Body composition (BC)-related phenotypes, including loss of muscle mass and fat tissue distribution, have been suggested to potentially modulate immunotherapy outcomes in lung cancer pts. In this light, our study aimed to evaluate BC and its potential correlations with ECOG PS, comorbidities, and survival outcomes in NSCLC pts receiving first-line PEMBRO.
A retrospective analysis of consecutive advanced NSCLC pts treated with PEMBRO as first-line therapy at two academic medical institutions from August 2017 to August 2020 was performed. The area (cm2) and density (Hounsfield Units [HU]) of skeletal muscle and adipose tissue (subcutaneous [SAT], visceral and intermuscular) were measured on pre-treatment computed tomography scans at the level of the third lumbar vertebra. Data were correlated to progression-free/overall survival (PFS/OS) using a Cox and logistic regression model. Log-Rank analysis was used for Kaplan-Meier curves comparison.
Data from 77 pts was gathered, with a median follow-up of 11 months (range 1-42). Forty (51.9%) pts were former smokers and 27 (35.1%) current smokers. ECOG PS was 0-1 in 56 (72.7%) pts and ≥2 in 21 pts (27.3%). Comorbidities were reported in 49 (63.6%) pts. All BC parameters were significantly correlated with the presence of comorbidities and ECOG PS. Median PFS and OS were 3 (95% CI, 2-4) and 10 (95% CI, 8-13) months, respectively. At univariate analysis, high SAT negatively correlated with PFS. Pts with pre-treatment SAT<143 had significantly longer 6-month PFS (median 8 vs. 3 months, p = 0.05). Although BC parameters were not associated with OS, this was numerically shorter in those pts with higher SAT (median 12 vs. 18 months, p = 0.11).
These preliminary results support the hypothesis that BC may impact on survival of advanced NSCLC pts treated with PEMBRO, suggesting a potential interaction between immune system and BC. Further analyses are ongoing in this pts’ cohort in order to monitor BC changes during treatment, as well as to explore the biological rational supporting the emerging close relationship between immune system and nutritional parameters.
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Has not received any funding.
M. Milella: Other, Personal, Invited Speaker: EUSA Pharma, Pfizer, MSD, AstraZeneca, Merck Serono and Mylan. E. Bria: Financial Interests, Personal, Invited Speaker: MSD, AstraZeneca, Celgene, Pfizer, Helsinn, Eli-Lilly, BMS, Novartis and Roche. S. Pilotto: Financial Interests, Personal and Institutional, Invited Speaker: AstraZeneca, Eli-Lilly, BMS, Boehringer Ingelheim, MSD and Roche. All other authors have declared no conflicts of interest.