Tsukagoshi Mariko, Yokobori Takehiko, Yajima Toshiki, Maeno Toshitaka, Shimizu Kimihiro, Mogi Akira, Araki Kenichiro, Harimoto Norifumi, Shirabe Ken, Kaira Kyoichi
Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine.
Division of Hepatobiliary and Pancreatic Surgery.
Medicine (Baltimore). 2020 Feb;99(7):e19059. doi: 10.1097/MD.0000000000019059.
Nivolumab, a monoclonal antibody targeting programmed cell death-1, significantly prolongs survival for patients with advanced non-small-cell lung cancer (NSCLC). However, little is known about the value of predictive biomarkers. Hence, we investigated the impact of skeletal muscle (SM) mass loss on clinical outcomes in NSCLC patients undergoing nivolumab treatment. Thirty patients with histologically confirmed NSCLC treated with nivolumab were included in this study. Computed tomography was used to determine SM loss based on the SM index (SMI). The SMI is the cross-sectional area of the bilateral psoas muscles at the third lumbar vertebra, divided by height squared. The cut-off values were defined as 6.36 cm/m for men and 3.92 cm/m for women. Among the 30 patients, 13 (43%) had SM loss. There was no significant association between SM loss and immune-related adverse events. The SM loss group had undergone significantly more prior chemotherapy cycles (P = .04). SM loss was significantly associated with fewer nivolumab cycles (P = .01). No patients in the SM loss group achieved a partial response. Patients with SM loss had a significantly shorter progression-free survival period (P = .008) and median overall survival than those with normal SM mass (10 vs 25 months, respectively, P = .03). SM loss was an independent prognostic factor of poor survival. In conclusion, SM loss may be a predictive factor of poor outcomes in NSCLS patients undergoing nivolumab therapy.
纳武单抗是一种靶向程序性细胞死亡蛋白1的单克隆抗体，可显著延长晚期非小细胞肺癌（NSCLC）患者的生存期。然而，对于预测性生物标志物的价值知之甚少。因此，我们研究了骨骼肌（SM）质量损失对接受纳武单抗治疗的NSCLC患者临床结局的影响。本研究纳入了30例经组织学确诊并接受纳武单抗治疗的NSCLC患者。采用计算机断层扫描根据SM指数（SMI）确定SM损失情况。SMI是第三腰椎水平双侧腰大肌的横截面积除以身高的平方。男性的临界值定义为6.36 cm/m，女性为3.92 cm/m。在这30例患者中，13例（43%）存在SM损失。SM损失与免疫相关不良事件之间无显著关联。SM损失组接受的既往化疗周期明显更多（P = 0.04）。SM损失与纳武单抗治疗周期数显著减少相关（P = 0.01）。SM损失组中无患者达到部分缓解。与SM质量正常的患者相比，SM损失的患者无进展生存期明显更短（P = 0.008），中位总生存期也更短（分别为10个月和25个月，P = 0.03）。SM损失是生存不良的独立预后因素。总之，SM损失可能是接受纳武单抗治疗的NSCLS患者预后不良的预测因素。
