Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy
Background Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy. Methods We performed a retrospective review of 90 patients enrolled on immunothe...
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| Veröffentlicht in: | The oncologist (Dayton, Ohio) Ohio), 2020-03, Vol.25 (3), p.e528-e535 |
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| creator | Bilen, Mehmet Asim Martini, Dylan J. Liu, Yuan Shabto, Julie M. Brown, Jacqueline T. Williams, Milton Khan, Amir I. Speak, Alexandra Lewis, Colleen Collins, Hannah Kissick, Haydn T. Carthon, Bradley C. Akce, Mehmet Shaib, Walid L. Alese, Olatunji B. Pillai, Rathi N. Steuer, Conor E. Wu, Christina S. Lawson, David H. Kudchadkar, Ragini R. El‐Rayes, Bassel F. Ramalingam, Suresh S. Owonikoko, Taofeek K. Harvey, R. Donald Master, Viraj A. |
| description | Background
Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy.
Methods
We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR |
| doi_str_mv | 10.1634/theoncologist.2019-0751 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7066707</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2376729118</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4722-cb5ab7fe945d513afc07a80fbafe852210ffc4cc10a8aeb03aa8211993d233ba3</originalsourceid><addsrcrecordid>eNqNkdtq3DAQhk1pyal5hVaXvXGqg21ZN4Vg0mQhdAubQu_EWJZ2VWxpK8kb9gH63tE2adrcFQSaGf3za4avKN4TfEEaVn1MG-2d8qNf25guKCaixLwmr4oTUleirAT-_jrHuGUlJ7U4Lk5j_IFxDhk9Ko4ZJQ1tMT8pfnV-6q3TA7oyRquEvEErCMpvtbOAwA1otY9JT1ahhTMjTBMk6x3KZzWHnd3BiKxDX3NVuxTRvU0bdDnswKlsukqw1qg7JAHdBQ0pF39LFtM0O5_3CLDdvy3eGBijPn-6z4pvn6_uupvydnm96C5vS1VxSkvV19Bzo0VVDzVhYBTm0GLTg9FtTSnBxqhKKYKhBd1jBtBSQoRgA2WsB3ZWfHr03c79pAeVJw4wym2wE4S99GDlyxdnN3Ltd5LjpuGYZ4MPTwbB_5x1THKyUelxBKf9HCVlvOFUENJmKX-UquBjDNo8f0OwPECULyDKA0R5gJg73_075XPfH2p_17i3o97_r69cfumWhBFB2QPtSbXB</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2376729118</pqid></control><display><type>article</type><title>Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy</title><source>Access via Oxford University Press (Open Access Collection)</source><source>Access via Wiley Online Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Bilen, Mehmet Asim ; Martini, Dylan J. ; Liu, Yuan ; Shabto, Julie M. ; Brown, Jacqueline T. ; Williams, Milton ; Khan, Amir I. ; Speak, Alexandra ; Lewis, Colleen ; Collins, Hannah ; Kissick, Haydn T. ; Carthon, Bradley C. ; Akce, Mehmet ; Shaib, Walid L. ; Alese, Olatunji B. ; Pillai, Rathi N. ; Steuer, Conor E. ; Wu, Christina S. ; Lawson, David H. ; Kudchadkar, Ragini R. ; El‐Rayes, Bassel F. ; Ramalingam, Suresh S. ; Owonikoko, Taofeek K. ; Harvey, R. Donald ; Master, Viraj A.</creator><creatorcontrib>Bilen, Mehmet Asim ; Martini, Dylan J. ; Liu, Yuan ; Shabto, Julie M. ; Brown, Jacqueline T. ; Williams, Milton ; Khan, Amir I. ; Speak, Alexandra ; Lewis, Colleen ; Collins, Hannah ; Kissick, Haydn T. ; Carthon, Bradley C. ; Akce, Mehmet ; Shaib, Walid L. ; Alese, Olatunji B. ; Pillai, Rathi N. ; Steuer, Conor E. ; Wu, Christina S. ; Lawson, David H. ; Kudchadkar, Ragini R. ; El‐Rayes, Bassel F. ; Ramalingam, Suresh S. ; Owonikoko, Taofeek K. ; Harvey, R. Donald ; Master, Viraj A.</creatorcontrib><description>Background
Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy.
