2115P - Pre-cachexia incidence in patients with solid cancer: A cross-sectional study

Background

Cancer-associated cachexia (CAC) is an ongoing loss of skeletal muscle which cannot be fully abolished by nutritional interventions. While ESMO suggests precise CAC definitions, pre-cachexia definition is vague.

Methods

Patients with solid cancers and lack of CAC at baseline, enrolled in the TRU Biobanking Program of the Medical University of Vienna between March 2019 and February 2022, were analyzed. At inclusion and each restaging, the prevalence of modified Glasgow Prognostic Score ≥1 (mGPS), weight loss ≥2% (WL), physical functioning <80 (PF2) and fatigue >30 (FA) was assessed clinically and with the EORTC QLQ-C30 questionnaire. In addition, we evaluated the burden of nutritional risk symptoms (diarrhea, nausea, vomiting, lack of appetite, constipation) with a score (NR) of 1-34. Pre-cachexia criteria were correlated with clinical parameters (age, gender, therapy status). Occurrence of CAC was evaluated using ESMO definitions.

Results

For analysis, 391 patients (47% female, 53% male, median age 59 years) were available. Median observation time was 4 months (range 0-46) with a median of 2 observations (range 1-13). Within the observed period 12% of patients developed CAC. Pre-cachexia as defined by mGPS was found in 52% of patients, by WL in 53%, by PF2 in 69%, by FA in 84%, and by NR ≥7 in 51% of patients. Pre-cachexia by WL was found less often in female (43%) than in male patients (62%; OR 2.14, 95% CI 1.43-3.23; p<0.001) and more often in treatment-naive patients (60%) than in those with prior systemic therapy (48%; OR 1.62, 95% CI 1.08-2.43, p=0.019). Patients with pre-cachexia by NR were younger (median 58, IQR 50-65) compared to the other patients (median 60, IQR 53-70; p=0.018). All other pre-cachexia definitions did not correlate with clinical characteristics (p>0.05). All five pre-cachexia definitions were fulfilled by 15% of patients, four by 27%, three by 29%, two by 14%, and one by 14%. No pre-cachexia definition was fulfilled by 2.3%. None of the investigated pre-cachexia definitions reliably identified patients with subsequent CAC development (p>0.05).

Conclusions

Further research on pre-cachexia-defining parameters is needed for the development of standardized screening methods as current definitions fail to identify patients with high CAC risk.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Financial support by the Austrian Federal Ministry for Digital and Economic Affairs, the National Foundation for Research, Technology and Development and the Christian Doppler Research Association.

Disclosure

M. Mair: Other, Travel support: Pierre Fabre. A.M. Starzer: Financial Interests, Personal, Invited Speaker, Lecture honoraria: AstraZeneca; Financial Interests, Institutional, Research Grant, Industry partner of institutional Christian Doppler Laboratory: Roche; Non-Financial Interests, Member, National Oncology Society: OeGHO; Non-Financial Interests, Member, Oncology society of USA: ASCO; Other, Travel support for conference participation: MSD, Lilly, PharmaMar. E. Hütterer: Financial Interests, Personal, Invited Speaker, Lecture honoraria: Fresenius Kabi; Financial Interests, Personal, Other, Expertmeeting: Takeda. E.S. Bergen: Financial Interests, Personal, Other, lectures, consultation or advisory board participation: Servier. M. Preusser: Financial Interests, Personal, Advisory Board: Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman, CMC Contrast, Glaxo Smith Kline, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dohme, Tocagen, Adastra, Gan & Lee Pharmaceuticals; Financial Interests, Institutional, Research Grant, Clinical Trials and research: Boehringer-Ingelheim, Bristol Myers Squibb, Roche, Daiichi Sankyo, Merck Sharp & Dohme, Novocure, Glaxo Smith Kline, AbbVie; Financial Interests, Institutional, Coordinating PI: PharmaMar; Non-Financial Interests, Leadership Role, Brain Tumor Group Chair (current): EORTC; Non-Financial Interests, Leadership Role, EANO Past-President (current): EANO; Non-Financial Interests, Other, Member Multi-Site Guideline Advisory Group: ASCO. A.S. Berghoff: Financial Interests, Personal, Invited Speaker: Roche, Bristol Myers Squibb, Merck, AstraZeneca; Financial Interests, Personal, Advisory Board: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Daiichi Sankyo, Roche. All other authors have declared no conflicts of interest.