts).

Background

Weight loss and lean body mass wasting are highly prevalent in NSCLC pts, but frequently underestimated. This study aimed to assess the prevalence of malnutrition and its correlation with outcome in A-NSCLC pts.

Methods

A-NSCLC pts treated at AOUI of Verona (2016-2018) received nutritional counselling by a qualified dietitian. Nutritional Risk Screening (NRS) 2002 was used to estimate the nutritional risk. Bilateral psoas major muscles were measured at L3 vertebrae level with routine staging-computed tomography (CT). Changes in psoas muscles were evaluated using Wilcoxon signed-rank test. Data were correlated to progression-free/overall survival (PFS/OS) and response rate (ORR) using a Cox and logistic regression model. Kaplan-Meier curves were compared with Log-Rank.

Results

Data from 38 pts (20 males [52.6%], 18 females [47.4%]) were gathered, with a median follow-up of 21 months (range 1-197). At baseline, 18.4% were underweight, 18.4% normal weight, 34.2% overweight and 31.6% obese. The majority (65.8%) were at risk of malnutrition (NRS≥3). At multivariate analysis, stage (HR 4.99, 95% CI 1.05-27.74, p = 0.04), performance status (HR 4.99, 95% CI 1.55-16.03, p = 0.007) and NRS (HR 7.61, 95% CI 1.52-38.11, p = 0.01), were significant independent predictors for PFS. Pts with baseline NRS≤3 had significantly longer 1-year PFS (58.6% vs 16.7%, p = 0.04) and 2-year OS (90.6% vs 68.3%, p = 0.03) and a better ORR than those with NRS > 3 (66.7% vs 21.4%). A significant loss in psoas muscle mass was detected in pts treated with both immunotherapy and other therapies (p = 0.01 and p = 0.002, respectively). Of interest, in immunotherapy-treated pts (n = 16) loss in psoas muscle mass correlated with worse ORR, PFS and OS, although differences did not reach a statistical significance.

Conclusions

Malnutrition was common in A-NSCLC pts and associated with poor ORR, PFS and OS. Particularly, in pts treated with immunotherapy, muscle mass wasting seems to impact on efficacy outcome, suggesting a potential interaction between immunological and nutritional parameters. The introduction in clinical routine of a comprehensive nutritional profiling and monitoring is highly recommended in A-NSCLC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

E. Bria: Honoraria (self): MSD, Astra-Zeneca, Celgene, Pfizer, Helsinn, Eli-Lilly, BMS, Novartis, and Roche; Research grant / Funding (self): AIRC-IG 20583. M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. S. Pilotto: Honoraria (self): Astra-Zeneca, Eli-Lilly, BMS, Boehringer Ingelheim, Roche, MSD and Istituto Gentili; Research grant / Funding (self): AIRC-IG 20583. All other authors have declared no conflicts of interest.