Methods
We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR <242 and nonsarcopenic), intermediate‐risk (PLR <242 and sarcopenic), high‐risk (PLR ≥242 and nonsarcopenic), and very‐high‐risk (PLR ≥242 and sarcopenic) groups with subsequent association with survival.
Results
Most patients (59%) were male, and the most common cancers were melanoma (33%) and gastrointestinal (22%). Very high‐risk, high‐risk, and intermediate‐risk patients had significantly shorter overall survival (hazard ratio [HR], 8.46; 95% confidence interval [CI], 2.65–27.01; p < .001; HR, 5.32; CI, 1.96–14.43; p = .001; and HR, 4.01; CI, 1.66–9.68; p = .002, respectively) and progression‐free survival (HR, 12.29; CI, 5.15–29.32; p < .001; HR, 3.51; CI, 1.37–9.02; p = .009; and HR, 2.14; CI, 1.12–4.10; p = .022, respectively) compared with low‐risk patients.
Conclusion
Baseline sarcopenia and elevated inflammatory biomarkers may have a combined effect on decreasing survival in immunotherapy‐treated patients in phase I trials. These data may be immediately applicable for medical oncologists for the risk stratification of patients beginning immunotherapeutic agents.
Implications for Practice
Sarcopenia and inflammation have been associated with poor survival in patients with cancer, but it is unclear how to apply this information to patient care. The authors created a risk‐stratification system that combined sarcopenia and platelet‐to‐lymphocyte ratio as a marker of systemic inflammation. The presence of sarcopenia and systemic inflammation decreased progression‐free survival and overall survival in our cohort of 90 patients who received immunotherapy in phase I clinical trials. The data presented in this study may be immediately applicable for medical oncologists as a way to risk‐stratify patients who are beginning treatment with immunotherapy.
The interaction between chronic inflammation and body composition is particularly important in the era of immunotherapy, considering that immune checkpoint inhibitors rely on the host immune system for their efficacy. This article reports on the combined effects of inflammation and sarcopenia on clinical outcomes in patients with solid tumors treated with immunotherapy‐based regimens.</description><identifier>ISSN: 1083-7159</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1634/theoncologist.2019-0751</identifier><identifier>PMID: 32162807</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Biomarkers ; Immunotherapy ; Immuno‐Oncology ; Inflammation ; Risk stratification ; Sarcopenia</subject><ispartof>The oncologist (Dayton, Ohio), 2020-03, Vol.25 (3), p.e528-e535</ispartof><rights>2019 The Authors. published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.</rights><rights>2019 The Authors. The Oncologist published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4722-cb5ab7fe945d513afc07a80fbafe852210ffc4cc10a8aeb03aa8211993d233ba3</citedby><cites>FETCH-LOGICAL-c4722-cb5ab7fe945d513afc07a80fbafe852210ffc4cc10a8aeb03aa8211993d233ba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066707/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066707/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,27924,27925,45574,45575,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32162807$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bilen, Mehmet Asim</creatorcontrib><creatorcontrib>Martini, Dylan J.</creatorcontrib><creatorcontrib>Liu, Yuan</creatorcontrib><creatorcontrib>Shabto, Julie M.</creatorcontrib><creatorcontrib>Brown, Jacqueline T.</creatorcontrib><creatorcontrib>Williams, Milton</creatorcontrib><creatorcontrib>Khan, Amir I.</creatorcontrib><creatorcontrib>Speak, Alexandra</creatorcontrib><creatorcontrib>Lewis, Colleen</creatorcontrib><creatorcontrib>Collins, Hannah</creatorcontrib><creatorcontrib>Kissick, Haydn T.</creatorcontrib><creatorcontrib>Carthon, Bradley C.</creatorcontrib><creatorcontrib>Akce, Mehmet</creatorcontrib><creatorcontrib>Shaib, Walid L.</creatorcontrib><creatorcontrib>Alese, Olatunji B.</creatorcontrib><creatorcontrib>Pillai, Rathi N.</creatorcontrib><creatorcontrib>Steuer, Conor E.</creatorcontrib><creatorcontrib>Wu, Christina S.</creatorcontrib><creatorcontrib>Lawson, David H.</creatorcontrib><creatorcontrib>Kudchadkar, Ragini R.</creatorcontrib><creatorcontrib>El‐Rayes, Bassel F.</creatorcontrib><creatorcontrib>Ramalingam, Suresh S.</creatorcontrib><creatorcontrib>Owonikoko, Taofeek K.</creatorcontrib><creatorcontrib>Harvey, R. Donald</creatorcontrib><creatorcontrib>Master, Viraj A.</creatorcontrib><title>Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Background
Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy.
