NUTRITIONAL DERANGEMENTS IN ADVANCED NON-SMALL CELL LUNG CANCER PATIENTS: PREVALENCE AND IMPACT ON TREATMENT OUTCOME

Abstract

To evaluate the nutritional status and its correlation with outcome in advanced (A) non-small cell lung cancer (NSCLC) pts. A-NSCLC pts treated at AOUI of Verona (2016-2018) received nutritional counseling by a skilled dietitian. Nutritional Risk Screening (NRS) 2002 was used to assess nutritional risk. Bilateral psoas major muscles were measured at L3 vertebral level with routine staging-computed tomography (CT). Changes in psoas muscles observed in subsequent scans were evaluated using the Wilcoxon signed-rank test. Data were correlated to progression-free/overall survival (PFS/OS) and response rate (ORR) using a Cox model. Data from 38 pts were gathered, with a median follow-up of 21 months (range 1-197). At baseline, only 18.4% of pts were underweight. The majority (65.8%) were at risk of malnutrition (NRS≥3). At multivariate analysis, stage (HR 4.99, p=0.04), performance status (HR 4.99, p=0.007) and NRS (HR 7.61, p=0.01) were significant independent predictors for PFS. Pts with baseline NRS≤3 had significantly longer 1-year PFS (58.6% vs 16.7%, p=0.04) and 2-year OS (90.6% vs 68.3%, p=0.03) and a better ORR than those with NRS>3 (66.7% vs 21.4%). In 16 pts treated with immunotherapy, loss in psoas muscle mass (p=0.01) correlated with worse ORR, PFS and, OS, although differences did not reach a statistical significance due to the limited sample. Malnutrition has a detrimental impact on ORR, PFS and, OS in A-NSCLC. Particularly, in pts treated with immunotherapy, muscle mass wasting seems to affect efficacy outcome, suggesting a potential interaction between immunological and nutritional parameters.