Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer
Immune checkpoint inhibitor (ICI)-based immunotherapy has significantly improved the survival of patients with advanced non-small cell lung cancer (NSCLC); however, a significant percentage of patients do not benefit from this approach, and predictive biomarkers are needed. Increasing evidence demon...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/4/1076 |
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| author | Clelia Madeddu Silvia Busquets Clelia Donisi Eleonora Lai Andrea Pretta Francisco Javier López-Soriano Josep Maria Argilés Mario Scartozzi Antonio Macciò |
| author_facet | Clelia Madeddu Silvia Busquets Clelia Donisi Eleonora Lai Andrea Pretta Francisco Javier López-Soriano Josep Maria Argilés Mario Scartozzi Antonio Macciò |
| author_sort | Clelia Madeddu |
| collection | DOAJ |
| description | Immune checkpoint inhibitor (ICI)-based immunotherapy has significantly improved the survival of patients with advanced non-small cell lung cancer (NSCLC); however, a significant percentage of patients do not benefit from this approach, and predictive biomarkers are needed. Increasing evidence demonstrates that cachexia, a complex syndrome driven by cancer-related chronic inflammation often encountered in patients with NSCLC, may impair the immune response and ICI efficacy. Herein, we carried out a prospective study aimed at evaluating the prognostic and predictive role of cachexia with the related changes in nutritional, metabolic, and inflammatory parameters (assessed by the multidimensional miniCASCO tool) on the survival and clinical response (i.e., disease control rate) to ICI-based immunotherapy in patients with advanced NSCLC. We included 74 consecutive patients. Upon multivariate regression analysis, we found a negative association between IL-6 levels (odds ratio (OR) = 0.9036; 95%CI = 0.8408–0.9711; <i>p</i> = 0.0025) and the miniCASCO score (OR = 0.9768; 95%CI = 0.9102–0.9999; <i>p</i> = 0.0310) with the clinical response. As for survival outcomes, multivariate COX regression analysis found that IL-6 levels and miniCASCO-based cachexia severity significantly affected PFS (hazard ratio (HR) = 1.0388; 95%CI = 1.0230–1.0548; <i>p</i> < 0.001 and HR = 1.2587; 95%CI = 1.0850–1.4602; <i>p</i> = 0.0024, respectively) and OS (HR = 1.0404; 95%CI = 1.0221–1.0589; <i>p</i> < 0.0001 and HR = 2.3834; 95%CI = 1.1504–4.9378; <i>p</i> = 0.0194, respectively). A comparison of the survival curves by Kaplan–Meier analysis showed a significantly lower OS in patients with cachexia versus those without cachexia (<i>p</i> = 0.0323), as well as higher miniCASCO-based cachexia severity (<i>p</i> = 0.0428), an mGPS of 2 versus those with a lower mGPS (<i>p</i> = 0.0074), and higher IL-6 levels (>6 ng/mL) versus those with lower IL-6 levels (≤6 ng/mL) (<i>p</i> = 0.0120). In conclusion, our study supports the evidence that cachexia, with its related changes in inflammatory, body composition, and nutritional parameters, is a key prognostic and predictive factor for ICIs. Further larger studies are needed to confirm these findings and to explore the potential benefit of counteracting cachexia to improve immunotherapy efficacy. |
| first_indexed | 2024-03-11T09:03:17Z |
| format | Article |
| id | doaj.art-ab4e50f8907c42cdb76208cfd98fad20 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T09:03:17Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ab4e50f8907c42cdb76208cfd98fad202023-11-16T19:35:59ZengMDPI AGCancers2072-66942023-02-01154107610.3390/cancers15041076Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung CancerClelia Madeddu0Silvia Busquets1Clelia Donisi2Eleonora Lai3Andrea Pretta4Francisco Javier López-Soriano5Josep Maria Argilés6Mario Scartozzi7Antonio Macciò8Medical Oncology Unit, “Azienda Ospedaliero Universitaria” of Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, ItalyDepartament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, University of Barcelona, Diagonal 643, 08028 Barcelona, SpainMedical Oncology Unit, “Azienda Ospedaliero Universitaria” of Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, ItalyMedical Oncology Unit, “Azienda Ospedaliero Universitaria” of Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, ItalyMedical