Does pre-checkpoint inhibitor sarcopenia, visceral, or subcutaneous fat predict survival in non-small cell lung cancer patients?

Sarcopenia defined by validated cutoffs did not statistically differ in survival compared to non-sarcopenic patients in NSCLC patients receiving checkpoint inhibitors.

• HR 1.21 (95% CI 0.63, 2.43) for sarcopenia vs. non-sarcopenia
• Sarcopenia was defined using validated cutoffs: males < 45.4 cm2/m2, females < 34.4 cm2/m2
• This finding remained consistent when males and females were examined separately
• The finding also remained consistent when the model was adjusted for timing to checkpoint inhibitor

The study cohort consisted of 46 NSCLC patients receiving checkpoint inhibitor therapy, predominantly pembrolizumab.

• 46 total patients: 25 males (54.3%) and 21 females (45.7%)
• 93.5% received pembrolizumab and 6.5% received nivolumab
• CT scans were obtained within 60 days of initiating checkpoint inhibitor therapy
• Median time from CT scan to checkpoint inhibitor initiation was 14 days (IQR: -47 to 18)
• This was a retrospective pilot study conducted at a single tertiary care center

One-year and two-year survival rates differed between males and females in this NSCLC cohort.

• One-year survival was 72.0% for males and 59.3% for females
• Two-year survival was 33.7% for males and 27.3% for females
• Cox proportional hazards models were used to evaluate associations between body composition and survival
• Analyses were stratified by sex

Body composition metrics were measured at the L3 vertebral level using TeraRecon software, capturing skeletal muscle index, visceral fat area, and subcutaneous fat area.

• Measurements were performed by a trained reader
• Skeletal muscle index (SMI), visceral fat area (VFA), and subcutaneous fat area (SFA) were all assessed
• The L3 vertebral level is a validated anatomical landmark for body composition assessment on CT scans

Pre-treatment body composition metrics overall did not significantly predict survival in NSCLC patients receiving checkpoint inhibitors in this pilot study.

• The study was described as likely underpowered with wide confidence intervals
• The authors note these findings provide 'a methodological framework for larger multicenter studies to validate the prognostic utility of CT-derived body composition in this population'
• The small sample size (n=46) limits definitive conclusions