Sarcopenia, or the loss of skeletal muscle mass, is significantly associated with a poor response to new treatments for advanced non-small cell lung cancer (NSCLC).
Programmed cell death (PD)-1 inhibitors are a new class of oncology medicines. They work by boosting the immune system’s ability to attack cancer cells, meaning their effectiveness relies on the patient’s immune function.
PD-1 inhibitors are an exciting development in cancer treatment, including NSCLC. However, only a small subset of people prescribed them achieve long-term progression-free survival.
It is well known that sarcopenia is common in people with advanced cancer and is a risk factor for poor outcomes in several types of the disease. Muscle degradation is also associated with a dysregulated immune response.
A team from Osaka University, Japan, set out to investigate how sarcopenia impacts the efficacy of PD-1 inhibitor therapy in people with lung cancer.
Researchers looked at the medical records and treatment outcomes of 42 people diagnosed with advanced NSCLC between January 2016 and September 2018.
All had undergone a computed tomography assessment of skeletal muscle mass receiving treatment with one of two PD-1 inhibitors.
Of the 42 patients analyzed, 52.4 percent experienced sarcopenia. This was significantly associated with poorer progression-free survival, which stood at a median of 2.1 months for those who experienced loss of muscle mass and 6.8 months for those who did not.
More than two thirds, 38.1%, of non-sarcopenia patients were still in remission one year after treatment. At the same time point, there was no sign of tumor progression in just 10.1% of patients with sarcopenia.
Ninety-one percent of those without sarcopenia responded to treatment, compared to just 40 percent of those who did develop it.
As Atsushi Kumanogoh, senior author of the study, observes: “The results were surprisingly emphatic.
“We found that the treatment outcomes for patients with sarcopenia at the start of therapy were far worse than those without.”1
The results have the potential to inform NSCLC treatment strategies, says lead author of the study, Takayuki Shiroyama.
“Our findings suggest that baseline skeletal muscle mass has a substantial impact on PD-1 inhibitor efficacy. As such, skeletal muscle mass might be useful for predicting whether treatment is likely to be effective,” he notes.1
Increasing muscle mass before embarking on treatment, could mean more patients are able to achieve optimal long-term treatment outcomes from PD-1-inhibitor therapy, the team concludes.
Shiroyama, T., Nagatomo, I., Koyama, S., Hirata, H., Nishida, S., Miyake, K., … & Masuhiro, K. (2019). Impact of sarcopenia in patients with advanced non–small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study. Scientific Reports, 9(1), 2447. Retrieved from https://www.nature.com/articles/s41598-019-39120-6
- Pumping iron could save your life. (2019, April 4). Retrieved from https://www.eurekalert.org/pub_releases/2019-03/ou-pic030419.php