Oncology Unit, “Azienda Ospedaliero Universitaria” of Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, ItalyDepartament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, University of Barcelona, Diagonal 643, 08028 Barcelona, SpainDepartament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, University of Barcelona, Diagonal 643, 08028 Barcelona, SpainMedical Oncology Unit, “Azienda Ospedaliero Universitaria” of Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, ItalyGynecologic Oncology Unit, ARNAS G. Brotzu, Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, ItalyImmune checkpoint inhibitor (ICI)-based immunotherapy has significantly improved the survival of patients with advanced non-small cell lung cancer (NSCLC); however, a significant percentage of patients do not benefit from this approach, and predictive biomarkers are needed. Increasing evidence demonstrates that cachexia, a complex syndrome driven by cancer-related chronic inflammation often encountered in patients with NSCLC, may impair the immune response and ICI efficacy. Herein, we carried out a prospective study aimed at evaluating the prognostic and predictive role of cachexia with the related changes in nutritional, metabolic, and inflammatory parameters (assessed by the multidimensional miniCASCO tool) on the survival and clinical response (i.e., disease control rate) to ICI-based immunotherapy in patients with advanced NSCLC. We included 74 consecutive patients. Upon multivariate regression analysis, we found a negative association between IL-6 levels (odds ratio (OR) = 0.9036; 95%CI = 0.8408–0.9711; <i>p</i> = 0.0025) and the miniCASCO score (OR = 0.9768; 95%CI = 0.9102–0.9999; <i>p</i> = 0.0310) with the clinical response. As for survival outcomes, multivariate COX regression analysis found that IL-6 levels and miniCASCO-based cachexia severity significantly affected PFS (hazard ratio (HR) = 1.0388; 95%CI = 1.0230–1.0548; <i>p</i> < 0.001 and HR = 1.2587; 95%CI = 1.0850–1.4602; <i>p</i> = 0.0024, respectively) and OS (HR = 1.0404; 95%CI = 1.0221–1.0589; <i>p</i> < 0.0001 and HR = 2.3834; 95%CI = 1.1504–4.9378; <i>p</i> = 0.0194, respectively). A comparison of the survival curves by Kaplan–Meier analysis showed a significantly lower OS in patients with cachexia versus those without cachexia (<i>p</i> = 0.0323), as well as higher miniCASCO-based cachexia severity (<i>p</i> = 0.0428), an mGPS of 2 versus those with a lower mGPS (<i>p</i> = 0.0074), and higher IL-6 levels (>6 ng/mL) versus those with lower IL-6 levels (≤6 ng/mL) (<i>p</i> = 0.0120). In conclusion, our study supports the evidence that cachexia, with its related changes in inflammatory, body composition, and nutritional parameters, is a key prognostic and predictive factor for ICIs. Further larger studies are needed to confirm these findings and to explore the potential benefit of counteracting cachexia to improve immunotherapy efficacy.https://www.mdpi.com/2072-6694/15/4/1076immune checkpoint inhibitorimmunotherapynon-small cell lung cancersurvivalinflammationcachexia |
| spellingShingle | Clelia Madeddu Silvia Busquets Clelia Donisi Eleonora Lai Andrea Pretta Francisco Javier López-Soriano Josep Maria Argilés Mario Scartozzi Antonio Macciò Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer Cancers immune checkpoint inhibitor immunotherapy non-small cell lung cancer survival inflammation cachexia |
| title | Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer |
| title_full | Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer |
| title_fullStr | Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer |
| title_full_unstemmed | Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer |
| title_short | Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer |
| title_sort | effect of cancer related cachexia and associated changes in nutritional status inflammatory status and muscle mass on immunotherapy efficacy and survival in patients with advanced non small cell lung cancer |
| topic | immune checkpoint inhibitor immunotherapy non-small cell lung cancer survival inflammation cachexia |
| url | https://www.mdpi.com/2072-6694/15/4/1076 |
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