Methods
We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR <242 and nonsarcopenic), intermediate‐risk (PLR <242 and sarcopenic), high‐risk (PLR ≥242 and nonsarcopenic), and very‐high‐risk (PLR ≥242 and sarcopenic) groups with subsequent association with survival.
Results
Most patients (59%) were male, and the most common cancers were melanoma (33%) and gastrointestinal (22%). Very high‐risk, high‐risk, and intermediate‐risk patients had significantly shorter overall survival (hazard ratio [HR], 8.46; 95% confidence interval [CI], 2.65–27.01; p < .001; HR, 5.32; CI, 1.96–14.43; p = .001; and HR, 4.01; CI, 1.66–9.68; p = .002, respectively) and progression‐free survival (HR, 12.29; CI, 5.15–29.32; p < .001; HR, 3.51; CI, 1.37–9.02; p = .009; and HR, 2.14; CI, 1.12–4.10; p = .022, respectively) compared with low‐risk patients.
Conclusion
Baseline sarcopenia and elevated inflammatory biomarkers may have a combined effect on decreasing survival in immunotherapy‐treated patients in phase I trials. These data may be immediately applicable for medical oncologists for the risk stratification of patients beginning immunotherapeutic agents.
Implications for Practice
Sarcopenia and inflammation have been associated with poor survival in patients with cancer, but it is unclear how to apply this information to patient care. The authors created a risk‐stratification system that combined sarcopenia and platelet‐to‐lymphocyte ratio as a marker of systemic inflammation. The presence of sarcopenia and systemic inflammation decreased progression‐free survival and overall survival in our cohort of 90 patients who received immunotherapy in phase I clinical trials. The data presented in this study may be immediately applicable for medical oncologists as a way to risk‐stratify patients who are beginning treatment with immunotherapy.
The interaction between chronic inflammation and body composition is particularly important in the era of immunotherapy, considering that immune checkpoint inhibitors rely on the host immune system for their efficacy. This article reports on the combined effects of inflammation and sarcopenia on clinical outcomes in patients with solid tumors treated with immunotherapy‐based regimens.</description><subject>Biomarkers</subject><subject>Immunotherapy</subject><subject>Immuno‐Oncology</subject><subject>Inflammation</subject><subject>Risk stratification</subject><subject>Sarcopenia</subject><issn>1083-7159</issn><issn>1549-490X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNqNkdtq3DAQhk1pyal5hVaXvXGqg21ZN4Vg0mQhdAubQu_EWJZ2VWxpK8kb9gH63tE2adrcFQSaGf3za4avKN4TfEEaVn1MG-2d8qNf25guKCaixLwmr4oTUleirAT-_jrHuGUlJ7U4Lk5j_IFxDhk9Ko4ZJQ1tMT8pfnV-6q3TA7oyRquEvEErCMpvtbOAwA1otY9JT1ahhTMjTBMk6x3KZzWHnd3BiKxDX3NVuxTRvU0bdDnswKlsukqw1qg7JAHdBQ0pF39LFtM0O5_3CLDdvy3eGBijPn-6z4pvn6_uupvydnm96C5vS1VxSkvV19Bzo0VVDzVhYBTm0GLTg9FtTSnBxqhKKYKhBd1jBtBSQoRgA2WsB3ZWfHr03c79pAeVJw4wym2wE4S99GDlyxdnN3Ltd5LjpuGYZ4MPTwbB_5x1THKyUelxBKf9HCVlvOFUENJmKX-UquBjDNo8f0OwPECULyDKA0R5gJg73_075XPfH2p_17i3o97_r69cfumWhBFB2QPtSbXB</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Bilen, Mehmet Asim</creator><creator>Martini, Dylan J.</creator><creator>Liu, Yuan</creator><creator>Shabto, Julie M.</creator><creator>Brown, Jacqueline T.</creator><creator>Williams, Milton</creator><creator>Khan, Amir I.</creator><creator>Speak, Alexandra</creator><creator>Lewis, Colleen</creator><creator>Collins, Hannah</creator><creator>Kissick, Haydn T.