Life science
Medicine / Healthcare
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Impact of sarcopenia in patients with advanced non-small
cell lung cancer treated with PD-1 inhibitors※ 印刷可能な解像度のものを電子ファイルにてご提供

Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine
Assistant Professor Takayuki Shiroyama

Researchmap https://researchmap.jp/shiroyama_t

Professor Atsushi Kumanogoh

Researchmap https://researchmap.jp/read0051725?lang=en

Life science

Abstract
The aim of this study was to investigate the clinical impact ofsarcopenia on the efficacy of programmed death (PD)-1 inhibitors.
We evaluated all patients treated with nivolumab or pembrolizumab
between January 2016 and September 2018 for previously treatedadvanced non–small cell lung cancer (NSCLC). The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra
on baseline computed tomography was assessed to calculate
the psoas muscle index (PMI). Sarcopenia was defined based on
PMI cut-off values for Asian adults (6.36 cm2/m2 for males and3.92 cm2/m2 for females). A total of 42 patients were analyzed. The
prevalence of sarcopenia was 52.4%. Sarcopenia was significantly
associated with poorer progression-free survival (PFS) (median, 2.1vs. 6.8 months, p = 0.004). Compared to patients with sarcopenia,
those without sarcopenia had a higher overall response rate (40.0%vs. 9.1%, p = 0.025) and 1-year PFS rate (38.1% vs. 10.1%). In
conclusion, sarcopenia at baseline as determined using computed
tomography is a significant predictor of worse outcome in patientswith advanced NSCLC receiving PD-1 blockade. Screening forsarcopenia may help identify patients more likely to achieve a longterm response in routine clinical practice.

Figure: Muscle mass assessment using abdominal CT.

▍ Background & Results
Programmed death (PD)-1 inhibitors such as nivolumab andpembrolizumab demonstrated promising efficacy for treating many
cancers, including lung cancer. However, long-term response iscurrently limited to a subset of patients. The currently available
predictive markers are incomplete, at least when used alone. We
found that sarcopenia was significantly associated with poorer progression-free survival (PFS) (median, 2.1 vs. 6.8 months, p = 0.004).
Compared to patients with sarcopenia, those without sarcopenia
had a higher overall response rate (40.0% vs. 9.1%, p = 0.025) and1-year PFS rate (38.1% vs. 10.1%).

▍ Significance of the research and Future perspective
Sarcopenia at baseline as determined using computed tomography is a significant predictor of worse outcome in patients withadvanced NSCLC receiving PD-1 blockade. Screening for sarcopenia may help identify patients more likely to achieve a long-term
response in routine clinical practice.

Figure: Kaplan-Meier curves of progression-free survival by (A) sarcopenia statusand (B) ECOG PS and sarcopenia status.

P a t e n t
Tr e a t i s e

Shiroyama, T; Nagatomo, I; Koyama, S et al. Impact of sarcopenia in patients with advanced non-small cell lung cancer treated with PD-1 inhibitors: A
preliminary retrospective study. Sci Rep. 2019; 9(1): 2447. doi: 10.1038/s41598-019-39120-6.

URLK e y w o r d sarcopenia, muscle mass, immune checkpoint inhibitor, lung cancer