Effect of longitudinal changes of cachexia on the efficacy and toxicity of immune checkpoint inhibitors in esophageal squamous cell cancer (ESCC) patients

Haoqian Li; Butuo Li; Xiaoqing Wang; Huan Zhang; Chunni Wang; Bingjie Fan; Linlin Wang

doi:10.1016/j.nut.2024.112462

Effect of longitudinal changes of cachexia on the efficacy and toxicity of immune checkpoint inhibitors in esophageal squamous cell cancer (ESCC) patients

Nutrition. 2024 Apr 5:124:112462. doi: 10.1016/j.nut.2024.112462. Online ahead of print.

Authors

Haoqian Li¹, Butuo Li¹, Xiaoqing Wang², Huan Zhang³, Chunni Wang¹, Bingjie Fan¹, Linlin Wang⁴

Affiliations

¹ Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
² Department of Portal Hypertension, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
³ Department of Nursing, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
⁴ Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China. Electronic address: wanglinlinatjn@163.com.

PMID: 38663128
DOI: 10.1016/j.nut.2024.112462

Abstract

Purpose: Immune checkpoint inhibitors (ICIs) have enhanced survival in advanced esophageal squamous cell cancer (ESCC) patients, but their efficacy varies. Cachexia, characterized by muscle loss and significant weight loss, might influence ICI response. This study examines the relationship between cachexia's longitudinal changes and ICI outcomes in ESCC patients.

Methods: ESCC patients undergoing at least two ICI cycles from 2017 to 2021 were studied. Cachexia's baseline and evolving patterns during ICI treatment were observed. Kaplan-Meier and Cox regression analyses were used to assess cachexia's effect on ICI efficacy. Chi-square tests were used to determine cachexia's link to immune-related adverse effects (irAEs).

Results: Two hundred seventy-eight ICI-treated patients had a median progression-free survival (PFS) of 5.78 months and overall survival (OS) of 8.3 months. Pretreatment cachexia led to worse outcomes: PFS 7.87 versus 5.3 months, time to progression (TTP) 10.9 versus 6.1 months, and OS 14.3 versus 9.2 months. Irreversible cachexia showed the poorest results. Cachexia's changes weren't associated with irAEs.

Conclusion: Baseline and evolving cachexia significantly impact ICI efficacy in ESCC patients. Continuous cachexia monitoring during ICI therapy is crucial for optimal ESCC management.

Keywords: Cancer cachexia; ESCC; Immune checkpoint inhibitor; Programmed death-ligand 1.