Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Thorac Cancer. 2023 Sep;14(25):2548-2557. doi: 10.1111/1759-7714.15017. Epub 2023 Jul 31.
This study aimed to comprehensively evaluate the efficacy and toxicity of afatinib in patients with sarcopenia, an important prognostic factor for treatment efficacy and toxicity in patients with cancer.
The clinical features of patients with advanced NSCLC treated with frontline afatinib between 2014 and 2018 at a medical center in Taiwan were retrospectively reviewed. Sarcopenia was evaluated based on the total cross-sectional area of skeletal muscles assessed by computed tomography (CT) imaging at the L3 level. Baseline characteristics, response rates, survival rates, and adverse events (AEs) were compared between sarcopenic and nonsarcopenic patients.
A total of 176 patients evaluated for sarcopenia by CT and treated with afatinib were enrolled in the current study. Sarcopenia was significantly associated with good performance status, low body mass index (BMI), low body surface area (BSA), and low total mass area (TMA). Sarcopenia did not influence the response rate (69.2% vs. 72.0%, p = 0.299), progression-free survival (median 15.9 vs. 14.9 months, p = 0.791), or overall survival (median 26.5 vs. 27.2 months, p = 0.441). However, BSA ≤ 1.7 and the 40 mg afatinib dose were associated with dose reduction. TMA was the only independent factor for afatinib discontinuation due to AEs.
Sarcopenia was not associated with treatment efficacy or toxicity among patients with NSCLC harboring common mutations treated with afatinib, indicating sarcopenic patients should not be excluded from afatinib treatment. Other factors, such as BSA and TMA, were associated with dose reduction and afatinib discontinuation, respectively, which may require additional evaluations in future studies.
本研究旨在全面评估阿法替尼在伴有肌肉减少症的患者中的疗效和毒性，肌肉减少症是癌症患者治疗疗效和毒性的重要预后因素。
回顾性分析了 2014 年至 2018 年期间在台湾一家医疗中心接受一线阿法替尼治疗的晚期 NSCLC 患者的临床特征。通过 CT 成像评估 L3 水平的骨骼肌总横截面积来评估肌肉减少症。比较了肌肉减少症和非肌肉减少症患者的基线特征、缓解率、生存率和不良事件（AE）。
共有 176 例患者通过 CT 评估肌肉减少症并接受阿法替尼治疗，被纳入本研究。肌肉减少症与良好的表现状态、低体重指数（BMI）、低体表面积（BSA）和低总质量面积（TMA）显著相关。肌肉减少症不影响缓解率（69.2% vs. 72.0%，p=0.299）、无进展生存期（中位 15.9 与 14.9 个月，p=0.791）或总生存期（中位 26.5 与 27.2 个月，p=0.441）。然而，BSA≤1.7 和 40mg 阿法替尼剂量与剂量减少相关。TMA 是唯一与因 AE 而停止阿法替尼治疗的独立因素。
在接受阿法替尼治疗的伴有常见突变的 NSCLC 患者中，肌肉减少症与治疗疗效或毒性无关，这表明肌肉减少症患者不应被排除在阿法替尼治疗之外。其他因素，如 BSA 和 TMA，分别与剂量减少和阿法替尼停药相关，这可能需要在未来的研究中进行进一步评估。
