• Jiajun Wang, Liu Cao, and Shun Xu.
• Department of Thoracic Surgery, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang 110001, Liaoning, China.
• Int. Immunopharmacol. 2020 Nov 1; 88: 106907.

BackgroundThe clinical impact of sarcopenia on the immune checkpoint inhibitor's (ICI) efficacy and immune-related adverse events in non-small cell lung cancer (NSCLC) patients is unclear. Therefore, the purpose of this study is to evaluate the association between sarcopenia and clinical outcomes of ICI immunotherapy.MethodsA systematic literature search of PubMed, Embase, Cochrane CENTRAL, and conference databases was conducted for the relevant studies. The primary outcomes were progression-free survival (PFS) and overall survival (OS) measured by hazard ratio (HR) with 95% confidence interval (CI), and the secondary outcomes were disease control rate, overall response rate, and immune-related adverse events measured by relative risk (RR) with 95% CI. Subgroup and sensitivity analysis were performed.ResultsPre-immunotherapy sarcopenia was significantly associated with worse OS (HR = 1.61, 95% CI = 1.24-2.10) and PFS (HR = 1.98, 95% CI = 1.32-2.97). Development or worsening of sarcopenia during immunotherapy also predicted worse OS and PFS. Both pre-immunotherapy sarcopenia (RR = 0.70, 95% CI = 0.56-0.86) and development or worsening of sarcopenia (RR = 0.62, 95% CI = 0.40-0.96) resulted in a lower disease control rate. Sarcopenia tended toward a lower overall response rate, although there was no significant difference (RR = 0.54, 95% CI = 0.19-1.53). Moreover, sarcopenia did not increase immune-related adverse events (RR = 0.99, 95% CI = 0.21-4.67).ConclusionSarcopenia was associated with worse treatment response and shorter long-term efficacy in NSCLC patients treated with ICI immunotherapy. Moreover, sarcopenia does not increase the rate of immune-related adverse events.Copyright © 2020. Published by Elsevier B.V.

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