Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

Abstract

Purpose Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes. Methods CC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored. Results Twenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle's dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified. Conclusions Limited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.

Daidzein alleviates cisplatin‐induced muscle atrophy by regulating Glut4/AMPK/FoxO pathway

“…Chemotherapy is widely used in the treatment of cancer (Frei 3rd., 1985), but many chemotherapeutic drugs can induce cachexia while suppressing tumour growth. Cancer patients will experience weight loss, body mass index loss, and sarcopenia after chemotherapy (da Rocha et al, 2019; Nattenmuller et al, 2017; White, Weekes, Grant, Baldwin, & Ahmed, 2020). Muscle loss in cancer patients during chemotherapy is associated with poor chemotherapy efficacy and poor prognosis (Daly et al, 2018; Griffin et al, 2019; Sasaki et al, 2019).…”

Application of the 2011 international consensus cancer cachexia classification in routine oncology dietetic practice: An observational study

“…6,7 Systemic inflammation requires further exploration to determine whether it should form part of the CC staging. 32 In the study population, only 9% were not on active antitumor therapy; most were being treated with palliative intent and/or have metastatic disease. This likely impacted the prevalence of CC identified.…”

Beta-hydroxy beta-methylbutyrate/arginine/glutamine (HMB/Arg/Gln) supplementation to improve the management of cachexia in patients with advanced lung cancer: an open-label, multicentre, randomised, controlled phase II trial (NOURISH)

“…Furthermore, even though recruitment during the NOURISH trial was focused at the earliest point in the clinical pathway, rather than only after symptoms of cachexia were noted, this trial concluded these issues still persisted suggesting most if not all patients who took part were not precachectic. It is interesting to note that, given the high proportion of NOURISH trial patients with NSCLC with metastatic disease, a very recent study suggests the majority of patients with advanced NSCLC present with some degree of cachexia [32].…”