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Nutritional status in the era of target therapy: poor nutrition is a prognostic factor in non-small cell lung cancer with activating epidermal growth factor receptor mutations

  • Park, Sehhoon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Seongyeol (Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Se-Hoon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Suh, Beomseok (Department of Family Medicine and Health Promotion Center, Seoul National University Hospital) ;
  • Keam, Bhumsuk (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Tae Min (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Dong-Wan (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Young Whan (Department of Internal Medicine, Seoul National University Hospital) ;
  • Heo, Dae Seog (Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2015.03.09
  • Accepted : 2015.05.28
  • Published : 2016.11.01

Abstract

Background/Aims: Pretreatment nutritional status is an important prognostic factor in patients treated with conventional cytotoxic chemotherapy. In the era of target therapies, its value is overlooked and has not been investigated. The aim of our study is to evaluate the value of nutritional status in targeted therapy. Methods: A total of 2012 patients with non-small cell lung cancer (NSCLC) were reviewed and 630 patients with activating epidermal growth factor receptor (EGFR) mutation treated with EGFR tyrosine kinase inhibitor (TKI) were enrolled for the final analysis. Anemia, body mass index (BMI), and prognostic nutritional index (PNI) were considered as nutritional factors. Hazard ratio (HR), progression-free survival (PFS) and overall survival (OS) for each group were calculated by Cox proportional analysis. In addition, scores were applied for each category and the sum of scores was used for survival analysis. Results: In univariable analysis, anemia (HR, 1.29; p = 0.015), BMI lower than 18.5 (HR, 1.98; p = 0.002), and PNI lower than 45 (HR, 1.57; p < 0.001) were poor prognostic factors for PFS. Among them, BMI and PNI were independent in multi-variable analysis. All of these were also significant prognostic values for OS. The higher the sum of scores, the poorer PFS and OS were observed. Conclusions: Pretreatment nutritional status is a prognostic marker in NSCLC patients treated with EGFR TKI. Hence, baseline nutritional status should be more carefully evaluated and adequate nutrition should be supplied to these patients.

Keywords

Acknowledgement

Supported by : Innovative Research Institute for Cell Therapy

References

  1. Argiles JM, Busquets S, Stemmler B, Lopez-Soriano FJ. Cancer cachexia: understanding the molecular basis. Nat Rev Cancer 2014;14:754-762. https://doi.org/10.1038/nrc3829
  2. Lieffers JR, Mourtzakis M, Hall KD, McCargar LJ, Prado CM, Baracos VE. A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr 2009;89:1173-1179. https://doi.org/10.3945/ajcn.2008.27273
  3. Ottery FD. Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract 1994;2:123-131.
  4. Paccagnella A, Morassutti I, Rosti G. Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol 2011;23:322-330. https://doi.org/10.1097/CCO.0b013e3283479c66
  5. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-239. https://doi.org/10.1016/S0261-5614(02)00215-7
  6. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 2013;31:1539-1547. https://doi.org/10.1200/JCO.2012.45.2722
  7. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489-495. https://doi.org/10.1016/S1470-2045(10)70218-7
  8. Brookes GB. Nutritional status: a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg 1985;93:69-74. https://doi.org/10.1177/019459988509300114
  9. Mitrache C, Passweg JR, Libura J, et al. Anemia: an indicator for malnutrition in the elderly. Ann Hematol 2001;80:295-298. https://doi.org/10.1007/s002770100287
  10. Bailey KV, Ferro-Luzzi A. Use of body mass index of adults in assessing individual and community nutritional status. Bull World Health Organ 1995;73:673-680.
  11. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi1984;85:1001-1005.
  12. Szkandera J, Gerger A, Liegl-Atzwanger B, et al. Pre-treatment anemia is a poor prognostic factor in soft tissue sarcoma patients. PLoS One 2014;9:e107297. https://doi.org/10.1371/journal.pone.0107297
  13. Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surg Today 2010;40:440-443. https://doi.org/10.1007/s00595-009-4065-y
  14. Kalantar-Zadeh K, Horwich TB, Oreopoulos A, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 2007;10:433-442. https://doi.org/10.1097/MCO.0b013e3281a30594
  15. Gridelli C, Ardizzoni A, Le Chevalier T, et al. Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel. Ann Oncol 2004;15:419-426. https://doi.org/10.1093/annonc/mdh087
  16. Yang JC, Hirsh V, Schuler M, et al. Symptom control and quality of life in LUX-Lung 3: a phase III study of afatinib or cisplatin/pemetrexed in patients with advanced lung adenocarcinoma with EGFR mutations. J Clin Oncol 2013;31:3342-3350. https://doi.org/10.1200/JCO.2012.46.1764
  17. Arora A, Scholar EM. Role of tyrosine kinase inhibitors in cancer therapy. J Pharmacol Exp Ther 2005;315:971-979. https://doi.org/10.1124/jpet.105.084145
  18. Reck M, Popat S, Reinmuth N, et al. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii27-iii39. https://doi.org/10.1093/annonc/mdu199
  19. Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol 2013;10:90-99. https://doi.org/10.1038/nrclinonc.2012.209
  20. Simons JP, Schols AM, Hoefnagels JM, Westerterp KR, ten Velde GP, Wouters EF. Effects of medroxyprogesterone acetate on food intake, body composition, and resting energy expenditure in patients with advanced, nonhormone-sensitive cancer: a randomized, placebo-controlled trial. Cancer 1998;82:553-560. https://doi.org/10.1002/(SICI)1097-0142(19980201)82:3<553::AID-CNCR18>3.0.CO;2-0
  21. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655. https://doi.org/10.1097/00000421-198212000-00014
  22. Finkelstein DM, Ettinger DS, Ruckdeschel JC. Long-term survivors in metastatic non-small-cell lung cancer: an Eastern Cooperative Oncology Group Study. J Clin Oncol 1986;4:702-709. https://doi.org/10.1200/JCO.1986.4.5.702
  23. Cessot A, Coriat R, Mir O, et al. Nutritional status is superior to the ECOG performance status in predicting the dose-intensity of the GEMOX chemotherapy regimen in patients with advanced cancer. Nutr Cancer 2013;65:1254-1257. https://doi.org/10.1080/01635581.2013.830315
  24. Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M. Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 2010;18:433-437. https://doi.org/10.1007/s00520-009-0681-8
  25. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 2005;23:1431-1438. https://doi.org/10.1200/JCO.2005.02.054
  26. Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 2012;104:371-385. https://doi.org/10.1093/jnci/djr556
  27. Berclaz G, Li S, Price KN, et al. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 2004;15:875-884. https://doi.org/10.1093/annonc/mdh222
  28. Dawood S, Broglio K, Gonzalez-Angulo AM, et al. Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res 2008;14:1718-1725. https://doi.org/10.1158/1078-0432.CCR-07-1479
  29. Key TJ, Appleby PN, Reeves GK, et al. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst 2003;95:1218-1226. https://doi.org/10.1093/jnci/djg022
  30. Halabi S, Small EJ, Vogelzang NJ. Elevated body mass index predicts for longer overall survival duration in men with metastatic hormone-refractory prostate cancer. J Clin Oncol 2005;23:2434-2435. https://doi.org/10.1200/JCO.2005.05.890
  31. Fearon KC, Voss AC, Hustead DS; Cancer Cachexia Study Group. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 2006;83:1345-1350. https://doi.org/10.1093/ajcn/83.6.1345

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