</creator><creator>Carthon, Bradley C.</creator><creator>Akce, Mehmet</creator><creator>Shaib, Walid L.</creator><creator>Alese, Olatunji B.</creator><creator>Pillai, Rathi N.</creator><creator>Steuer, Conor E.</creator><creator>Wu, Christina S.</creator><creator>Lawson, David H.</creator><creator>Kudchadkar, Ragini R.</creator><creator>El‐Rayes, Bassel F.</creator><creator>Ramalingam, Suresh S.</creator><creator>Owonikoko, Taofeek K.</creator><creator>Harvey, R. Donald</creator><creator>Master, Viraj A.</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202003</creationdate><title>Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy</title><author>Bilen, Mehmet Asim ; Martini, Dylan J. ; Liu, Yuan ; Shabto, Julie M. ; Brown, Jacqueline T. ; Williams, Milton ; Khan, Amir I. ; Speak, Alexandra ; Lewis, Colleen ; Collins, Hannah ; Kissick, Haydn T. ; Carthon, Bradley C. ; Akce, Mehmet ; Shaib, Walid L. ; Alese, Olatunji B. ; Pillai, Rathi N. ; Steuer, Conor E. ; Wu, Christina S. ; Lawson, David H. ; Kudchadkar, Ragini R. ; El‐Rayes, Bassel F. ; Ramalingam, Suresh S. ; Owonikoko, Taofeek K. ; Harvey, R. Donald ; Master, Viraj A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4722-cb5ab7fe945d513afc07a80fbafe852210ffc4cc10a8aeb03aa8211993d233ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biomarkers</topic><topic>Immunotherapy</topic><topic>Immuno‐Oncology</topic><topic>Inflammation</topic><topic>Risk stratification</topic><topic>Sarcopenia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bilen, Mehmet Asim</creatorcontrib><creatorcontrib>Martini, Dylan J.</creatorcontrib><creatorcontrib>Liu, Yuan</creatorcontrib><creatorcontrib>Shabto, Julie M.</creatorcontrib><creatorcontrib>Brown, Jacqueline T.</creatorcontrib><creatorcontrib>Williams, Milton</creatorcontrib><creatorcontrib>Khan, Amir I.</creatorcontrib><creatorcontrib>Speak, Alexandra</creatorcontrib><creatorcontrib>Lewis, Colleen</creatorcontrib><creatorcontrib>Collins, Hannah</creatorcontrib><creatorcontrib>Kissick, Haydn T.</creatorcontrib><creatorcontrib>Carthon, Bradley C.</creatorcontrib><creatorcontrib>Akce, Mehmet</creatorcontrib><creatorcontrib>Shaib, Walid L.</creatorcontrib><creatorcontrib>Alese, Olatunji B.</creatorcontrib><creatorcontrib>Pillai, Rathi N.</creatorcontrib><creatorcontrib>Steuer, Conor E.</creatorcontrib><creatorcontrib>Wu, Christina S.</creatorcontrib><creatorcontrib>Lawson, David H.</creatorcontrib><creatorcontrib>Kudchadkar, Ragini R.</creatorcontrib><creatorcontrib>El‐Rayes, Bassel F.</creatorcontrib><creatorcontrib>Ramalingam, Suresh S.</creatorcontrib><creatorcontrib>Owonikoko, Taofeek K.</creatorcontrib><creatorcontrib>Harvey, R. Donald</creatorcontrib><creatorcontrib>Master, Viraj A.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The oncologist (Dayton, Ohio)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bilen, Mehmet Asim</au><au>Martini, Dylan J.</au><au>Liu, Yuan</au><au>Shabto, Julie M.</au><au>Brown, Jacqueline T.</au><au>Williams, Milton</au><au>Khan, Amir I.</au><au>Speak, Alexandra</au><au>Lewis, Colleen</au><au>Collins, Hannah</au><au>Kissick, Haydn T.</au><au>Carthon, Bradley C.</au><au>Akce, Mehmet</au><au>Shaib, Walid L.</au><au>Alese, Olatunji B.</au><au>Pillai, Rathi N.</au><au>Steuer, Conor E.</au><au>Wu, Christina S.</au><au>Lawson, David H.</au><au>Kudchadkar, Ragini R.</au><au>El‐Rayes, Bassel F.</au><au>Ramalingam, Suresh S.</au><au>Owonikoko, Taofeek K.</au><au>Harvey, R. Donald</au><au>Master, Viraj A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy</atitle><jtitle>The oncologist (Dayton, Ohio)</jtitle><addtitle>Oncologist</addtitle><date>2020-03</date><risdate>2020</risdate><volume>25</volume><issue>3</issue><spage>e528</spage><epage>e535</epage><pages>e528-e535</pages><issn>1083-7159</issn><eissn>1549-490X</eissn><abstract>Background
Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy.
Methods
We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR <242 and nonsarcopenic), intermediate‐risk (PLR <242 and sarcopenic), high‐risk (PLR ≥242 and nonsarcopenic), and very‐high‐risk (PLR ≥242 and sarcopenic) groups with subsequent association with survival.
Results
Most patients (59%) were male, and the most common cancers were melanoma (33%) and gastrointestinal (22%). Very high‐risk, high‐risk, and intermediate‐risk patients had significantly shorter overall survival (hazard ratio [HR], 8.46; 95% confidence interval [CI], 2.65–27.01; p < .001; HR, 5.32; CI, 1.96–14.43; p = .001; and HR, 4.01; CI, 1.66–9.68; p = .002, respectively) and progression‐free survival (HR, 12.29; CI, 5.15–29.32; p < .001; HR, 3.51; CI, 1.37–9.02; p = .009; and HR, 2.14; CI, 1.12–4.10; p = .022, respectively) compared with low‐risk patients.
Conclusion
Baseline sarcopenia and elevated inflammatory biomarkers may have a combined effect on decreasing survival in immunotherapy‐treated patients in phase I trials. These data may be immediately applicable for medical oncologists for the risk stratification of patients beginning immunotherapeutic agents.
Implications for Practice
Sarcopenia and inflammation have been associated with poor survival in patients with cancer, but it is unclear how to apply this information to patient care. The authors created a risk‐stratification system that combined sarcopenia and platelet‐to‐lymphocyte ratio as a marker of systemic inflammation. The presence of sarcopenia and systemic inflammation decreased progression‐free survival and overall survival in our cohort of 90 patients who received immunotherapy in phase I clinical trials. The data presented in this study may be immediately applicable for medical oncologists as a way to risk‐stratify patients who are beginning treatment with immunotherapy.
The interaction between chronic inflammation and body composition is particularly important in the era of immunotherapy, considering that immune checkpoint inhibitors rely on the host immune system for their efficacy. This article reports on the combined effects of inflammation and sarcopenia on clinical outcomes in patients with solid tumors treated with immunotherapy‐based regimens.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32162807</pmid><doi>10.1634/theoncologist.2019-0751</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The oncologist (Dayton, Ohio), 2020-03, Vol.25 (3), p.e528-e535 |
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| source | Access via Oxford University Press (Open Access Collection); Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Biomarkers Immunotherapy Immuno‐Oncology Inflammation Risk stratification Sarcopenia |
| title | Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy |
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