The prognostic value of early onset, CT derived loss of muscle and adipose tissue during chemotherapy in metastatic non-small cell lung cancer

Abstract

To evaluate the relationship between early changes in muscle and adipose tissue during chemotherapy and overall survival (OS) in stage IV non-small cell lung cancer (NSCLC). Materials and methods: In this post-hoc analysis of the first line NVALT12 trial (NCT01171170) in stage IV NSCLC, skeletal muscle (SM), radiation attenuation (RA), subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were assessed at the third lumbar level on CT-images obtained before initiation of chemotherapy and shortly after administration of the second cycle. The contribution of changes in different body compartments to overall survival was assessed. Results: CT scans of 111 patients were included. Analysis of body composition changes between the baseline and the follow-up scan, revealed that overall SM cross sectional area (CSA), radiation attenuation and SAT CSA decreased respectively by −1.2 ± 2.9 cm 2 /m 2 (p < 0.001), −0.7 ± 3.3 HU (p = 0.026) and −1.9 ± 8.7 cm 2 /m 2 (p = 0.026), while no significant changes in VAT tissue were observed. Longitudinally, median OS was significantly shorter among patients losing SM compared to patients with preserved SM (9.4 versus 14.2 months; HR 1.9, 95% CI: 1.23, 2.79, p = 0.003). Multivariate analyses showed that proportional loss of muscle mass was associated with poor OS (HR 0.949, 95% CI: 0.915, 0.985, p = 0.006) independent from important clinical prognostic factors including WHO-PS, gender, age and Charlson comorbidity index. Conclusion: Early loss of SM during first line chemotherapy is a poor prognostic factor in stage IV NSCLC patients. Future studies have to reveal whether early supportive intervention guided by initial CT muscle response to chemotherapy can influence the wasting process and related mortality risk.

The prognostic value of weight and body composition changes in patients with non‐small‐cell lung cancer treated with nivolumab

“…Although, this observation of early weight loss is in line with our previous study in patients with stage IV NSCLC treated with first‐line platinum‐based chemotherapy, weight loss was accompanied by a significant decrease of CT‐derived SMM, SM radiation attenuation, and SAT at week 6 (i.e. 2 cycles of chemotherapy) 16 . Furthermore, in patients treated with chemotherapy, loss of muscle mass was significantly predictive for OS in the absence of weight loss 16 .…”

“…2 cycles of chemotherapy) 16 . Furthermore, in patients treated with chemotherapy, loss of muscle mass was significantly predictive for OS in the absence of weight loss 16 . Patient cohorts of the current study population and patients treated with chemotherapy were comparable regarding age, WHO‐PS, and BMI.…”

“…Therefore, we previously validated the use of CT scans for analysing changes in SMM, skeletal muscle attenuation, SAT, and VAT on the level of the first lumbar vertebra (L1) compared with L3 15 . In a subsequent study, we showed that loss of SMM assessed at L1 after treatment with only two cycles of palliative chemotherapy is a strong independent negative predictor for OS in patients with stage IV NSCLC 16 . We hypothesized that next to early weight loss, early muscle loss at week 6 of treatment with nivolumab in patients with metastatic NSCLC is also associated with poor outcomes.…”

The Extract of Arctium lappa L. Fruit (Arctii Fructus) Improves Cancer-Induced Cachexia by Inhibiting Weight Loss of Skeletal Muscle and Adipose Tissue

“…These symptoms reduce cancer patients’ quality of life and reduce the efficiency of therapies such as chemotherapy and radiotherapy [ 3 ]. Furthermore, systemic inflammatory responses and skeletal muscle loss are caused by cancer, and chemotherapy makes the cachexia much worse [ 4 , 5 , 6 ]. More than half of cancer patients suffer from cachexia, and approximately 20% of them die because of cachexia [ 7 ].…”

Early Loss of Fat Mass During Chemoradiotherapy Predicts Overall Survival in Locally Advanced Squamous Cell Carcinoma of the Lung, but Not in Locally Advanced Squamous Cell Carcinoma of the Head and Neck

“…In addition to body weight, data on body composition and the presence of sarcopenia/cancer cachexia, could provide information on the expected prognosis of the patient and may therefore support the multidisciplinary team in clinical decision-making. Loss of skeletal muscle mass on CT scans is a strong predictor for poor prognosis in both NSCLC and head and neck cancer (24)(25)(26). However, this technique is expensive and time consuming and therefore not routinely feasible in daily clinical practice.…”