1065P - Prospective assessment of nutritional status in patients with advanced non-small cell lung cancer and renal cell carcinoma treated with immune checkpoint inhibitors

Background

The nutritional status of patients with advanced cancer seems to affect the immune activity against tumor cells. We investigated the prognostic role of nutritional status in patients with advanced non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC) treated with immune checkpoint inhibitors (ICIs).

Methods

We prospectively enrolled patients with advanced NSCLC and RCC receiving ICIs from June 2021. Patient nutritional status at baseline and after three months of treatment (T1) was evaluated using the controlling nutritional status (CONUT) score (serum albumin, total cholesterol, and lymphocyte count) and body composition (BC), assessed by trained dietitians through bioelectrical impedance analysis (BIA). Data were correlated to disease control rate (DCR) and progression-free/overall survival (PFS/OS).

Results

Among 69 patients enrolled, 71% (N=49) had NSCLC, 78% (N=54) were treated in first line and 58% (N=40) with ICIs as monotherapy. At a median follow up of 11 months (95%CI 8.2-15.9), patients with a low CONUT score (score value lower than or equal to 4), meaning a good nutritional status, had higher DCR (74% vs 38%, p=0.004), longer PFS (HR: 0.28, 95%CI 0.14-0.55, p<0.001) and longer OS (HR 0.33, 95%CI 0.14-0.80, p=0.01) compared to those with high CONUT score (score value > 4), characterized by poor nutritional status. Among BC parameters, skeletal muscle index (SMI: skeletal muscle mass/height²) predicted clinical outcomes: patients with high SMI (>8.9 for male, > 6.4 for female) showed higher DCR (74% vs 40%, p=0.02), longer PFS (HR: 0.40, 95%CI 0.17-0.92, p=0.03) and longer OS (HR 0.20, 95% CI 0.07-0.56, p=0.002), compared to those with low SMI, defined as sarcopenic patients. Patients with any grade of SMI drop at T1 had shorter PFS (HR 3.04, 95% CI 1.18-7.79, p=0.02) compared to those with stable or increased SMI.

Conclusions

Nutritional status assessed by CONUT score and BC may predict clinical outcomes in patients with advanced NSCLC and RCC treated with ICIs. The study is ongoing to mature follow up and additional translational analyses are planned to disentangle the immunophenotypic features related to patients’ nutritional status.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

R. Berardi: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Boehringer Ingelheim, EISAI, Novartis, MSD, Otsuka, Eli Lilly, Roche, Italfarmaco, Seagen. All other authors have declared no conflicts of interest.