Abstract
Body composition refers to the proportional content of body fat mass and lean body mass that can lead to a continuum of different phenotypes ranging from cachectic/sarcopenic state to obesity. The heterogenetic phenotypes of body composition can contribute to formation of some cancer types and can sometimes lead to disparate outcomes. Both of these extremes of the spectrum exist in patients with non-small cell lung carcinoma (NSCLC). The discovery of new pathways that drive tumorigenesis contributing to cancer progression and resistance have expanded our understanding of cancer biology leading to development of new targeted therapies including tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) that have changed the landscape of NSCLC treatment. However, in the new era of precision medicine, the impact of body composition phenotypes on treatment outcomes and survival is now being elucidated. In this review, we will discuss the emerging evidence of a link between body composition and outcomes in patients with NSCLC treated with TKI and ICI. We will also discuss suggested mechanisms by which body composition can impact tumor behavior and anti-tumor immunological response.
Highlights
Body composition refers to the proportional distribution of different body mass contents amongst various compartments including adipose tissue and lean body mass
We highlight the available studies conducted to analyze the implications of body composition phenotypes on survival outcomes in patients with non-small cell lung cancer (NSCLC) who were treated with either epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) or immune checkpoint inhibitors (ICI); we provide our recommendations on the conceptual utility of incorporating body composition calculations into prospective trials
The calculation of Body Mass Index (BMI) cannot distinguish between different patterns of body fat distribution which could lead to multiple heterogeneous obesity phenotypes that could be associated with different biology and are not accurately reflected by BMI [30]
Summary
Body composition refers to the proportional distribution of different body mass contents amongst various compartments including adipose tissue and lean body mass. A distinct overlap syndrome of increased adipose tissue (obesity) and loss of lean body mass (sarcopenia) has been recognized as an important factor contributing to worse prognosis in some cancers including NSCLC [12]. These effects of obesity on mortality and worse prognosis in the presence of sarcopenia in cancer patients have generated an unprecedented interest in the field of oncology to study the interconnection between body composition phenotypes and cancer behavior including NSCLC (which will be the focus of this review) in an attempt to solve this conundrum. We highlight the available studies conducted to analyze the implications of body composition phenotypes on survival outcomes in patients with NSCLC who were treated with either EGFR TKI or ICI; we provide our recommendations on the conceptual utility of incorporating body composition calculations into prospective trials
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