Effects of Sarcopenia on the Outcomes and Safety of Chemoradiotherapy Followed by Durvalumab for the Treatment of Patients With Locally Advanced Non-Small Cell Lung Cancer.

Abstract

Background: Sarcopenia is associated with poor outcomes of various cancers treated with immune checkpoint inhibitors. Durvalumab is the standard of care for patients with locally advanced (LA) non-small cell lung cancer (NSCLC) after chemoradiation therapy (CRT). However, the effect of sarcopenia on the efficacy and safety of durvalumab in patients with LA-NSCLC remains unclear.

Methods: This single-center retrospective study was conducted between 2018 and 2021. Body composition indices were measured using computed tomography scans taken at the third lumbar vertebra before and after CRT. The cutoff values were set based on the change ratios for each index before and after CRT. Tumor response, survival, and the efficacy and safety of durvalumab were compared between patients who showed skeletal muscle loss and those who did not.

Results: Among 153 eligible patients (median age: 65 years; 74.5% men), skeletal muscle index (SMI) significantly decreased during CRT. With the threshold set at a -10% change in SMI, no significant difference in objective response rate (ΔSMI ≤ -10% vs. ΔSMI > -10%: 76.6% vs. 75.7%, p = 1.000), progression-free survival (hazard ratio [HR], 0.99, p = 0.983), overall survival (HR 1.04, p = 0.909), or the frequency of immune-related adverse events (44.9% vs. 44.2%, p = 1.000) was observed between the two groups.

Conclusions: Although muscle loss during CRT is common, it does not compromise the efficacy or safety of subsequent durvalumab therapy in patients with LA-NSCLC. Future studies are needed to delineate sarcopenia criteria specific to LA-NSCLC and assess interventions, including rehabilitation and pharmacotherapy.