Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Support Care Cancer. 2022 Feb;30(2):1633-1641. doi: 10.1007/s00520-021-06572-4. Epub 2021 Sep 22.
Programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors plus chemotherapy have become the standard first line of treatment in patients with advanced non-small-cell lung cancer (NSCLC). However, few studies have explicitly focused on the impact of weight loss on the efficacy of PD-1/PD-L1 inhibitors plus chemotherapy. Thus, we evaluated the clinical implications of weight loss on the survival outcomes in patients who received this treatment.
We conducted a retrospective review of medical records of patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitors plus chemotherapy from December 2018 to December 2020. Significant weight loss was defined as an unintentional weight loss of 5% or more over 6 months. We evaluated the progression-free survival (PFS) and overall survival (OS) of patients with or without weight loss.
Among the 80 included patients, 37 (46%) had weight loss, and were associated with a lower objective response rate (30 vs 51%, P < 0.05), poorer PFS (2.3 vs 12.0 months, P < 0.05), and poorer OS (10.8 vs 23.9 months, P < 0.05) than those without weight loss. The Cox proportional-hazard ratios (95% confidence interval) of weight loss were 1.77 (1.01-3.10) for PFS and 2.90 (1.40-6.00) for OS, with adjustments for Eastern Cooperative Oncology Group performance status, PD-L1 tumour proportion score, histology, and central nervous system metastases.
Pre-treatment weight loss may reduce treatment efficacy and shorten survival time in patients receiving PD-1/PD-L1 inhibitors plus chemotherapy. Early evaluation and intervention for weight loss might improve oncological outcomes in patients with advanced NSCLC.
程序性死亡受体 1（PD-1）/程序性死亡配体 1（PD-L1）抑制剂联合化疗已成为晚期非小细胞肺癌（NSCLC）患者的标准一线治疗方法。然而，很少有研究明确关注体重减轻对 PD-1/PD-L1 抑制剂联合化疗疗效的影响。因此，我们评估了体重减轻对接受这种治疗的患者生存结果的临床意义。
我们对 2018 年 12 月至 2020 年 12 月期间接受 PD-1/PD-L1 抑制剂联合化疗的晚期 NSCLC 患者的病历进行了回顾性分析。显著体重减轻定义为 6 个月内非自愿性体重减轻 5%或更多。我们评估了有或没有体重减轻的患者的无进展生存期（PFS）和总生存期（OS）。
在 80 名纳入的患者中，37 名（46%）有体重减轻，与较低的客观缓解率（30%比 51%，P<0.05）、较差的 PFS（2.3 比 12.0 个月，P<0.05）和较差的 OS（10.8 比 23.9 个月，P<0.05）相关。体重减轻的 Cox 比例风险比（95%置信区间）为 PFS 的 1.77（1.01-3.10）和 OS 的 2.90（1.40-6.00），调整了东部合作肿瘤组表现状态、PD-L1 肿瘤比例评分、组织学和中枢神经系统转移。
治疗前体重减轻可能降低接受 PD-1/PD-L1 抑制剂联合化疗的患者的治疗效果并缩短生存时间。对体重减轻进行早期评估和干预可能改善晚期 NSCLC 患者的肿瘤学结局。
