Cancer Cachexia Reduces the Efficacy of Nivolumab Treatment in Patients With Advanced Gastric Cancer

Fujii, Hironori; Makiyama, Akitaka; Iihara, Hirotoshi; Okumura, Naoki; Yamamoto, Senri; Imai, Takeharu; Arakawa, Shinichiro; Kobayashi, Ryo; Tanaka, Yoshihiro; Yoshida, Kazuhiro; Suzuki, Akio

doi:10.21873/anticanres.14734

Cited by 29 publications

(19 citation statements)

References 34 publications

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“…One study showed that cancer patients with more advanced cachexia had lower serum concentrations of immunotherapy [ 35 ]. Recently, other studies have found that the progression of cachexia decreases the efficacy of immunotherapy treatment in patients with NSCLC and gastric cancer [ 36 , 37 ]. The present study corroborates these data, as nearly all patients included in this study had advanced and long-standing disease, and severe malnutrition was significantly associated with a decrease in the efficacy of immunotherapy at M2 and M4 in the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

Gouez

Delrieu

Bouleuc

et al. 2022

Cancers

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Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival.

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Section: Discussionmentioning

confidence: 99%

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

Gouez

Delrieu

Bouleuc

et al. 2022

Cancers

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“…The onset of anorexia/cachexia syndrome may also inhibit immunomodulators activity thus rendering the treatment less useful [71,72]. In a retrospective study of 156 nonsmall-cell lung cancer (NSCLC) patients treated with PD-1/PD-L1 inhibitors, those with high muscle quality showed higher response rate (35.0 vs. 15.8 %, p < 0.05) and longer PFS (median, 4.5 vs. 2.0 months, p < 0.05) than those with low muscle quality [73].…”

Section: Nutritional Care During Immunotherapy: Does the Boundless Prairie Have A Fence?mentioning

confidence: 99%

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Aprile¹,

Basile²,

Giaretta³

et al. 2021

Nutrients

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Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients’ overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients’ nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.

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“…In various cancers, including AGC, it has been reported that cancer-induced cachexia, which more often occurs in patients with gastrointestinal cancers who suffer decreased oral intake, reduces the effects of ICIs [ 5 , 6 , 7 ]. Poor oral intake due to cachexia is associated with weight loss [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Improvement of Body Weight and Nutritional Status in Gastric Cancer Patients Enhances the Benefit of Nivolumab Therapy

Ikoma

Matsumoto

Kurioka

et al. 2022

JCM

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Nivolumab improves overall survival (OS) in patients with advanced gastric cancer (AGC) refractory to at least two previous chemotherapy regimens. We investigated whether changes in body weight and nutrition from first-line chemotherapy to nivolumab affected its efficacy. The correlation between weight change and nutritional status up to the start of nivolumab treatment and OS and progression-free survival (PFS) after starting nivolumab treatment was determined. Nutritional status was examined using the C-reactive protein/albumin ratio (CAR). A loss in body weight (LBW) from the onset of the first treatment of <4.5% led to OS prolongation and improved PFS outcomes. The median OS values in the LBW < 4.5% and ≥4.5% groups were 11.4 and 3.6 months, respectively. Similarly, changes in CAR from first-line chemotherapy (ΔCAR) affected OS; the ΔCAR < 0.01 group had a better prognosis than the ΔCAR ≥ 0.01 group. The median OS values in the ΔCAR < 0.01 and ≥0.01 groups were 9.4 and 4.5 months, respectively. The median OS in the group with LBW < 4.5% and ΔCAR < 0.01 was 12.9 months. LBW and deterioration of nutritional status following first-line chemotherapy are poor prognostic factors in AGC patients who received nivolumab as third- or later-line therapy. Early intervention to maintain body weight and nutritional status may improve the efficacy of immune checkpoint inhibitors.

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Cancer Cachexia Reduces the Efficacy of Nivolumab Treatment in Patients With Advanced Gastric Cancer

Cited by 29 publications

References 34 publications

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Improvement of Body Weight and Nutritional Status in Gastric Cancer Patients Enhances the Benefit of Nivolumab Therapy

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